Temblor drives ED staff, patients into outdoor tent

Disaster call tree ensures adequate staffing

While weather-related disasters such as hurricanes or tornadoes can present some tough challenges for an ED manager, you generally have at least a few hours to prepare for the possibility of severe weather. But when an earthquake hit Hawaii at about 7:10 a.m. on Oct. 15, there was no warning at all for Kathy Kotecki, RN, the charge nurse who was running the ED at Kona Community Hospital in Kealakekua, HI.

"I started to feel things shake, but this happens frequently," Kotecki recalls. "I thought it would just stop, but it lasted for what seemed like a couple of minutes." The lights went out, and the backup generator did not come on right away, she says.

'We had to stay open'

While the hospital stayed dark for a couple of minutes, it suffered minor structural damage such as fallen ceiling tiles and damage to an operating room. However, much of the damage in the ED was limited to overturned equipment and items thrown off shelves into hallways. Nevertheless, the decision was made to evacuate the hospital. Kotecki, however, remained to treat any new patients who might need help.

"Med/surg evacuated, the OR was closed, OB was evacuated, but we had to stay open because we needed to treat people who just walked in," Kotecki explains. "There was no way we could turn them away."

Immediately after the initial shaking stopped, Kotecki told the rest of the staff to get out of the ED and into the parking lot.

"This was the strongest quake I'd felt in my life," she says. "We're on the basement level, and since the hospital is a three-story building, I was thinking we could get crushed."

The three ED patients, who already were in gurneys, were brought outside, along with portable equipment such as cardiac monitors. Then they started their disaster call tree. "One of the unit secretaries called everyone and asked additional staff to come in," says Kotecki. About 90% of the total staff — 20 RNs and six physicians — showed up. "Maintenance showed up and put up a tent." (The "tent" was actually a vinyl dome typically used for chemical disasters. It can cover five gurneys in a row, plus supplies.)

Lynn Guillermo, RN, a staff nurse that day, notes that other departments pitched in. "Central supply brought carts outside, so we had all the equipment we needed for IV supplies, bandages, and so forth," she recalls. The dietary department helped by bringing water and ice for the patients, she adds.

There was no central source of electricity in the tent for more serious patients who were on monitors, notes Kotecki, so they eventually had to be treated inside. "The battery life was not long enough," explains Guillermo.

"I stayed in the ED because we still had people walking in, and we assumed we'd have traumas coming in pretty soon," she says. "Luckily, that did not happen." Instead, what she saw were "Mostly abdominal pains, chest pains, some anxiety chest pains — in other words, 'regular' ED patients," Kotecki says.

Ten people were admitted to the Kona ED with earthquake-related injuries, none of which were life-threatening. "Some of them came straight to the tent, but some went into the ED and were triaged first," says Guillermo, who notes that she had as many as six or seven patients outside at one time.

By about 2 p.m., all of the tent patients had been discharged, and the ED stopped using the tent. "Everybody was eventually discharged, except for a chest pain patient who ended up being flown out to Oahu," says Guillermo.

Not a one-day event

Things were not nearly back to normal the next day, recalls Lori Cannon-Salis, RN, a staff nurse who worked as the ED supervisor on Oct. 16.

"Only 10% of the hospital was operational," she notes. "The emergency patients had been relocated back to the ED, and we did continue to get some lacerations or minor injuries."

The changes in the rest of the hospital affected the ED, she continues. "The entire second floor was shut down, and they relocated the OB unit and the med/surg unit to the ICU, which has only nine beds," notes Salis. "At one point, we had laboring patients in the ED until we could get them upstairs."

Because other departments still were closed, "We [the ED] had to troubleshoot transferring patients off-island from other departments," she recalls. "We actually got a C-130 [airplane] to get our patients off."

There also was added pressure on the ED because of their location, adds Kotecki. "There were no other hospitals available, except on the other side of the island," she says. "It was very scary."

Sources

For more information on ED operations following an earthquake, contact:

  • Lori Cannon-Salis, RN, Lynn Guillermo, RN, Kathy Kotecki, RN, Emergency Department, Kona Community Hospital, 79-1019 Haukapila St., Kealakekua, HI 96750. Phone: (808) 322-9311.