Outpatient surgery goes wherever the patients are
Outpatient surgery goes wherever the patients are
Katrina medical relief workers share stories
After Hurricane Katrina, some medical relief workers found themselves performing outpatient surgery procedures on a gym mat or in an 18-wheeler tractor-trailer that had been converted to mobile hospital.
The mobile hospital, named MED 1, was funded by state and federal government resources and based at Carolinas Medical Center in Charlotte, NC. It had a staff of 100, including an orthopedic surgeon, an anesthesiologist, and two trauma surgeons, including Preston "Chip" Rich, MD, division chief of trauma and critical care at University of North Carolina Hospitals and trauma medical director at UNC Healthcare System, both in Chapel Hill.
MED 1 is designed to handle disasters and mass casualties, but this was its first deployment. The staff traveled 30 hours and set up in the parking lot of a destroyed Kmart in Waveland, MS. They became affectionately known as "Kmart General." "We were the only hospital for a six-county area directly between Biloxi and New Orleans," Rich says.
A SWAT team accompanied the hospital and their staff and created a safe perimeter around the hospital with wrecked cars. Other security initially included members of the Bureau of Alcohol, Tobacco, Firearms, and Explosives; U.S. marshals; police; and members of the National Guard. A wire fence was rolled around the hospital to keep out looters and drug thieves.
The hospital sets up like a MASH military unit and has a massive tent that holds 100 beds. Trailers carried disaster equipment and served as living quarters. Decontamination tents were converted to triage areas and showers. The tractor-trailer has slide-out areas and includes two ORs, a four-bed intensive care unit, and several acute care beds. The hospital includes a blood bank and a portable CT scan that was obtained with the assistance of a local hospital that had closed due to hurricane damage. MED 1 can perform any major abdominal and chest operations, Rich says.
"We have full orthopedic [surgery] equipment, as well as an autoclave so we can sterilize our own instruments," he says.
One of the first items of business was to set up a helipad. "We painted an H, set up flares, and 15 minutes later helicopters began bringing patients," Rich says. The medical team treated everything from trauma to diarrhea.
Doing surgery inside a tractor-trailer meant less space, "but [we] were able to work within that confinement," Rich emphasizes.
The primary difference was that the OR was in the middle of a disaster zone. However, when he was inside the tractor-trailer, he couldn’t tell the location, he says. "We had absolutely everything that a full standing hospital would need, including surgical supplies."
They treated several lacerations and abscesses as well as performed some debridements. After the surgeries, patients went to the large tent that had air conditioning.
Rich was deployed to the hospital for 10 days, and the facility treated about 200 patients a day.
The mobile hospital probably will be open until the end of December, when the local hospital hopes to reopen.
Performing outpatient surgery on a gym mat with no analgesia sounds like a scene from a horror film, but this was the situation one outpatient surgery nurse encountered when she traveled as a member of an American Red Cross National Disaster Team after Hurricane Katrina. A high school in Pascagoula, MS, was converted to a clinic and shelter.
"We had one patient who had a very infected knee and was in a lot of pain," says Teri Roberts, RN, pre-op nurse at Valley Ambulatory Surgery Center in St. Charles, IL, owned by Symbion Healthcare.
There was no medication, but it was the patient’s decision to go ahead, she recalls. A doctor from the Federal Emergency Management Association (FEMA), who was rotating through the facility, lanced open the area, pulled out the infected area, cleaned the wound, and sewed it back together. The patient held on to Roberts and another staff person, she says. When Roberts saw the patient the next day for a dressing change, his pain had subsided dramatically.
At the beginning of her assignment, there were 400 evacuees in the shelter being cared for by about 20 volunteers, including Roberts and two other health care providers. There was no power for the first three or four days, and there was no communication until a ham radio was set up the fifth day for emergencies.
Not all of the evacuees were sick, but many people needed medications, Roberts points out. Medical care included treating infections for evacuees who had to go through floodwaters to get out of their homes. When they changed wound dressings, the staff had to use whatever supplies the National Guard brought. Roberts’ experience of using a variety of dressings in outpatient surgery helped her adapt.
Roberts’ background also assisted in treating evacuees who had been emotionally affected by their experiences during and after the hurricane, "When we prepare a patient mentally for surgery, it sometimes requires a lot of counseling," she explains. "That helped me there, not to be out of touch with people’s emotions."
Mark Mayo, administrator at Valley Ambulatory, says, "Our center is proud of Teri and the work she did. It made us all feel more a part of the relief effort to know that a very caring nurse was in Mississippi helping people."
After Hurricane Katrina, some medical relief workers found themselves performing outpatient surgery procedures on a gym mat or in an 18-wheeler tractor-trailer that had been converted to mobile hospital.Subscribe Now for Access
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