FEATURES

NURSES RESPOND TO HURRICANE KATRINA

Inside the PHS Command Center

by Deidre M. Blank

“I am pleased to let you know that you have been selected for a hurricane relief assignment.” Those were the first words of an e-mail message that Commander Dan Beck, Office of the U.S. Surgeon General, Public Health Service (PHS), sent to me, a nurse volunteer, at 0130 hours on Oct. 3, 2005. Of the more than 33,000 health care professionals and relief personnel who had responded to the Katrina disaster, only about 100 civilian nurses had been selected.

Deidre M. Blank

In the initial letter, we were informed we could expect the following: “12 hour shifts, austere conditions (possibly no showers, housing in tents), no air conditioning, long periods of standing, sleeping accommodations on a bed roll, military ready-to-eat meals, and portable toilets.” Within 24 hours of my initial notification, travel orders arrived. Destination? Lafayette, La.

I arrived in Lafayette on Oct. 5 and immediately took a one-hour bus ride east with other nurses and physicians to Camp Allen, located on the Mississippi River in Baton Rouge. Dubbed “FEMA Tent City,” Camp Allen would be my home for the next 24 hours.

Each of the 15 tents at the camp accommodated about 100 people, and each person was assigned a military-style cot. Tent 9—my tent—provided unisex accommodations for nurses, physicians and other health-related workers, both commissioned PHS officers and civilians. It also provided accommodations for a host of fire ants, several of which regarded me as a good meal. After showering in the camp’s only gender-specific facility and brushing my teeth in the common wash area—an open trailer containing about 12 sinks—reality began sinking in when I saw the 100 or so portable toilets lined up alongside the river. No one complained; at least we had clean facilities.

Sleeping in a tent with 100 or so strangers went smoothly, considering that my personal space extended only about 20 inches beyond my cot. To the head of my cot was a male physician from San Diego. On the other three sides were females: a 2002 graduate of Emory University School of Nursing, a mortuary assistant from Washington, D.C., and an operating room nurse from Michigan. Through the kindness of a newly met colleague from Oregon, I had two blankets to keep me warm. The roar of the huge air conditioning unit muffled extraneous noises, including snoring, thus enabling 100 people to coexist in a tent.

The next morning, I was assigned to administration and promptly whisked away to the Joint Field Operations building in downtown Baton Rouge. After being “federalized,” which involved signing several forms and being sworn in and photographed, I was shuttled to Camp Phoenix Command Center, one of the first civilians thus assigned. Prior to Katrina, Camp Phoenix was known as the Louisiana School for the Visually Impaired.

We were met by a lieutenant commander, a pharmacist from Oklahoma. For several days, she and her assistant had been working two shifts daily while another officer, a medical technician, worked the night shift. Glassy-eyed from lack of sleep and perspiring profusely from lack of air conditioning in the high heat and humidity—there still was no electricity—the officers clearly needed our help, and we quickly got to the business at hand.

The objective of the command center was to provide both technical and emotional support for about 15 PHS missions that were currently operating in Louisiana. Some of those missions included taking care of the health needs of displaced people living in shelters, caring for and finding homes for displaced animals, rescuing residents from a nursing home, and providing medical care via mobile examination units. We did everything from providing transportation to mission sites and emergency transportation home to providing lodging to health care professionals and offering emotional support to staff succumbing to burnout.

Compared to Camp Allen, accommodations at Camp Phoenix were somewhat upscale. My living quarters was a recreation room that I shared with 14 women, including nurses and physicians, who were either commissioned officers or civilians. We shared one toilet and one sink, and I quickly became accustomed to cold showers.

I spent Oct. 7, my first day on the job, getting to know my new role. From the minute my new colleagues—Sue Gamache, RN, from Stormville, N.Y., and Kate Borger, RN, from Altadena, Calif.— and I walked into the office at 7 a.m., the telephone rang almost continuously. Within minutes, we were answering phones and learning on the spot. It was chaotic, the amount of information overwhelming. Sue became our computer person. Kate took over some of the general administrative tasks. I became billeting “general.”

