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