OCTOBER 1995, VOL 62, NO 4

A perioperative nurse’s perspective of

a day that changed lives t was an ordinary, busy day at Presbyterian Hospital, Oklahoma City. I was circu-

lating on a cardiovascular proce- dure, and I had just left the OR to update the patient’s family about the status of the surgery. It was about 9 AM, and as I began speaking with the patient’s fami- ly members, the hospital shook violently.

places, and a door that led to the parking lot was forced off its hinges. No one was injured, and after checking with the surgeons, I told the patient’s family members that everything was fine in the OR and that I would investigate the tremor. One of the patient’s family members said, “They’re saying it was a bomb!”

I called the assistant head nurse, who had felt the tremor and was checking into the situation. The surgeons thought the tremor might have been caused by a rup- tured oxygen tank, so I ran across the hall to the intensive care unit (ICU) because the hospital’s load- ing dock is visible from there. To my horror and disbelief, I saw the plume of black smoke rising from the A. P. Murrah Federal Build- ing, which was approximately 10 blocks from the hospital.

1 immediately reported the source of the blast to the assistant head nurse, who activated the hospital’s disaster plan. Most of the staff members already were on duty by 9 AM, so implement- ing the disaster plan was quick and easy.

Ceiling tiles fell down in some

THE DISASTER PLAN

had not begun were cancelled. The OR secretary began calling staff members who were not on duty and requesting that they come in to help. Some nurses arrived early for their shifts; others who had the day off hurried in to help.

The perioperative clinical man- ager took over the assignment board and spent the next six hours coordinating patient arrivals, staffing 14 ORs, and supplying equipment and instrumentation to the entire hospital as needed (eg, a craniotomy, which required neuro- surgical instruments and a power drill, was performed in the eye clinic).

The perioperative nurse man- ager was out of town on business when she heard the news, but she quickly curtailed her business and returned to Oklahoma City to help. Staff members tuned the radios in each OR to news sta- tions-we all hoped there were no fatalities, and we waited anxiously for the news of injuries.

All elective surgical cases that

MY FIRST PATIENT

cardiovascular procedure that was underway, the first two patients

Before we could complete the

KAREN PATTER- SON, RN, BSN, CNOR, is a perioperative staff nurse at Presbyterian Hospital, Okla- homa City.

from the disaster site arrived in the OR. I later learned that the fiist patient involved in the bombing arrived in the emergency depart- ment (ED) just 18 minutes after the blast.

assisting on the cardiovascular procedure, completed his part of the surgery and left the OR to pre- pare for emergent surgeries. For the next several hours, he was the triage officer for patients arriving in ambulances, he performed emergent surgery, and he placed central venous access lines in patients in the ICU.

additional care stations were set up in accordance with our hospi- tal’s disaster plan. The OR hold- ing area also became a care sta- tion. We treated 23 patients in the first four hours after the bombing; 77 patients in all. Of the patients treated, 54 were treated and released and 23 were admitted. Six, including one three-year-old, were in critical condition.

for one patient, and I grabbed a percutaneous central venous access kit as I ran to OR eight to receive my trauma patient. My coworkers had partially prepared the room, and two other perioper- ative nurses and I procured sup- plies and scrubbed for the next procedure.

Mr K was brought to the OR, and although he was alive, he was bleeding profusely. Flying glass and debris had lacerated his hands, neck, head, back, chest, and face;

The chief of surgery, who was

The ED filled quickly, and two

I prepared an arterial line setup

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blood was everywhere. The anesthesia care provider

anesthetized Mr K and inserted an arterial line into the patient’s right radial artery and a central venous access line into the patient’s right external jugular vein. I requested an additional TV fluid warmer, and another nurse took an arterial blood gas sample to the laborato- ry. Another nurse procured 0- negative blood for transfusion from the blood bank refrigerator.

We removed Mr K’s blood- soaked dressings and discovered that his carotid artery was lacerat- ed. Surgical team members then quickly performed multiple preps (ie, head, neck, chest, bilateral arms), and surgeons began repair- ing Mr K’s carotid artery. After the surgeons repaired Mr K’s carotid artery, we placed Mr K in a lateral position to repair his other lacerations.

During the next several hours, the anesthesia care provider and five to six surgeons worked simul- taneously on Mr K’s injuries. Changing gloves as often a s nec- essary to avoid contaminating sup- plies in the OR was difficult because gloves were in constant demand throughout the hospital.

During the procedure, one of the surgeons suggested that I con- tact Mr K’s family members and let them know he was in stable condition. I frantically looked through the telephone book but could not find a telephone number for the name listed on Mr K’s ankle identification band. I called the operator, who discovered that the name was spelled incorrectly on the patient’s identification band.

When I finally reached Mr K’s wife, I held the phone so the sur- geon could talk with Mrs K. After the surgeon explained the situation, I reassured Mrs K that, under the

circumstances, things were going well. She wanted to come to the hospital immediately, but I encour- aged her to stay at home, close to the phone. I updated her frequently throughout Mr K’s procedure, and she tearfully thanked me.

“Jane“ looked as if she had been

dragged across concrete pave men t

at 100 miles per hour.

