- Email: [email protected]
Responding to a natural disaster
Responding to a natural disaster A u t h o r : Patricia A. N o r m a n d i n , RN, MSN, CEN, B o s t o n , M a s s a c h u s e t t s
aturday, S e p t e m b e r 16, 1995: "Can you deploy?" A s a m e m b e r of t h e Boston D i s a s t e r M e d i c a l A s s i s t a n c e T e a m (DMAT), this is w h a t I really w a n t e d a n d w h y w e h a d b e e n training. Now, t h e t i m e h a d c o m e . It w a s for real. C a n I r e a r r a n g e m y life? H o w long would we be gone? I had many apprehensions. S o m e w e r e selfish. Could I t o l e r a t e t h e lack of h o m e comforts? Would I c a t c h a d i s e a s e from t h e lack of s a n i t a r y s e r v i c e s a n d f l e s h w a t e r ? I w a s a n e w ED n u r s e m a n a g e r . Would this j e o p a r d i z e m y job? M y family a n d c o - w o r k e r s rallied a r o u n d me. I w a s r e a d y a n d e x c i t e d to go. Sunday, S e p t e m b e r 17, 1995: w e left for St. T h o m a s . T h e flight w a s b u m p y a n d noisy. T h e s k y w a s b e a u t i f u l blue; t h e c l o u d s w e r e well defined, w h i t e , a n d b r e a t h t a k i n g . I e v e n s a w a rainbow. This magical journey had truly begun and I was awestruck. Finally, w e w e r e flying over t h e Virgin Islands. E v e r y t h i n g looked so peaceful, d e s e r t e d , a n d d e v a s t a t e d . O v e r t u r n e d aircraft could b e s e e n at t h e airport; t h e y looked like toys. T h e airport roof w a s b l o w n off. Debris a n d w a t e r d a m a g e w e r e e v e r y w h e r e . It l o o k e d like a b o m b h a d e x p l o d e d . E v e r y v e h i c l e h a d b r o k e n w i n d o w s , a n d m a n y w e r e overturned. Boats w e r e s c a t t e r e d on t h e roadway. St. T h o m a s , a s I k n e w it from a v a c a t i o n , no longer existed. T h e d e v a s t a t i o n w a s o v e r w h e l m i n g . H o w w o u l d this island ever recover? I w a s s u r p r i s e d to s e e so m a n y p e o p l e at t h e airport, j u s t w a i t i n g to b e t a k e n off t h e island. T h e t o u r i s t s a n d local p e o p l e looked e x h a u s t e d . All w e r e v e r y friendly a n d a s k e d w h o w e were, t h e n t h a n k e d u s for c o m i n g to help St. T h o m a s . Before m y m i s s i o n h a d e v e n b e g u n , I felt a d e e p p e r s o n a l r e w a r d . Our first n i g h t there, w e h a d to s l e e p at t h e airp o r t b e c a u s e our s a f e t y c o u l d not b e e n s u r e d . Stories of looting a n d t o u r i s t s b e i n g a t t a c k e d w e r e circulating. I b e g a n to feel a p p r e h e n s i v e ; w a s this g o i n g to b e safe? I w a s frustrated, b e i n g in t h e m i d d l e of d e v a s t a t i o n b u t not y e t b e i n g a b l e to help. On t h e other hand, I was excited, anticipating the unknown. T h e n e x t d a y w e w e r e e s c o r t e d to St. T h o m a s
S
Patricia Normandin is a staff nurse, Emergency Department, Winchester Hospital, Winchester, Massachusetts. Reprints not available from author. J Emerg Nuts 1996;22:632-3. Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/9/77999
632
Volume 22, Number 6
Hospital. T h e w e a t h e r w a s beautiful. S e c u r i t y police escorted us down devastated roadways, blocked w i t h trees, live electrical wires, debris, a n d boats. The t o p t w o floors of t h e h o s p i t a l a p p e a r e d to b e b l o w n o f f - - w i r e s , debris, d i s h e v e l e d l a n d s c a p e w e r e s c a t t e r e d all around. T h e h e a t w a s extreme. It h a d a n eerie q u i e t n e s s .
