November 10, 2005
Thoughts on Serving: Two Weeks as a Post-Hurricane Volunteer
It is
Tuesday, October 4, 2005 at 4:00 pm. As is a normal day at home, I am
juggling homework with my children, attempting to make something edible for
dinner, balance the PTO checkbook for the next meeting, and get ready for a
night at work. Naturally, the phone begins to ring.
I
reluctantly answer, while thinking up an excuse for what seems like the 10th
telemarketer that day. To my surprise it is Lieutenant Commander Pellen,
with the Office of the Surgeon General! Can I still help with a medical
relief mission being organized for the Gulf Coast?
Never in a million years did I think they would actually call, after so many
people stepped forward to volunteer.
I feel
truly blessed to have each and every one in my life, and extremely fortunate to
have been a part of an amazing experience of nursing in the face of disaster.
Melissa Bless, RN
Michigan
November 10, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (3)
September 22, 2005
Health Professionals and Hurricane Rita -- Tell Us Your Stories
With Hurricane Rita now moving toward Texas, we are concerned that there will again be a need for health professionals to step forward and provide relief efforts and/or to care for large numbers of displaced people. If you are a health professional (physician, nurse, NP, PA, pharmacist) living and working in the Gulf Coast, do let us know what is happening. How is your workplace preparing for this storm? Are patients being evacuated from hospitals and nursing homes? What unusual experiences have you had? How difficult is it to tend to your own life and family and to your professional responsibilities as well? Click here to write us with your first-person accounts; photos are also welcome. Please include your permission for us to consider posting your story or photos on the blog.
September 22, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (1)
Midwives, Blankets, and Babies
Don't miss this press release from the American College of Nurse Midwives about their "Blankets for Babies " campaign. Thousands of blankets and baby clothes, donated to the Texas Health Care Nurse-Midwives of Fort Worth, Texas, will be distributed to women and babies displaced by Hurricane Katrina. Check out this link for more information.
Nurse-Midwives Help Hurricane Katrina Evacuees; Displaced women, babies receive donations
September 22, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (0)
September 16, 2005
Psychiatric/Mental Health and Gerontology Registered Nurses
Certified Psychiatric/Mental Health and Gerontology Registered Nurses Needed for Katrina Response and Recovery Effort
In response to a request from the
Substance Abuse and Mental Health Services Administration (SAMHSA), the American
Nurses Association (ANA) and the American Nurses Credentialing Center (ANCC) are
recruiting approximately 100 certified psychiatric and mental health and gerontology nurses to work in Louisiana.
Selected registered nurses will be deployed as part of a
multi-disciplinary team that includes psychiatrists, psychologists, social
workers, substance abuse counselors, and pastoral counselors. The assignments will be for two weeks and
there will be four deployment cycles starting on September 18 with the last
two-week deployment cycle starting on November 1, 2005. Expenses related to travel, housing and meals
will be covered. Selected participants
will also receive a $200 per day honorarium. Applicants must hold a current active RN license; be certified by ANCC in
psychiatric/mental health OR gerontological nursing; and have professional
liability insurance. In addition,
applicants must be able to withstand the rigors of working in a disaster
response area for a continuous two week period.
September 16, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (0)
September 13, 2005
A Rewarding Experience
Debra Hunt, ARNP, is from Clermont, Florida
and she has just returned from volunteering in Ocean Springs, Mississippi.
I
am trying to process the magnitude of the destruction from Katrina. I was
part of a mobilization organized by the Florida Health Department of over 100
medical personnel, the majority of us nurses. My particular team
consisted of 2 other nurse practitioners and an ED nurse. We helped
establish a primary and special needs clinic in an abandoned restaurant in a
mall.
Each day we treated nearly 100 patients with a variety of rashes and respiratory illnesses associated with the contaminated flood waters, as well as abscesses, lacerations, and puncture wounds. That was the easy part. Listening to the horror stories from our patients was heartbreaking. So many people were stranded in their homes in sea water contaminated with sewage, dead bodies, and oil. One 5-year-old little boy sat on my lap as he told me about his roof being in the next yard with all his toys, clothes, and many other belongings. What could I say to this innocent little child as we looked into each others eyes and talked about such horror?
