What to do before and after an emergency

Communication is critical

The most critical issue before, during, and after any emergency is communications, say the Florida home health managers who faced multiple hurricanes during the 2004 hurricane season.

"We had no electricity after the hurricane, so we had no phone system for the home health agency," says Sheila Carlson, director of Lee Memorial Home Health in Fort Myers, FL.

"Cell phones were not always effective because the cell phone system was so stressed with the volume of calls people were making," she adds. "Our field staff have wireless laptops, so they were able to communicate with each other, but our managers don’t have them, so it was a challenge to keep in touch with all of our staff."

Her agency also discovered that the hospital’s telephone system continued working, thanks to backup generators and a more sophisticated system. "We will use the hospital’s voice mail system next time," Carlson explains. "We can leave messages for staff members who can call in for updates and information."

"We are considering two-way radios for our emergency communications," says Bobbie D’Angola, administrator of United Home Care Services in Miami. "Our employees see patients in their own geographical area, so they can check on patients once travel is possible, but with no telephone or sporadic cell phone service, we can’t always communicate with them," she notes.

Prior to all of the hurricanes’ arrivals, home health staff members throughout the state got on the telephone with all clients and staff members to verify their plans for evacuation. Although this season has been unusually active, Floridians are very aware of the possibility of evacuation in case of weather emergencies, says Karen Rutledge, RN, director of nursing for Omni Home Health in Homosassa Springs, FL. Evacuation is a reality for many of her patients because they live in mobile homes near the Gulf of Mexico, she adds.

"All new patient admissions include the completion of an emergency medical service contact form that includes a description of the patient’s needs and the patient’s plans or needs in case of evacuation," Rutledge says.

At the beginning of each hurricane season (June 1 through Nov. 30), staff members contact each patient to update the forms, she explains.

Copies of the forms are forwarded to the county emergency medical service (EMS) so EMS personnel know which patients need assistance for evacuation. As weather worsens, or the threat of severe weather increases, home health nurses contact patients to check on them and see if they need further help, Rutledge adds.

Following the hurricane, staff members contact patients who planned to stay alone in their homes during the storm, she says. "If we can’t reach them by telephone, we go to them if we are able to travel to the area, or we ask EMS personnel to check on them."

Prepare patients for evacuation

Admission information for Homosassa Springs’ patients also includes a checklist for items to include in an evacuation kit. "We make sure patients have all of their medications, a copy of their medical history with names and phone numbers of physicians or health care providers, a list of allergies, a copy of their living will (if they have one), and any other information that will help them continue receiving care in the area to which they evacuate," Rutledge says.

Because United Home Care also provides community-based services to patients other than Medicare-certified patients, staff help prepare their patients for the hurricane by stocking pantries with water and three to five days of meals that don’t require electricity to store or prepare, D’Angola adds.

"We’ve been lucky this season because our personal care attendants have been able to continue seeing patients with no more than a one-day delay," she says.

Traumatized patients need reassurance

Because many Miami residents still have horrible memories of the devastation wrought by Hurricane Andrew in 1992, the aides and nurses often are responsible for reassuring patients and reducing their anxiety, D’Angola notes.

"We make sure our employees know to stay upbeat and calm during threats of hurricanes so that we are able to prepare our patients for the weather and possible evacuation without scaring them," she says.

"If we do have a patient who is extremely anxious, and the aide cannot reassure [that person], our licensed clinical social worker will visit the patient to counsel him or her," D’Angola adds.

Most home health agencies are providing counseling services to patients and employees, and it is a needed service, Rutledge explains. The emotional toll on staff and patients from this year’s busy hurricane season concerns her.

"I noticed that, with each hurricane watch or warning, people were more laid back, less alert," she says. "I know that continuous warnings of a storm that doesn’t always arrive create a wait and see’ attitude that can be dangerous," Rutledge admits. She plans to continue teaching staff and patients to take each warning seriously.

One of the more depressing aspects of a hurricane is that even when the threat is taken seriously, plans can backfire. Rutledge explains, "One of our nurses decided that she would leave our area when Jeanne was approaching. She left the night before to head to Jacksonville, only to discover the next day that the storm changed direction and Jacksonville was right in the middle of its path."