That evening, I met a nurse from Ohio and a social worker from Iowa who, along with 26 other colleagues, had completed evacuation of more than 150 residents of a nursing home in the Lake Charles area that had been abandoned by staff members. For 36 hours, they worked nonstop. One patient died. Burned out by the experience, a few relief workers required rest before going back into the field. Others returned home. It was heartbreaking to see the look of despair on their faces.

The days that followed brought a strange mix of experiences and emotions. One evening we drove to Camp Allen for a great dinner of barbequed salmon, with all its Southern charm, and were encouraged when told we were doing a great job. Another evening, we drove to New Orleans on the I-10 interstate, viewed destruction that was beyond words and drove past the Superdome. It was eerie. Ours was the only car we saw in that part of downtown New Orleans.

With permission from guards who patrolled with drawn rifles, we entered the Ninth Ward, one of the most devastated areas of the city. It looked like a nuclear disaster. Twice during our stay, we drove to New Orleans’ French Quarter. Though this area was less devastated than other parts of the city, we knew things still weren’t back to normal when we easily found a parking spot.

One evening we toured the Magnolia Mound Plantation after hours and at no charge, an expression of appreciation from staff members for our status as volunteer workers. That same evening, we went to a restaurant and, instead of the usual 45-minute wait, were quickly seated when a family yielded their table to us to show appreciation for our work.

A week and a half after we arrived at Camp Phoenix, we had an opportunity to visit a Disaster Medical Assistance Team (DMAT), a response unit of the National Disaster Medical System. Designed to provide emergency medical care during times of disaster, the system is under the auspices of the Department of Homeland Security. The self-contained unit that accompanies a DMAT encompasses several tents (including tents for acute/severe conditions, lacerations and other problems), a hand-washing unit, a refrigerated truck capable of preserving corpses, and laboratory and x-ray facilities. It can be dropped by air and contains everything that medical and nursing personnel will need for a 72-hour period. Our host from the Ohio DMAT explained that the concept originated in the mid 1980s, and that there were about 56 teams throughout the United States. According to our host, 90 percent of the DMATs had been deployed in response to the Katrina disaster.

Fourteen days after arriving in Louisiana, the other civilian nurse volunteers and I prepared for departure. After saying our goodbyes to everyone at the end of our work shift, we attended a 6 p.m. “muster” with Admiral Vanderwagon, the PHS officer in charge of Camp Phoenix, and Roseanne Prats, director of emergency preparedness for Louisiana.

The admiral thanked us for our hard work and told us that nearly 300 civilians and 300 officers had been deployed for the two-week assignment, thus enabling the PHS to double its efforts during this period. Prats tearfully thanked everyone. Finally, the children from the school serenaded us with “The Star Spangled Banner” and other patriotic songs.

In reflecting back on my two-week experience with PHS officers and civilian volunteers in Baton Rouge, I became aware that an overwhelming majority seemed to possess that important altruistic or philanthropic characteristic of unselfish concern for others. So while the overall system may not have worked as well as it should have during the Katrina disaster, the human element, at least as seen from within the PHS-civilian collaborative effort of which I was a part, proved to be very effective. RNL

Deidre M. Blank, RN, DSN, FAAN, is a nurse analyst for Behavioral Measurement Database Services, an online service for health and psychological instruments.

For more photos, click on images below:

Photos courtesy Kate Borger, RN

 

Five days in Hattiesburg: Nursing lessons learned from Hurricane Katrina

by Amy Spurlock

For 12 senior nursing students from Troy University School of Nursing, a recent nursing graduate, a dean of nursing and two professors of nursing—one of whom was me—Hurricane Katrina provided an opportunity to learn, in an overwhelming situation, that we could make a difference, one patient at a time. We learned that being a nurse is not just knowing skills and performing clinical tasks, but living out the ideals of the profession.

On Aug. 29, 2005, Hurricane Katrina roared into Louisiana, Mississippi and Alabama with Category 4 winds of up to 140 miles per hour. Its impact on the U.S. Gulf Coast was phenomenal. In the Hattiesburg, Miss., area alone—70 miles inland—325 houses and businesses were completely destroyed, and 2,216 houses and businesses sustained major damage (Maute, 2005).