We
also went on several "house calls" and the violence of Katrina was so
dramatic. People are living with dead fish and sewage in their
yards. The black mold has taken over the inside of their homes so they
live in the yard in pup tents.
In
spite of the sadness and destruction I can say that, without a doubt, this was
the most rewarding experience of my personal and professional life. The
people I met were some the kindest, warmest individuals I have ever had the
honor of meeting. We experienced no violence or hatred, just thanks and
heartfelt gratitude for any little thing we did for them. I feel blessed and
honored to have helped our neighbors in Mississippi
and I thank them for allowing me into their lives. I received so much
from them, perhaps more than we gave. I have a new appreciation for my
family and my colleagues because of this experience.
September 13, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (0)
September 11, 2005
A Small Hospital Takes on a Big Job
Tim Bush, RN, is Administrative
Supervisor, St. Elizabeth Hospital, Gonzales, Louisiana.
I can not begin to document the events of the days after hurricane Katrina made land fall in southeast Louisiana. I was reminded of recent medical mission trips to impoverished countries abroad, mainly because of the enormous need and the same unselfish acts I witnessed by those working beside me.
St. Elizabeth Hospital is a small hospital just west of New Orleans, with an average inpatient census of 35. On Tuesday morning after the hurricane we were the closest fully functional hospital outside the city. We began receiving patients almost immediately. An ER that usually sees about 1600 patients a month saw over a 1000 in a few days! Our inpatient census more than doubled.
Several adjustments were made in an effort to accommodate the influx. Triage stations were set up in our auditorium and PACU, and clinical and nonclinical team members were used where ever there was a need. Storage areas were converted into patient rooms and beds were borrowed from other less acute facilities. Available supplies quickly ran low, but we began receiving shipments from outside facilities and vendors within a couple of days. We had enough supplies to help supply law enforcement, military units, and other portable medical units that set up in the area.
We had very little to no notification when patients were coming. They came by ground and air and they kept on coming. Sometimes there were 1 to 2 patients and sometimes there were 8 to 10 at a time. At first people came directly from the city and then from shelters and surrounding areas that were evacuating. Patients presented with an assortment of ailments. These included a 60-year-old who broke both ankles while trying to get in a rescue craft, a bus full of evacuated nursing home patients who had not received care in several days (the driver stopped because one had died on the way), a patient on the back of a military truck who had been there for several days because she was too large to move by conventional means, people with numerous infections from unsanitary conditions, and the list goes on and on. We even cared for 40 swat team members involved in a chemical explosion who needed decontaminating. We put our decontamination tent up and had them all wet and naked in less than an hour. We were seeing every type of injury and illness you can imagine.
Our leadership team was phenomenal. They held several planning meetings per day in an effort to anticipate needs and solve existing challenges. In the days since the storm I have not heard one of our team members complain. Many have been displaced themselves, but all of them pulled together and did whatever needed to care for those that continue to come. The effort has been enormous.
There have been challenges, as one could imagine. Transportation was a big issue. We would treat and then try to send the less acute patients to the smaller outlying facilities to make room, but ran into trouble trying to get them transportation. Some patients would be treated and discharged but refused to go to a shelter. Several shelters sprang up. Some were set up in local churches, schools, large public buildings, and individual homes. There remain several thousand refugees in our area. Aid is being sent from several places, but the enormity of this is unbelievable. These people, several thousand of them, have nowhere to go. They are toe-to-toe in the shelters under difficult conditions and their medical needs are only going to grow. In the northern parishes there are thousands who still can not leave from their homes. Many, and I mean many, have lost every worldly possession they have. The fortunate have family to stay with or have found residence in the surrounding areas. The populations of some local cities have grown by 40 to 50% overnight.
We have been witness to the best and the worst of human kind during these past days. Healthcare workers, fireman, law enforcement of every kind, the military, volunteers, and many others have given much in an effort to help. There is much to be done. This tragedy will affect us for years to come. I thank God for His mercy and pray for the strength to continue helping these people in the days to come. I would ask that you do the same.
