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S
CRNA Emergency
Preparedness Marjorie Everson CRNA, PhD
FANA March 9, 2017
1
Objectives
S Describe CRNA and SRNA experiences during/after
Hurricane Katrina.
S Examine disaster policies implemented in a trauma hospital
after Hurricane Katrina and how they can be utilized for
any disaster
S Discuss preparation for unexpected disasters
2
Disclosure
S I was not on duty during HK
S I wish to thank all the CRNAs and former SRNAs who
shared their stories with me
S Study partially funded by AANA Foundation
3
Think about the first thing you saw r/t
HK…what image sticks in your mind?
http://www.hurricanekatrina.com/ accessed 10/20/2010 4
August 26, 2005
katrina.noaa.gov accessed 10/12/12 5
TX FL
August 27, 2005
S Caught off guard
S Hurricane
S Direction
S Magnitude
6
August 27, 2005
S Activation of unsuspecting CRNAs
S Riding bike….beeper kept going off….aggravated….what
hurricane?????
S Having a family cookout
S A few on call that day and a few on call the next day…default
S Some sent family off (evacuation)
7
August 28, 2005
S Quickly secure homes
S Windows
S Lawn furniture
S First floor furniture
S Stuff to take to hospital on call
S Most people…not much…just going to be 1 day
S Clothes
S Food leftover from cookout
S water
8
August 28, 2005
S Family and pets to hospital
S Start of call/activation
S Setting up ORs on 1st floor (surgery on 12th floor)/ OB
S Dividing up duty call (8-12 hour shifts)
S “hanging out with the ICU nurses, or residents, or other
anesthesia personnel”
S Watching TV, board games, libations “jovial”
S Sleeping arrangements
9
10
Tell me about your activation
experience
August 28-29, 2005 Evening/Night
ultimatechase.com accessed 10/14/12
11
ER ramps Smokers
Windows bowing/busting; rain coming in
Superdome roof Eerie sounds
August 29, 2005
S Early morning:
S WHEW!!!! We dodged a bullet
S Sun started coming out
S Very little water on ground
S Walking around outside to assess some damage
S One person walked home….too much debris in road to drive
S “WE ARE ALL GOING HOME SOON”
12
August 29, 2005
S Later that morning……
S Hmmmm something doesn’t seem right
S Water starting to rise in the streets
S Walking back to hospital from home….water rising quickly
almost didn’t make it
S People flocking to hospital
13
August 29, 2005
tzj.nontaxit.eu accessed 10/14/12 14
Poor communication
Why is water starting to rise
CHAOS
People turned
away; tub baby
Flock to hosp
August 29, 2005
hurricanekatrina.com accessed 10/14/12 15
August 29, 2005
en.wikipedia.org accessed 10/14/12
16
August 29, 2005
S Water still rising
S Generators getting flooded
S Electricity now completely out ICU vent pt
S Poor communication
S Rumors Superdome & convention center
17
August 29, 2005
18 Photo Courtesy of Henry Au CRNA
Started evacuating patients
Boiler room- garage
Fresh CABG chest tube
August 29, 2005
19
Photo Courtesy of Henry Au CRNA
ER ramps-boats
HUGE ventilated pt
August 29, 2005
• Now what do we do????
• Evacuated some critical patients
• Patient family members still in
hospital getting restless
• Cell phones not working well and
running out of battery charge
• Are my family members OK?
• Battery operated TV shows chaos
in city
• When will water recede?
• When will we get out?
• Enough provisions?
geniussquared.com accessed 10/14/12 20
August 30-September 1, 2005 What was it like in Private Hospitals
S Lost electricity
S Hot/humid/dark
S Ran out of food
S Rumors causeway/twin span
S Poor communication/text
S Radio cries for help
S Roof at night helicopters/sniper
S Dead bodies/ frail no rescue 21 Photo courtesy of Henry Au CRNA
August 30-September 2, 2005 What was it like in Charity Hospitals
S No electricity; hot/dark
S Poor communication/ landline
crosswalk
S Rooftop; help signs
S Food running out; restless
families; vending machines
S Dead bodies
S Too many people; feared for
lives; scalpels
S Looter got shot 22 Photo courtesy of Henry Au CRNA
Rescues/Evacuation Private
Hospitals
S Pts gone, free to leave
S Musketeers: drive
S Borrowed boats neutral
ground helicopter; causeway;
monster truck; BR; resident loan
S Free ride to
dome/convention…no way; van
from Hope, Ark
23 Photo courtesy of Henry Au CRNA
Rescues/Evacuation Charity
Hospitals
S Big C- free to leave- popo-
interstate; hot; help; ambulance;
BR
S Little C boat ride; rifles; no
swim; dumped airport; plane to
?; TX; lined up; prisoners; plane
to BR ; cut off scrubs
24 katrinahelp.com a accessed 10/15/12
Psychosocial Effects
S Short-term increased ETOH use
S Inability to sleep…. Helicopters, gun shots, lights
S Can’t sleep in the dark
S Anxiety disorder
25
Different Stories, Same Themes is this similar to your experiences/feelings?
Theme Descriptors Caught off guard Course of storm, preparation for storm,
magnitude of storm
Sense of duty To employer, to patients
Uncertainty/powerlessness/frustration safety of their families, their own safety,
lack of communication, rumors in
the city, and rescue/evacuation from
the hospital
Group identity and cohesiveness CRNAs, other nurses and doctors
Anger Too many patients and family members
in hospital, government inability to
rescue patients, staff, citizens
Life-changing event Pre-Katrina, post-Katrina, appreciate
little things in life 26
Procedures/Policies
Pre-Katrina
S Shelter in place
S Activation inconsistent
S Family & pets can use hospital as
a shelter
S Poor communication
S Who is in charge?
