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Hurricane Katrina left New Orleans, Louisiana, in a state of emergency with streets flooded, homes destroyed and thousands in need of healthcare. Many needed attention after sustaining injuries directly related to the storm, already hospitalized patients needed to be transferred, while others were running out of regular medication needed to treat underlying chronic medical conditions. The situation pulled at the hearts of healthcare professionals, and many were anxious to lend their expertise and skills to help alleviate the mounting frustration and suffering.
When the National Institutes of Health (NIH) called on the Society of Critical Care Medicine (SCCM) to help the institution find volunteers to staff field hospitals in the New Orleans area, SCCM jumped into action. Within hours, SCCM staff enabled a system allowing healthcare professionals to join a database of potential volunteers from its Web site, sending email communications, posting messages on the Web site and making RSS feeds and podcasts available to alert the entire membership of the need for volunteers. The overwhelming response proved that members were ready for the call. In just two days, 372 healthcare professionals entered their information into the database, with 312 meeting the specific needs of the NIH. The response exemplified the members' dedication to providing quality care to the critically ill and injured.
The Society's president, Peter Angood, MD, FCCM, expressed great satisfaction with the response from members, saying that their efforts helped save lives. “The SCCM leadership and staff join the rest of the world in providing comfort, care and hope to all at risk and aiding all who have been injured. As critical care professionals, it is an honor to commit our resources and knowledge to benefit others in their time of need,” he said.
Members offering their skills in the wake of Hurricane Katrina were able to help in a variety of ways. Some were on the front lines providing clinical aid while others observed the situation from an objective standpoint to analyze the disaster response.
Care at the Front Lines
Barbara McLean, MN, CCRN, DRNP, FCCM, an intensive care nurse from Atlanta, Georgia, volunteered at the Houston Astrodome and George Brown Center. She relayed stories in regular emails about the stamina of her and her colleagues as they strived to treat as many patients as possible.
“Although food, water, coffee and drinks are in abundance, we have not stopped to eat or drink since beginning our shifts,” McLean reported. “Although relief is available, the compelling desire to help is too overwhelming. The task of organization is monumental; the disaster center was organized, staffed and completely stocked by hospitals and corporate partners in less than five hours of planning.” She recalled helping a young woman who had lost both her children after waiting seven hours in freezing waters waiting for help. With the help of a pharmacist, McLean was able to get the woman medicine quickly and help her connect with other family members. “She is one of the lucky ones,” McLean said.
Society member Janice Zimmerman, MD, director of medicine emergency services at Ben Taub General Hospital in Houston, Texas, said her hospital district assisted in setting up and stocking the clinic at the Houston Astrodome and commended the level of preparedness the district exhibited, though resources were strained at the hospitals. “We had no empty beds most days since last week and have housed ICU and other patients in the emergency department.” Most patients, she said, were treated for diarrheal illness and cellulitis and other leg infections from walking through high waters.
"It Took Every Member of the Team"
Far from the scene at the Astrodome, Carol Thompson, PhD, CCRN, FCCM, was treating more of the “lucky ones” at the University of Tennessee Health Science Center. About 40 evacuees streamed into the hospital system with nothing more than the clothes on their backs, requiring staff to initiate its disaster plan. Bed availability quickly became a pressing issue as patients looked to be treated for congestive heart failure, hypertensive crises, seizures and post-traumatic stress disorders, she said. Beds that were closed due to nursing staff shortages were reopened and staffed with overtime workers. “All staff – nurses, physicians, social workers, pastors – everyone was eager to rise to the occasion. If they were not needed for overtime at the hospital, they signed up to volunteer at the shelters.”
Thompson said she was most impressed with the way the team came together and how each member took on a variety of different roles. At one point, Thompson, an acute care practioner, found herself playing cards with a 3-year-old girl while the girl's parents sorted out their medical matters. “I'm quite capable of (providing intensive care), but I saw a little girl who needed some attention,” she said.
“Any professional barriers were absolutely gone,” Thompson added. "It was a whatever it takes" attitude. The importance of team work is what made this happen as smoothly as it did. It took every member of the team.” Patients were distributed across the various hospitals based on their specific needs. For example, one hospital had more dialysis capability so an effort was made to triage most patients with that need there. “With the initial onslaught of patients, the system did what it was supposed to because we had a disaster plan,” she said.
Even with the best disaster plan in place, Thompson said that seeing how evacuees were affected by this crisis was overwhelming.
“The grief while trying to connect with family members or find out if family members were alive or dead was a universal need. A portion of that, from the patients" perspectives, was a higher priority than their medical needs,” she said.
Learning Lessons About Disaster
Responding to the disaster caused by Hurricane Katrina stretched beyond treating patients on the front lines. Society member Lewis Rubinson, MD, PhD, made his contribution by touring the Gulf Coast region and analyzing the response effort in an attempt to better procedures and plans in the future.
Rubinson was invited to tour New Orleans by Paul K. Carlton, MD, director of homeland security at the Texas A&M University System Health Science Center, and Ray Swienton and Mike Proctor, both from Natural Disaster Life Support. During his four-day tour, he viewed conditions at several unconventional medical facilities set up to handle the patient surge, including the Louis Armstrong International Airport and the Pete Maravich Assembly Center in Baton Rouge. “We want to make sure the Society gets first-hand information to make sure the work we are doing is appropriate when applied in a true situation. The Society should figure out what things went wrong and what went right.”
Rubinson said he was impressed with all of the sites, which were set up within days. The field hospital established at the airport was probably the largest triage effort in an unconventional medical facility set up after a natural disaster in the United States, according to Rubinson. It may become a model for general surge capacity facilities, he added.
Rubinson said Hurricane Katrina's devastating effects will teach the healthcare community many lessons about the importance of preparing for disasters, what works and what ideas should be tweaked. Disaster management is a core aspect of SCCM's mission, and the Society hopes these lessons will give way to opportunities to improve the quality of care for critically ill and injured. “Our response starts with a good plan,” he said.
An article in the October issue of Critical Care Medicine written in part by Rubinson provides recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a mass-casualty disaster. (Crit Care Med 2005 Vol. 33, No. 10. The article is available ahead of print at www.ccmjournal.org or on the SCCM Disaster Response Page at www.sccm.org/professional_resources)
The article suggests several steps are necessary to implement a long-term strategic effort to prepare hospitals for large-scale emergencies. Regional planning between hospitals and state agencies to share personnel, patient loads, medicines and medical equipment, the development of clear expectations about what federal help can be expected in a crisis and how quickly that aid can be delivered, and an information technology strategy for hospitals are among the elements vital to surviving a natural disaster such as Hurricane Katrina, a terrorist attack or disease epidemic.
“(The healthcare workers at the scene) did by far the best they could do. A tremendous number of heroes . . . were involved in the response. I was able to get some data, but obviously there is so much more to do,” Rubinson said.
Look for more stories from members who helped in the Hurricane Katrina relief effort from the iCritical Care Podcasts. For more information, visit www.sccm.org/publications/syndication |
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