September 11, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (0)
September 07, 2005
Paramedics and Firemen: The Caregivers Suffer as Well
We heard
from Thomas
Lahut, PA, MS, in a
previous dispatch. He just returned home to upstate New York today, but before he left Baton Rouge, he provided Medscape with this
report.
On Monday, September 5, 2005 I was
summoned (“Please come now!”) at noon from the chapel. That’s where sleeping accommodations have
been made (darkened windows, cots) for medical workers who are working late
night shifts at the P-MAC (Pete Maravich Assembly Center at LSU), the temporary
medical evaluation area in Baton Rouge for Katrina evacuees.
New Orleans paramedics and firemen, who have essentially worked 24/7 since the storm hit and the levees broke were finally being relieved. Firefighters from Houston are now able to replace these men and women, who have given so much, and who still remain victims themselves.
The paramedics and firemen have been
bussed out in large groups from New Orleans and they need to decompress. As an urgent
perk, the City of New Orleans has solicited
charter airflights, accommodations, and stipends to allow these rescuers to
take their families out of the area, and out to Las Vegas or Atlanta for
a 5-day furlough.
They were first sent to Baton Rouge and brought
to a formerly grand and now-seedy hotel “in the bad end of town,” as an initial
staging point.
These workers needed an initial
medical/psychiatric evaluation -- urgently. As a physician's assistant, I worked with 4 docs and 3 nurses and we
were accompanied by dozen psychiatric liaison staff – physicians, social workers, and nurse practitioners.
Also included were offerings of warm
food and clean clothes. As a separate (screwed up) offering, FEMA was supposed
to be present to offer coordination of low-cost loans and initiation of housing
assistance for these people who gave so much. After multiple requests, with one of our docs getting quite agitated in
a cell phone call to HQ, FEMA finally came, but very, very late, after many
firemen had left to seek out their displaced families.
Firemen and paramedics are tough
folk. They prepare for the worst, they
offer excellent medical care, but they were in rough shape. They were tired, anxious, apprehensive, and
dry at this time. They maintained the
facade of normalcy, but when questioned directly, they made frustrated
references to the Superdome; they saw death and a lot of people too ill to
save. The psychiatric liaison staff was excellent.
A paramedic who had surgery days
before the hurricane, and who had worked above and beyond any description for
the past week, was ill appearing. She
was anorexic, looked pale, BP 90/30, tachy, pale conjunctiva. She was shipped out STAT to a local hospital,
and went directly to the operating room.
A fireman, carrying a puppy with big
ears, was a magnet for the attention of the support staff. The pup was named
“Ernie,” for the place he was rescued from: the Ernest N. Morial Convention Center -- the Superdome.
Psychiatric issues of depression,
substance abuse, memory problems, difficulty sleeping, and feeling estranged
could only be transiently and superficially addressed. The burden of that work will be passed to
future clinicians.
September 7, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (0)
Atlanta's Incoming Survivors
Marilyn Ringstaff is an advanced practice nurse from Rome, Georgia. She is working with the Georgia Public Health
relief effort, caring for Katrina survivors at Dobbins AFB in Atlanta, Georgia.
September 7, 2005: I
was with Georgia public
health for our second day of emergency relief meeting the incoming Katrina
survivors at Dobbins AFB in Atlanta
yesterday. Sunday we saw the most
appreciative folks, but yesterday we were seeing a lot of angry people. These
are the ones who said they were forced from their homes at gunpoint who didn't
want to leave, or had been waiting on their roofs for rescue for several days,
or who had been separated from their families. I learned that in the three days
we were there, around 1500 people were screened and transported either to
shelters, hospitals, or nursing homes. They were exhausted, disoriented, and
many still in denial; mental health workers were present to talk with everyone.
