How to set up emergency treatment area at a church
When patients were evacuated from Sumter Regional Hospital in Americus, GA, after an F3 tornado hit on March 1, 2007, a temporary treatment center was set up next to the shelter area inside the town's First Baptist Church.
Much of the ED's equipment was salvageable, even though there was water on the floor, says Schelly Murray, RN, BSN, nurse manager and ER clinical coordinator. "[The Joint Commission] says no equipment on the floor," she points out.
After all of the patients were evacuated from the badly damaged hospital, Murray moved two $15,000 pieces of equipment that recently had been purchased: a glide scope and an ultrasound machine. Other equipment that wasn't needed immediately was moved to a large warehouse that the hospital recently had purchased, Murray says.
The temporary treatment center was set up primarily by Betsy Jordan, RN, CEN, clinical analyst in the Clinical Informatics Department at Phoebe Putney Memorial Hospital in Albany, GA. Jordan, who is married to a paramedic at Sumter Regional and knew Murray, had worked in the ED at Phoebe Putney for 12 years and was a former flight nurse. While the Sumter ED staff were evacuating patients and meeting, Jordan loaded supplies into her car and the car of a soldier who had showed up to help. "I threw them in the back of my Suburban," she says. "It was full to the ceiling."
Lifesaving equipment, including crash carts, was transported. Murray says, "We emptied the ER completely of supplies." Many of the linens had been used to transport patients to the ED for triage, but they were replenished by area hospitals, a nursing home in Americus, and the Red Cross. An EKG machine was transported from the ED in a staff member's car.
Setting up in the social hall
At First Baptist, Jordan unloaded the supplies in the dark as large spotlights were set up. The treatment center was set up on about one-half of the first floor of the church building.
The center included a treatment room (normally a chapel and social hall) that contained a triage area, cots provided by the church, a physician examination area, and a treatment area. A pharmacy was located in a small kitchen area of that room and included a sink, refrigerator, and cupboards. Adjacent Sunday school rooms were designated as a resuscitation unit; an obstetrics room, with fetal monitors, for emergency deliveries if needed; and a room stocked with emergency supplies and equipment. Pieces of paper labeled different areas of supplies, such as suction, respiratory, gloves, and orthopedics.
Two entrances were set up for the treatment center at First Baptist: one for emergency medical services (EMS) and one for ambulatory patients. In terms of staffing, two nurses were placed at each of two triage tables. As more nurses showed up, Jordan asked them about their jobs, credentials, and experience. Nurses who knew first aid were assigned to the treatment area.
Don't forget your forms and policies
After the evacuation, Murray salvaged her computer, policies, and data, including contact information for staff. "Policies are supposed to be on the network, but I'm not sure it's salvageable," she said.
About 500 hard copies of a one-page form titled "Emergency Triage Nursing Notes" were brought from the ED. That form has been used previously when the hospital was out of power or had multiple victims at once. Having the 500 copies proved valuable as there was no copy machine available at the church, Murray says.
Jordan says the form worked well. "It may not meet [requirements of The Joint Commission] with every 'I' dotted and every 'T' crossed, but it statistically tracked patients or could be used if family members were looking for loved ones."
For the walking wounded, the original forms were kept at the treatment room. For patients who were moved to areas hospitals, nurses wrote a general summary of the patient on another sheet of paper and sent the original form with the patient. "We had a trail of the patient," Jordan says. Accepting hospitals were notified of what patients were coming with which conditions.
Any infection control concerns?
Because the treatment center was set up in an area of the church that was used regularly, it was fairly clean with no dirt or dust on the walls or floors.
To prepare for patients coming in, Jordan put trash cans with red bags in each treatment area. "I decided that people might be bloody," she says. She also set up sharps disposal areas. Jordan put waterless antiseptic agents on all tables. Gloves of all sizes were placed at every station.
Dirty linens were being transported to an area hospital.
Help came from near and far away. First Baptist set up phones for the hospital to use. Orthopedic supplies were donated by a doctor's office in a nearby town.
Some paramedics from Medical College of Georgia Hospital in Augusta made repeated runs to the hospital to retrieve ED equipment and medications, including wheelchairs, stretchers, and tetanus. The night of the tornado, before the pharmacy was established at First Baptist, CVS brought a mobile pharmacy and was able to provide medications.
The treatment area was staffed with a minimal number of people, Murray says. Within the first three days of the tornado, the center treated about 50 patients.
One of the critical elements for making the treatment area work well was communication, Jordan says. As nurses showed up, Jordan gave them a walking tour and oriented them to the process, just as if they were a new employee, she says. "Communication needed to be clear in order to deliver efficient care," Jordan says. "Otherwise, there would be more chaos."
The EMS command set up in the hallway at the back door of the building, where ambulances arrived, which was just outside the treatment center. Jordan suggested putting a nurse there who would know what was happening in the treatment center. That nurse made a list of facilities accepting patients and had them designate one contact person at each. "They knew our situation and our process," Jordan says. "We knew if they could take none, or three patients."
If your ED ever is faced with relocating, act quickly, even if you don't have a process in place, emphasizes Jordan, who felt led to take this role. "Don't stand around and ask for direction," she says. "We were working at 4 a.m.; and by 6 a.m., we had patients rolling in. And we had a process in place."
Sumter Regional now has set up a temporary treatment center across the street from the hospital building. (See contact information in resource section, below.) The three tents, which are intended to be used for two weeks, house a 50-bed unit. Patients can stay in the unit for 23 hours for stabilization and corrections of problems such as breathing difficulties. The buildings are sealed, so they can be heated and cooled.
There was a hard surface building being delivered for the ED to move into, but at press time, it wasn't certain when that ED would be established, Murray says.
For information on temporary treatment tents and other disaster mitigation products, contact:
- EMS Innovations, P.O. Box 239, Pasadena, MD, 21123-0239. Phone: (888) 236-1267.