Staffing up helps EDs handle Katrina surge
Staffing up helps EDs handle Katrina surge
Pre-ordering extra supplies is a winning strategy
Hurricane Katrina’s impact was felt far beyond those areas that received the storm’s direct fury. From Alabama to Texas, EDs that already were overcrowded had to deal with a sudden influx of transfers that, in most cases, doubled their normal censuses. How were they able to handle this sudden surge of patients? ED managers on the front lines said a combination of good planning, staffing up, and a healthy dose of outside assistance helped them to soar instead of sink.
"Our numbers have about doubled. We were just seeing 40-50 patients a day, and now it’s up to 100," says Chris Ritchey, MD, FAAP, medical director of the Children’s ED at Women’s & Children’s Hospital in Lafayette, LA. Calls from transferring facilities in the New Orleans area alerted him ahead of time, which was a big help, he says.
"We were able to put all our docs on call, and they came in for extra shifts," Ritchey adds. "Nursing was tough for a while, but HCA [Hospital Corp. of America, which owns Ritchey’s facility] has really done well getting us staff from other locations."
Anticipating needs is crucial
He also tried to anticipate the kinds of supplies he would need. "We thought we’d see a lot of injuries, cuts and wounds, so we got extra suture kits and bandages," Ritchey explains. "People were in that water for awhile, so wound infections were a concern. We got extra [intravenous] fluids for dehydration and antibiotics for infection."
One week after the hurricane hit, Summit Hospital in Baton Rouge, LA, still was averaging about 45 patients more than a normal day, which is about 78, says Dave Miller, RN, the ED director.
"We had to gear up staffing mainly," he says. "As long as we were staffed well enough, we were able to move patients through pretty quickly."
Miller says he increased his nursing and physician levels by about 35%. "Normally during peak times, we have six nurses, and we were running about nine to 10," he says.
Usually the ED has one physician with a physician assistant (PA) eight hours a day, Miller says. "We went to a PA 24 hours a day and a swing shift with an extra physician," he notes.
Handling 25,000 patients
Surprisingly, the area with the largest influx of new patients seemed to handle them as well if not better than any other relief locale.
Houston took in more than 200,000 evacuees and about 25,000 hospital patients, "but almost all of our hospitals were kept off diversion," asserts Mary Frost, RN, trauma coordinator at Texas Children’s Hospital.
The reason is the creation of Houston’s Regional Unified Medical Command Center, which was established following the destruction of Hurricane Allison in 2001. "We have coordinated the responses of hospitals," she explains.
Patients were treated at the Astrodome and at the George R. Brown Convention Center. "We were manning some of those ourselves to address pediatric needs," Frost says.
The local medical schools, Baylor and the University of Texas, provided staff at the request of the mayor and the county judge to provide adult care, and they also had out-of-state Disaster Medical Assistance Teams (DMAT) teams.
Patients were first triaged at the Astrodome and then were sent to a shelter, to the on-site clinic at the dome or, if they were sick enough, they were transferred to a hospital, Frost says.
Patients were spread through all the hospitals in the region to keep all the EDs flowing, she continues. "Otherwise, we all would have been on divert."
No hospital, including Texas Children’s, had to activate its disaster plan, Frost notes. "And we cared for people [who live] in Houston, plus the additional stress of a holiday weekend, plus our guests from New Orleans."
Many of the patients suffered from chronic illnesses, she says. "We tend to think of injuries when we think of disasters, but we had 10 patients a day coming off the buses needing dialysis. If we hadn’t planned ahead and knew who to call, we could never have pulled it off, but we had an organization that was there just to coordinate chronic dialysis."
There is room for improvement — especially in communications, Frost adds. They learned a lot about patient tracking, she says.
"Our hospital planning group had some very significant contact with the Red Cross, and they are now another entity within this planning process," Frost points out. "We will all have forms for data collection ready for the next time, which were developed on the fly to help us keep track of patients."
Benefitting from previous experiences
Previous hurricane experiences have affected disaster planning in several areas of the country. For example, ED managers at St. Joseph’s/Candler Health System in Savannah, GA, have been concerned for some time about their low-lying, waterfront location. Subsequently, they made improvements, says Judy Peterman, RN, MSN, director of critical care and emergency services.
"Generators and backup systems used to be in the basements of both hospitals," she notes. "We have had some near-misses, and they are now on the second floors."
At Texas Children’s Hospital in Houston, several changes grew out of Hurricane Allison, which hit in 2001 and caused six hospitals to flooding, Frost adds.
"We understand what New Orleans [flooding] means," she says. "We took from our experience, built on it, and developed relationships we had not had before. Among the changes to the area hospitals themselves were the addition of flood doors, Frost says.
There’s no doubt that once you’ve been through such an experience, you have a totally new perspective on preparation, says Obed Cruz, RN, the ED manager at Mercy Hospital in Miami. He went through an evacuation prior to Hurricane Ivan last year.
"If I had not gone through one, I’d be just as blissful as anyone else," Cruz concedes.
Sources
For more information on handling patient surge during a disaster, contact:
- Dave Miller, RN, ED Director, Summit Hospital, 17000 Medical Center Drive, Baton Rouge, LA 70816. Phone: (225) 755-4858.
- Chris Ritchey, MD, FAAP, Medical Director, Children’s Emergency, Women’s & Children’s Hospital, 4600 Ambassador Caffrey, Lafayette, LA 70508. Phone: (337) 521-9100.
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