I was there with several other nurse practitioners (NPs),
but we were so handicapped by Georgia's
My first family was a family of 10 people, one of the little
girls was named Katrina and when I asked her name to start the paperwork she
came up and whispered it to me so no one would hear her. Five of the family
members had been on their roof since Tuesday, 5 days; they ran out of food and
water. They saw the helicopters going back and forth past their house, they
were waving t-shirts and anything they could find 'but they just kept going on
by.' We taped Pampers on the toddler's feet because the Red Cross had run out
of shoes and she loved it.
Another woman, Toni, didn't know where she was. I said
something like "Welcome to Atlanta,"
A family of 7 people arrived who had been sleeping on the bridge after reaching it by boat, and they finally decided to leave their home after the water started turning black from the bodies. They had a 3-week-old pit bull puppy with them -- they were feeding "Lady" with a dropper. Lady probably has Parvo and animal control took her to an Emergency Vet, no word yet on her condition. But I'll keep checking.
It's good to come home and see that our hometowns have so
many relief efforts in place. All of
these families are going to need long term support.
September 7, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (0)
September 06, 2005
3 Days in Louisiana: A PA Reports
Thomas Lahut, PA, MS, usually works at St. Peter's Hospital Emergency
Department, in Albany, NY. But for the last few days he has worked in Baton Rouge, LA, at the
Temporary Medical Operations Staging Areas for the evacuees from New Orleans.
Monday, September 5, 2005: Some of the patients, seen at the Temporary Medical
Operations Staging Area at the P-MAC in Baton Rouge are described here. Most had reluctantly been evacuated from New Orleans now that
martial law has been established by a growing 40-state National Guard contingent:
- 48 yo female, SOB, dehydrated,
schizophrenic, no meds, ETOH 1hr PTA
- 21 yo male, hypothermic, in water for 3 hours
attempting to get to a rescue boat for family with autistic member, succeeds,
then struck by helicopter landing gear exiting with wind gust. Gash without fracture; now shaking with
audible wheezes.
- 55 yo female, substernal chest
pain, anxious, improves with psych liaison
- 64 yo male, prior TBI, BMI >40,
Code Brown – rehydrated, sent for
- 42 yo male, uremic, no HD x 7
days, FSG 42, improves to 127mg/dl
- 55 yo female, BP 210/108 after EMS
placed foley and IV Lasix 40mg; greatly improved with NTG and Lisinopril,
pharmacy fills a week of meds to go.
- 36 yo female, ‘trench foot’ after
punctures and multiple immersions for 3 days, IV Abx with return in AM planned.
- 45 yo male, IDDM, tarry feet & puncture, (no shoes);
Rx insulin and Keflex
- 91 yo female, SDAT, HTN, never
uses meds per daughter, now combative and mute; rehydrated after U/A and labs
It goes on. The patient/family
interactions are a great source of satisfaction, as well as the wonderful
professional contacts.
************************
Sunday, September 4, 2005: Deeply troubling to see the extent of devastation - the
lives of people here, after the Hurricane Katrina. The stories of victims, as well as those
stories of the extremely generous people here, are very moving.
Tragedy brings out
extremes. But I cannot commend highly
enough the churches, university, local police, and the whole of the community
her, for opening up their lives to the difficulties in the New Orleans region.
The magnitude of the difficulties is
analogous to an iceberg. Even hearing
first hand of the problems, it is difficult to adequately place it all in
context.
My work is just one element of the
multiple needs here. Accounting of death
has not been attempted. The survivors
tell stories, but obviously the young and old, weak and frail were most vulnerable
in the hurricane.
Enduring in the subsequent flooding,
lack of water and electricity, and the mandatory exodus has been a burden many
have poorly tolerated. Families are
missing, couples have been separated; the disruption and the task of reconnecting
is a great unknown. “I last saw my
daughter a day after the storm hit… “
Medical issues range the
complications of untreated chronic problems –
asthmatics, diabetics, atrial fibrillation / cardiac problems, arthritic /
orthopedic; plus new stressors of injury and infection.
Mental health issues are extensive,
burdensome, and are difficult to address.