S Generators in basement
S 3-5 days of food/water
Post-Katrina
S Shelter in place up to category 3 S Storm in Gulf, admin monitors it;
organized activation/recovery teams
S No family/pets allowed S Ham Radio S Clear Hierarchy S Generators higher; fuel readily
available S 7 day supply of perishable food &
7 day supply of non-perishable food
27
Procedures/Policies
Pre-Katrina
S Inability to communicate with
employees
S Activated employees like” free
range chickens”
Post-Katrina
S 1-800# for employees to report whereabouts; emergency notifications on website
S Activation Packets- parking pass, assigned sleeping quarters; expectations of employees (self-provision)
S Flashlights & emergency outlets checked periodically
28
Procedures/Policies
S Departmental:
S Fewer (essential) CRNAs activated
S Clear expectations of activated personnel
S Emergency equipment checked periodically
S Institutional:
S Better communication
S Clear hierarchy
S Generators periodically checked and fuel source available
29
Procedures/Policies
S City/State:
S Early warnings to citizens
S No false hope that the state or city can help individuals
(shelter)
S Transport system for those unable to transport self
S Better communication with surrounding states for contraflow
and evacuation expectations
S Registry for nurses who wish to help during disaster
30
Hurricane Isaac
S August 29, 2012
S What worked???????
S Hospital:
S Everything
S Had electricity when surrounding buildings did not
S Able to cancel code gray by August 31, 2012 (0700)
S ALWAYS LEARNING FROM EXPERIENCE
31
32
SRNAs LSUHSC
S Many didn’t want to evac
S Some stayed at hosp
S Lost everything
S Cats
33
SRNAs LSUHSC
S Phone trees for communication
S Eventually website
S “kicked out of clinicals”
S Tried to get jobs as RNs
S Greatest worry was “am I going to graduate on time?”
34
SRNAs
S THREE THEMES:
S Seriousness of urgency
S Managing uncertainty
S Stability = relief
S Psychosocial Effects
S Short-term ETOH
S Long-term smoking
35
SRNAs
S Important to communicate with students and clinical sites
S Liability insurance is still in effect (CNA)
S Resume classes as soon as possible
S Face-to-face if possible
S Reassure that they will graduate (if they meet criteria)
S COA can help expedite clinical sites
S Publishers help with books
S Manufacturers help with scrubs/equipment
36
37
Florida
S FEMA.gov
S 2016
S Hurricane Mathew
S Hurricane Hermine
38
39
Expect the Unexpected
40
8/1/07
Slow, go home
Don’t leave
Set up ORs
Lady in labor
Fire Bag
41
42
Carilion Emergency Preparedness Plan Anesthesia
Emergency Evacuation Kit
S Contents
S 1 Oxygen regulator
S 1 oxygen tank washer (new)
S 1 tank wrench
S 1 manual resuscitation bag (adult)
S 1CO2 detector cap
S 1 bulb syringe (to be used as a manual suction device)
S 1 isothermal disposable blanket
S 1 flashlight
S 1 magic marker
43
Carilion Emergency Preparedness Plan Anesthesia
Emergency Evacuation Kit
S Directions
S Remove O2 “E” tank from back of anesthesia machine.
S Position new washer on tank
S Place O2 regulator on tank and tighten
S Open tanks with wrench & make sure there are no leaks
(tighten regulator more or check washer for proper fit)
S Adjust to the desired flow with knob on regulator
S Attach manual resuscitation bag + ETCO2 detector cap
44
Carilion Emergency Preparedness Plan Anesthesia
Emergency Evacuation Kit
S Place patient’s chart and all items needed from the anesthesia
common cart (airway supplies, medications, etc) into red duffle bag
and prepare to transport/evacuate patient to the designated location.
S When leaving your room, the door should be marked with an “X” to
aid hospital personnel with search and rescue or search and recovery
efforts
45
Resources
S The Joint Commission:
S https://www.jointcommission.org/emergency_managemen
t.aspx
46
Active Shooter
S An active shooter is an individual actively engaged in killing or
attempting to kill people in a confined and populated area; in most
cases, active shooters use firearm(s) and there is no pattern or
method to their selection of victims. Active shooter situations are
unpredictable and evolve quickly. Typically, the immediate
deployment of law enforcement is required to stop the shooting
and mitigate harm to victims. Because active shooter situations are
often over within 10-15 minutes, before law enforcement is on the
scene, individuals must be prepared both mentally and physically
to deal with an active shooter situation.
S Active Shooter: How to Respond, U. S. Department of Homeland Security October 2008
47
Active Shooter
S AANA Journal December 2016 – by Brenda Wands
S Boston January 2015
S Colorado Springs 2015
S 2014-2015 Active shooter events
S 231 casualties
S 2 events in health care facilities
48
Active Shooter
S Dept. of Homeland Security RUN-HIDE-FIGHT
S https://www.dhs.gov/video/options-consideration-active-
shooter-preparedness-video
S The Joint Commission Resources for Active Shooter
S https://www.jointcommission.org/emergency_managemen
t_resources_violence_security_active_shooter/
49
50
YOUR TURN
S What is worse thing that has happened to you.
S How did you handle it?
S What worked?
51
Take Home Points
S BON Registry for CRNAs who will volunteer during
disaster
S Check your emergency equipment at least every six months
S Clear disaster policies (Clinical areas and Educational areas)
52
Take Home Points
S Learn from experience
S Change plans based on experience
S Ensure new employees understand policies/procedures
53
WHAT IF???
54
55
56