Heather Anderson, BSN, RN, Director of the Medical Surgical Unit at Adventist Health St. Helena in northern California, received an unexpected call soon after she arrived home from work on August 19.
Anderson, a member of the facility’s disaster preparedness team, needed to return to the hospital immediately because winds had shifted the nearby LNU Lightning Complex Fire, and the state fire department had issued an evacuation order for the area.
Anderson knew this was not only the first evacuation in the hospital’s 140-year history, it was also happening during a natural disaster and a pandemic.
Two days earlier, leaders from the hospital’s disaster team had met after they heard about the fire. But actually communicating was challenging because the pandemic’s social distancing requirements had forced the team to meet via Zoom.
The rural hospital did not have a large conference room where team members could sit six feet apart.
“Online, a conversation that would normally take 10 minutes took twice as long,” Anderson said. “We had to learn how to avoid talking over one another, and on a screen, it’s difficult to see body language cues that are critical for communication.”
Evacuating 51 patients also was complicated by the fact that nearby hospitals were grappling with increased patient volumes from COVID-19 cases – not to mention the closest hospital was 30 minutes away.
“Our COVID-19 patients were among the last to leave because it was difficult to find hospitals that could take them,” Anderson said.
As natural disasters such as fires and hurricanes ravage cities throughout the country, facilities like Adventist Health St. Helena have been confronting the fact that disaster plans must be updated to ensure the safety of patients, staff, and communities during the pandemic.
At Anderson’s hospital, all 51 patients were successfully transferred in less than nine hours. The experience provided an opportunity to identify areas for improvement.
During the evacuation, for example, nurses relied on checklists to prepare patients for transfer, but it later became clear that certain items needed to be added to the list. One important discovery was that there were no reports being given to nurses at the facility receiving a patient.
As a result, sometimes EMTs were serving as go-betweens as they received patient information and passed along clinical details to staff. “Direct communication between nurses at each facility is important because it gives staff the opportunity to ask questions,” Anderson said.
Protecting Patients During Natural Disasters
One week after Anderson started evacuating patients, Gerald Bryant, DPN, RN, Executive Vice President of Nursing and CNO of Lake Charles Memorial Health System in Louisiana confronted a similar situation as Hurricane Laura approached. Although the staff is well-versed in hurricane preparedness, the pandemic complicated things.
On August 26, 19 NICU babies had to be transferred from the one-story Lake Charles Memorial Hospital for Women to the 10-story main hospital’s upper levels that were not at risk of flood damage.
The babies were moving from a large 24-bed NICU unit to a smaller 12-bed pediatric unit in the main hospital, and nurses worked carefully to ensure the patients were safely distanced from one another.
The same day, members of the main hospital’s Team A group — nurses, physicians, and support staff who would stay at the hospital after the hurricane made landfall — arrived to care for 160 patients. During the height of the storm as the building swayed from winds up to 150 mph, nurses had to ensure patients were masked and six feet apart when staff moved beds into hallways away from windows that could shatter.
The hospital relied on generator power to maintain critical infrastructure and lost access to potable water.
According to Bryant, one of the struggles for staff amidst the chaos was prioritizing their personal safety as they lived at the hospital for 65 hours.
“Many of them were overstimulated because they were trying to keep patients safe while they simultaneously dealt with the stress of being separated from their families and uncertainty about the damage to their own homes,” Bryant said. “It was tempting for people to let down their guard with details like keeping masks on at all times when they were not caring for patients. But the administrators gently reminded them.”
As the storm started to subside, the Team A staff prepared all the patients for evacuation — including 15 who were COVID-19-positive — because forecasters were predicting “unsurvivable” storm surges. Many patients could be transported on the AMBUS — an EMS vehicle that can hold 18 patients — but COVID-19 patients were transferred individually. Hospital staff also carefully checked that the EMS providers transporting the COVID-19-positive patients were equipped with face shields or goggles, masks, disposable gowns, and gloves.
Social Distancing During a Storm
As hurricanes strike during the pandemic, finding enough space for Team A staff members to sleep six feet apart also proved challenging, says Jennifer Dumal, BSN, MPH, RN, Senior Vice President of Patient Care Services and CNO of Memorial Hospital at Gulfport in Mississippi.
“To create more spacing, we decided to use new areas like the same-day surgery unit, cardiac rehab unit and cath lab,” said Dumal, who oversees sleeping accommodations during hurricanes.
On September 16, 850 staff members who were part of Team A were called in to prepare for Hurricane Sally, but the socializing traditions for the staff had to be changed due to the pandemic.
“People like to share snacks and food they cooked at home as they hang out during a storm, but the managers and directors walked around and reminded people to stay six feet apart,” Dumal said.
Dumal had also learned from past experiences with storms like Hurricane Katrina that it is critical to maintain access to supplies. Deliveries are not as reliable during the pandemic, she said.
The hospital was previously depending on a company in California for COVID-19 testing kits, but she knew this was risky. “It’s important to have contracts with multiple vendors in case one is not able to deliver due to a disaster,” she said.
Staff members at Baptist Health Care in Florida were also preparing for Hurricane Sally. The Category 2 storm drenched the Florida Panhandle with up to 30 inches of rain. Although the storm eventually weakened to a tropical depression, any hurricane — mild or severe — is an opportunity to practice disaster preparedness, said Cynthia Gamache, DBA, RN, NEA-BC, CNO for Baptist Hospital in Pensacola.
“We do not take any storms lightly,” she said. “We always over-plan because things can change in an instant.”
Take these courses to learn more about disaster preparedness:
Protecting Older Adults in Disasters: Nurses Matter
(1 contact hr)
Major disasters affect everyone, but the older adult population is particularly vulnerable. Of the people who died in Hurricane Katrina in 2005, 50% were older than age 75. Similar disproportionate deaths among older adults have been documented in more recent natural disasters. This module informs nurses about how to protect older Americans who are faced with disaster.
COVID-19: Fall 2020 Update
(1 contact hr)
Relias offers nurses and healthcare providers free education resources to help them navigate the coronavirus pandemic. In our Fall 2020 update, you’ll read research and information covering a variety of topics related the impacts on COVID-19 on hospital employee health. Originally published by our sister company, Relias Media, topics covered in this text-based CE course include: why nurses are calling for OSHA regulations related to the pandemic, evidence about how universal masking may help societies navigate the possible “second wave,” how nurses might use COVID-19 as a platform for ensuring their importance as healthcare providers is elevated in the future, how cases of the virus among healthcare workers may be grossly underestimated, and more.
When Disasters Strike: Preparing for the Unexpected
(1.5 contact hrs)
This module features an overview of disaster management in EDs, including the definition of the four stages of disaster management and the triage of patients. Preparation of ED personnel will help them to respond to natural disasters and other disasters, and the patient populations affected by them more effectively.