Complicating all these is a basic
lack of clean water, simple food, underclothing, and shoes for bare feet. “If I could have just a shower… “
Financial complications with car,
home, job are included in the phrase, “Nothing will be the same, “ for so many
here.
The chapel is room and board for
about 50 medical providers: physicians,
nurses, EMTS, and more. It’s about a 1
mile walk through the lovely campus of LSU, to the P-MAC, now seeing patients
24/7.
I attended church on Sunday and one
parishioner told a story, finding a family of four, parent and young kids,
standing by their car in a downtown area of Baton Rouge. He wanted to be a Good Samaritan,
and offered them help -- perhaps a shower and an opportunity to so some
laundry. The family had been living in
their car for the past five days, and was greatly relieved at the parishioner’s
offer. But they also wanted to bring the
“rest of the family,” also in cars. Suddenly
15 people were chatting with the parishioner. Then, as word spread among the parked cars, this became an extended
family of 37, ages from 1 to 87. The
“family” stayed 36 hours, bathed, and ate and they planned to continue to drive
north for potential resettlement.
*********************************
Saturday, Sept 3, 2005: This day had been spent at the P-MAC, the Pete Maravich Assembly Center
The mix of staff and volunteers is
extensive. Border Patrol guards hefting
M-16s provide excellent security, although the contrast with the lush,
contemporary and stately campus exaggerates the effect. National Guard
personnel provide the logistics of coordinating the extensive supplies,
organizing the flow of patients and providers, and troubleshooting any rough
spots. Nurses, docs, technicians, and
eager students are all volunteers. The
providers have been nephrologists, ER physicians, pulmonologists, orthopedic
surgeons, and more.
Local physicians have been helpful with describing Louisiana "Good Samaritan" laws, which are applicable for volunteer medical providers in protection for liability concerns.
I was assigned to a team with two
nurses, two techs (med students). The
level of respect and communication has been excellent. Folks from this area are pleasantly surprised
that health professionals have come from Ohio, Florida, and New York.
I have seen very few traumas, but
mostly medically related problems, such as diabetics with foot injuries,
dehydration, lost meds, cellulitis, COPD exacerbation, and many other acute-on-chronic
variations.
The stories are multiple: Patient is status post CABG x 2yrs when the
levees broke. Water entering the living
room, and patient dropped the NTG, now floating right out of the house. Patient chases, winds up treading water for
30 minutes with substernal chest pain, finally rescued by patrolling boat.
Volunteer is radiology resident who
ended 24-hour shift when Katrina hit; she stayed in a purgatory of providing care for patients for five days
straight, through no water, no electricity, extensive bagging of some
patients. Rescue finally comes for
patients by helicopter, but the medical personnel are told to go to the hell
occurring at the Superdome.
People overall have been positive
and upbeat through miserable circumstances. I personally have been feeling very well accepted as a PA, working with
my assigned team and the other providers.
It is a fine privilege to be in Baton Rouge today.
September 6, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (1)
Physician Report from the Astrodome
Amy
is an MD who volunteered at the Houston Astrodome. Here is her on-the scene-report.
I
don’t even know how to explain how bad it is down here for those of you who
aren’t here. It’s just unreal that so many people are here in Houston, and it seemed
like the Red Cross was unprepared for the onslaught of refugees, even though
they knew ahead of time they were coming.
Well
I was watching the news Thursday night as over 100 buses were headed to the
Astrodome from New Orleans and it seemed like all hell was breaking loose. With about 60 people on each
bus, that meant that about 6000 people would need to be processed, registered,
and settled into the Astrodome. Then I heard that they were also triaging
everyone medically too, since so many people on the buses were very sick- so
many hadn’t had their medications since the hurricane, hadn’t eaten or drinken
anything, had gotten cut or badly hurt in the flood waters, or were simply sick
for other reasons. Then, one of the volunteer doctors came on the TV and begged
any doctors, nurses, paramedics, PAs, volunteers, etc to come down and help get
these people some medical care because they were getting overwhelmed in the
ER/clinic they had set up in the AstroHall.