Troy University is located in Troy, Ala., an area well-acquainted with hurricanes. After watching on television the devastation wreaked by Katrina, senior students in public health pleaded with us for an opportunity to assist those impacted by the hurricane. The next day, the 16 of us left for Hattiesburg—about five hours and 250 miles away—where we spent five days in early September providing for these students a clinical experience we never could have planned.

Upon arriving at Wesley Medical Center in Hattiesburg, we changed into scrubs and were ready to go to work, despite trepidation of what we might experience. As professors, we teach students in public health that nurses possess knowledge that supports the response and recovery of a community after a disaster (Stanhope & Lancaster, 2004). However, it is one thing to teach or learn disaster nursing in a classroom and quite another to be in the midst of it. Even as instructors, we found ourselves questioning whether we were ready for the challenge.

We divided into teams, some working in the emergency room, others helping in labor and delivery, and still others assisting on a medical-surgical unit. One side of the ER was set up to treat acute illnesses, seizures and injuries—some caused by chainsaws and gunshots—and other emergent conditions. The other side of the ER was used as a clinic to treat those with chronic illnesses and minor injuries.

We took vital signs, acted as escorts, gave medications, assisted physicians and other nurses, and consoled distraught patients. One student fed a patient who had waited many hours for something to eat. Another sat with a patient who was suicidal, while other students worked feverishly to save additional lives. Afterward, a student wrote in a journal: “Pain was not just physical; it went much deeper because of what had occurred in [the patients’] lives.”

Katrina not only brought death and destruction, it also induced the arrival of new lives. In the labor and delivery and nursery units, we fed, rocked, changed and bathed babies. During deliveries, we assisted other nurses in calming anxious mothers and families. In what would normally be a joyous occasion, fear and worry remained constant emotions. Another student wrote in a journal: “It is doing what is required for the patient at that given moment that makes a nurse. … using experience and knowledge to do the right thing.”

On the med-surg unit, we performed assessments, gave medications, started intravenous lines, assisted with baths and linen changes, and admitted and discharged patients. We also spent a great deal of time just listening to the concerns of those under our care. Many of the patients on this unit were evacuees from Slidell, La., who had no idea if their homes were still standing or if their family members were alive. With three RNs and three student nurses caring for 15 or more patients daily in an unfamiliar environment, teamwork became the rule.

We worked in rotating shifts, around the clock, altogether donating approximately 800 hours of labor. Contrary to our fears, we found that we were indeed ready to handle the challenges. The students rose wonderfully to the occasion, proving to themselves that nursing is not just their chosen career, but their profession. After the experience, one student wrote in a journal: “I began telling myself that I could do this. I was ready. The instructor believed it. The nurse believed it. I felt that I should believe it, too. This was real. I was the nurse.”

Another student wrote: “I came to know that clinical skills are not the most important part of nursing. Reaching out to patients with love and sincerity is. Whatever doubts I had about being an effective nurse vanished.”

During our five days in Hattiesburg, we learned to be thankful for the seemingly small things that we take for granted: running water, electricity, food and shelter. We returned home exhausted in body, but nourished in spirit. As one student beautifully wrote, “I learned that when people work together in a positive manner, so much more can be accomplished for the greater good.”

And those 12 senior BSN students? They are graduating soon, and already studying for the NCLEX-RN exam. What they don’t realize is that they are already nurses. RNL

Amy Spurlock, RN, PhD, is associate professor in the School of Nursing, College of Health and Human Services, at Troy University in Troy, Ala., USA.

For photo, click on image below:

References

Maute, N.D. (2005, September 10). Pine belt sees 325 homes, businesses destroyed, 8,500 damaged. Clarion Ledger. Retrieved September 26, 2005, from http://clarionledger.com

Stanhope, M., & Lancaster, J. (2004). Community and public health nursing (6th ed.). St. Louis: Mosby.