EDs pool resources to weather flood

Staffs combine to meet patient needs during crisis

Three hospital EDs in Binghamton, NY, overcame late June floodwaters that caused one of them to close by sharing staff and other resources to enable the remaining two to function with increased caseloads until operations returned to normal.

It had rained for about a week. Water was covering cars and the first level of many homes when "on the 27th, we received notification that if it continued to rain that day and night it would put us at a dangerous level," recalls Maria Berry, BSN, CEN, director of emergency services at Lourdes Hospital.

Following preset disaster policies, a command center was set up, each department called in extra personnel, and supplies and staff were assessed. "Initially, we just evacuated the ground floor, which includes the lab, the cafeteria, supplies and purchasing, social services, radiology, and oncology," she reports. "The ED sits on the main floor, which is the upper level, so we knew we would be safe."

The power plant sits on the ground floor. When it started to take flood, the hospital went to auxiliary power. However, when water overcame the plant, the decision was made to evacuate the hospital — even before the loss of auxiliary power.

Although the hospital evacuation began at 10:30 a.m., the Lourdes ED remained open. "We were on generator, although we had no air conditioning," says Berry. "We kept accepting patients and had probably six extra nurses and two extra PAs [physician assistants] and physicians." At that hour, the ED normally has one doctor, one PA, and five nurses, but the night shift remained on duty.

By 1:30 p.m., the Lourdes ED stopped accepting ambulances and began transferring their patients to the EDs at Wilson Regional Medical Center and Binghamton General Hospital, which had remained open.

Seeking extra staff

Meanwhile, the other EDs were facing a staffing crisis. "This couldn't have come at a worse time," says Stephen Gomez, MD, FACEP, medical director of the EDs at Wilson Regional and Binghamton General. "That week was the first week after two physicians had left on vacation. In fact, every physician who was not scheduled to work was out of town."

Once he heard Lourdes had closed, "I went in and tried to get a read on how bad things would be," he recalls. Gomez coordinated with his administration to ascertain the availability of additional personnel outside the ED, as well as a place to put their overflow ED patients.

He called every one of his staff members who was in town and already scheduled to work and let them know what was happening, and he told them that they needed to be on standby in case extra staff were needed. "Everyone who was in town readily agreed," says Gomez.

Despite the fact that some staffers had flooded homes and children affected by closed schools, they continued to work. With so many flooded roads, some staffers had to take alternative routes.

Once he knew for sure his EDs would be getting more patients, Gomez started calling his staff and assigned them to the two EDs. "Wilson was where we handle trauma and cardiac cases, so they got the bulk of our additional patients," he says. "Then, I started making contact with Maria Berry to check on the availability of their practitioners."

Berry sent basically everyone who scheduled to work the regular shift to the two open hospitals, "and we continued to do that for the next 12 days," she says. In addition, she says, Lourdes sent intravenous pumps, beds, stretchers, and monitors. The items were transported by the National Guard and local fire departments, says Berry. Wilson Regional and Binghamton General also sent trucks to pick up equipment. Fortunately, the road between the hospitals was completely clear of floodwaters.

Once the Lourdes staff arrived, the ED nurses were paired up with staff nurses, met the other staff and managers, and went through orientation. "Within a short period of time, they got full access to our computer system and the meds administration system," says Gomez.

The additional staff were more than welcome. In one day, the volume at the two remaining EDs went up 60%. Gomez found additional help as well. "We have a teaching program of internal medicine and family practice at Wilson Memorial, and some senior residents and attendings came in and helped out during times of really peak volume," he says. "The key really was to assign them to areas in which they were comfortable, which was not too difficult, as most of those cases were medical cases, not trauma cases."

To help accommodate the additional patient demand, Gomez had the gastrointestinal lab turned into an overflow area, staffed by nurses, for several patients who were waiting for test results. Stretchers were brought in for those patients. "That worked out well," says Gomez.

Sources

For more information on dealing with disasters, contact:

  • Maria Berry, BSN, CEN, Director of Emergency Services, Lourdes Hospital, Binghamton, NY. Phone: (607) 798-5111.
  • Stephen Gomez, MD, FACEP, Emergency Department Medical Director, Wilson Regional Medical Center, Binghamton General Hospital, Binghamton, NY. Phone: (607) 763-6412.