I
was only one of about 6 doctors for hundreds of patients, so there was just
such a sense of urgency to get these patients seen. So I dusted off my white
coat, unpacked my scrubs, and found my stethoscope and drove at 1 am to the
Astrodome to help in any way I can. I wasn’t sure what I could do since I don’t
have my Texas license yet, but I was willing to hand out Band-Aids if that’s
all they’d let me do. I explained my situation to the head MD, and he said
since I was a doctor, he didn’t care. They needed help so badly that I saw all
my own patients, decided my own treatments, transfers, follow-ups, etc, and
just ran it by the attendings if needed. They simply signed off on my charts
and prescriptions at the end of the cases, so that I’d be protected in the
state of Texas,
Anyway,
the patients were so sick. It became routine to see blood sugars over 400 and
blood pressures way over 200/100. They hadn’t had their medications for days,
along with no food and water. But they were so thankful for the treatment they
were getting and were so patient about having to wait so long. They were just
so grateful to be in Houston.
I had to hold back tears so many times at how horribly these people had been ravaged by this storm and what it had done to their lives.
My toughest patient of the night was a young man who began seizing in the waiting area -- where he had been waiting for over 12 hours after getting off his bus. He had a grand mal seizure for over 3 minutes, hitting his head hard on the concrete floor when it started. I was the only doctor around at the time, so I had to step up to the challenge. There was no patient chart, no family with him, and no one knew anything about him. His finger stick glucose reading was so high it was off the charts, so we went from there, injecting whatever insulin was available. Then we had to hand hold 2 IV bags wide open while he was still lying on the floor in the waiting room, because we didn’t have enough help to get him up and into a bed yet. Finally we got him into a “room” on a stretcher and he told us that he’s diabetic and epileptic and had been off all his meds since the hurricane. He also hadn’t had anything to eat for 4 days. Since we didn’t have any lab services at that time and our only “EKG” was off of the defibrillator machine, I still had no idea if he was in ketoacidosis or just seizing from his lack of meds. Luckily his sugar came down, he stabilized, and we were able to transfer him to the VA, since we had no Dilantin to load him with, he needed to be ruled out for a possible head injury, and he obviously needed more intensive care. It’s amazing what you can do with so little when you have to. The teamwork and camaraderie around here among the healthcare personnel is awesome, and I think that’s why so much is getting done with so little.
For you orthopods- I also saw a horrible case of tibial osteomyelitis with a draining sinus- the med students were so interested in it. They’re literally seeing things they would only see in a third world country. I had to transfer him to the VA for his pending below knee amputation before he became septic, it was so bad.
The medical set up is pretty impressive and ever evolving. When I got there, it was just a large square area with about 20 curtain rooms, no lab services, no x-rays, no monitors, and very limited medications. The only IV antibiotic was Ancef, which some of you know doesn’t cover the brackish water organisms. There were a few other oral antibiotics, but not many. We had no pain meds, no diuretics (and everyone had edema on their legs!), only a few anti-hypertensives, and one or two types of insulin. There was a free pharmacy that was able to get more home medications, but they had to come back the next morning to pick them up, so who knows if they’ll do it. By the time I returned the following night, it had evolved to where there was an area for each specialty, an xray area, a lab trailer, an area for the ambulances to pull in, fast track and emergent care. And by then there were so many more medications and supplies. I’m so impressed by the way the Harris County Hospital District has handled this. They are really organized and proactive. Most of the medications, supplies, doctors, nurses and other personnel, stretchers, wheelchairs, etc are from Harris County Hospital District so it’s just an amazing effort by these guys to help out in any way they can.
Anyway, I urge everyone just to do whatever you can to help. There’s no way to explain how devastated these people are. But they still have their spirit and dignity and faith.
I included some pics I took. I didn’t take as many as I wanted to, because the people getting off the buses were so fragile. They didn’t need some doc snapping their pic. The photo here is from inside, where you can see some of the treatment area and the waiting area.
Take care and lots of love. God bless the victims of Hurricane Katrina.
September 6, 2005 in Hurricane Katrina: Nurses and NPs Help | Permalink | Comments (4)