IDENTIFYING JANE DOE My shift had ended, but I

would not leave the hospital for several hours. On my way back to the OR after transferring Mr K to the postanesthesia care unit, another nurse stopped me in the hallway. She was pleading for assistance with her patient, who had multiple injuries and needed arterial and central venous access lines placed.

The patient was listed as Jane Doe, but there already was a Jane Doe in the OR. Our hospital poli- cy is to identify Jane Does accord- ing to race and injuries; however, I believed we needed a more specif- ic identification to avoid confus- ing the two patients. In addition to the second Jane Doe’s race and injuries, I included her blood band number on her identification band.

One Jane Doe identified herself using sign language. “My” Jane Doe, however, was not identified until two days later. It was then that I learned her name and that

she, her mother, and her sister, with her sister’s two children, had been in the social security office in the federal building. “Jane” was rescued early, but her sister’s chil- dren and her mother were killed. Her sister survived, but she had been trapped for several hours, and rescuers had to amputate her leg to remove her from the rubble.

Two surgeons stood ready as an orthopedic surgeon explored “Jane’s” right shoulder injury. After initial wound exploration, we irrigated her wounds. An otorhinolaryngology surgeon examined what was left of the patient’s right ear and carefully debrided the area. It looked as if “Jane” had been dragged across concrete pavement at 100 miles per hour.

There were huge pieces of glass and bright blue plastic debris lodged in her skin. After we removed the glass and debris, we sent the pieces to the laboratory. The blue plastic was thought to be part of the bomb, and eventually, the pieces were given to the US Federal Bureau of Investigation as evidence.

NO TIME FOR GRIEF I was devastated to learn that I

had touched what was thought to be part of the bomb, but there was no time for grief. A scrub techni- cian needed to be relieved, so I scrubbed in to assist for the final phase of imgation and packing of “Jane’s” wounds. Other people, including members of the commu- nity who volunteered to help, also remained busy.

The coordinator of an area vocational surgical technology program washed instruments until our technician arrived, and the OR materials coordinator came in dur- ing her vacation to help procure

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prep trays, sponges, drapes, and power irrigation devices from local storage areas. Assistive per- sonnel loaded all available carts with extra supplies, but there were never enough to go around. Even cafeteria staff members worked overtime, making sandwiches for staff members who could not leave the OR.

MEMORIES OF FLIGHT NURSING The devastation I saw April

19, 1995, reminded me of the wounds of war I saw as a flight nurse in 1966, when we air-evac- uated wounded soldiers out of Vietnam. At Ft Sam Houston Air Force Base, San Antonio, in 1962, I learned how to care for patients at high altitudes and in limited spaces. I learned what to do if the transport vehicle decompressed during the flight, but I was told it probably would never happen. On my first flight over the Pacific Ocean, however, the transport vehicle decom- pressed. My practice paid off, and that experience taught me how important it is to be pre- pared for disaster.

Having practiced our disaster

drill at the hospital helped prepare us somewhat, but nothing could have prepared us completely for the devastation we saw that day. Eye, limb, and facial injuries were evident in nearly every patient- just as they had been in Vietnam.

The bombs were made of different

mate r i a Is, but the wounds that resulted were

the same.

The bombs were made of different materials, but the traumatic wounds that resulted were the same.

AND THEN THERE WERE NONE

were no more patients. I kept wondering, “Where are the patients?” I did not want to face

Finally, almost suddenly, there

the reality that there were no more survivors. At 1:30 PM, the city’s disaster coordinator informed ED personnel that our influx of patients was over and that those few who were rescued would be taken to other hospitals.

to remove my blood-splattered scrubs, I saw the unused IVs hanging ready, but there were no patients on which to use them. I was sad and angry that our ORs were empty-that there were no more survivors.

As I walked to the locker room

CONCLUSlON

day, and the question that we all kept asking was, “Why?” Those of us who have dedicated our lives to restoring health and preserving life are never satisfied when that opportunity is taken away.

Although we see death and tragedy almost daily, our lives were changed forever that day in Oklahoma City. The part of us that trusted that our community was quiet and safe was ripped from us along with many friends, family members, and coworkers. A

More than 160 lives ended that

Electrical Stimulation Helps Overcome Paralysis Physicians are testing a new type of technology that make coordinated movements. So far, more than 20 enables people with paralysis in their hands to grasp and release objects. The key to the technology is electrical stimulation, according to an article in the July 5 , 1995, issue of Hospitals & Health Networks.

A surgically implanted device sends electrical signals directly to the muscles in a patient’s hand and arm, circumventing the damaged nervous systems. These signals allow the patient to grasp objects as small as toothbrushes, combs, pens, and eating uten- sils. In addition to the implanted device, there is an

paralyzed people are using the new technology as part of a trial to determine the device’s safety and effectiveness. Additional study participants are sought by the research team-individuals with quad- riplegia who are able to move their shoulders and bend their elbows but who cannot use their hands are encouraged to apply. For more information about the study, call Linda Marshall, Veterans Affairs Medical Center, Baltimore, at (410) 605-7171.

external control unit that patients carry with them. “Technology,” (Cunents) Hospitals & Health Networks 69 According to the article, patients can learn to (July 5, 1 995) 13- 14.

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