W e w e r e flying o v e r t h e Virgin I s l a n d s . E v e r y t h i n g looked so peaceful, deserted, and devastated. Overturned aircraft c o u l d b e s e e n at t h e airport; t h e y l o o k e d like toys. T h e airport roof w a s b l o w n off.
T h e h o s p i t a l w a s d e v a s t a t e d . It w a s w i t h o u t air c o n d i t i o n i n g a n d water, a n d h a d s u s t a i n e d m u c h damage. Stagnant water and debris were scattered t h r o u g h o u t t h e building. T h e p u n g e n t , u n p l e a s a n t odor is one t h a t I will n e v e r forget; it w a s n a u s e a t i n g . T h e h o s p i t a l s e e m e d too quiet. Only t h e loud e m e r g e n c y g e n e r a t o r could b e heard. T h e e m p t i n e s s of t h e h o s p i t a l e n t r a n c e , hallways, a n d lab a r e a w a s eerie. I w a s in c h a r g e of triage. We w e r e e x t r e m e l y b u s y t h e first f e w d a y s - - w e s a w a p p r o x i m a t e l y 900 p a t i e n t s d u r i n g our stay. D e p e n d i n g on t h e chief s y m p t o m , s o m e p a t i e n t s w e r e a b l e to b e t r e a t e d a n d d i s c h a r g e d b y t h e t r i a g e nurse. T h e first d a y I w a s alone in triage, b u t after that, it v a r i e d from one to three nurses and an emergency medical technician. We all w o r k e d 16-hour shifts t h e first few d a y s b e c a u s e it w a s so busy. During t h e first few days, t h e t r i a g e a r e a h a d no electricity, light, or phone. I w o r k e d b y flashlight. I l e a r n e d to a d a p t quickly a n d u s e d t h e few r e s o u r c e s t h a t I h a d available. It w a s v e r y r e w a r d i n g b e c a u s e I w a s able to i n c o r p o r a t e all m y n u r s i n g k n o w l e d g e . T h e r e w e r e no p h o n e lines in service. The Boston DMAT t e a m b r o u g h t its o w n c o m m u n i c a t i o n s y s t e m , w h i c h involved p o r t a b l e p h o n e s . It w a s e x t r e m e l y
Normandin/JOURNAL OF EMERGENCYNURSING
difficult to call h o m e b e c a u s e e v e r y o n e on t h e i s l a n d w a s t r y i n g to call out. E v e n t h o u g h I w a s w i t h a l a r g e g r o u p of friends, b e i n g in t h e e x t r e m e heat, not e a t i n g or s l e e p i n g well, a n d w i t n e s s i n g this c o m p l e t e d e v a s t a t i o n of a b e a u t i f u l i s l a n d m a d e m e feel v e r y lonely, a n d I w i s h e d I w a s b a c k h o m e .
D u r i n g t h e first f e w d a y s , the triage area had no electricity, light, or p h o n e . I w o r k e d b y flashlight. I l e a r n e d to a d a p t quickly and used the few resources t h a t I h a d available.
St. T h o m a s n a t i v e s h a d d i f f e r e n t s a y i n g s . Specifically, t h e o n e t h a t I will n e v e r forget is t h e s y m p t o m of "nail chuck." P a t i e n t s w o u l d c o m e to t r i a g e a n d say, '3 h a v e a nail chuck." With t h e a c c e n t , it s o u n d e d like " w o o d c h u c k . " It totally c o n f u s e d m e
ENA Special Interest Groups
at first, b e c a u s e all I could t h i n k was, "What is a w o o d c h u c k d o i n g in St. T h o m a s , a n d w h y are t h e s e p e o p l e c o m i n g to tell m e a b o u t it?" A little a s s e s s m e n t c l e a r e d it u p - - t h e p a t i e n t w o u l d r e m o v e a shoe, a n d h e or s h e h a d s t e p p e d on a nail. M a n y t i m e s I felt s c a r e d . I w o u l d g e t a police officer a n d h e w o u l d s t a n d r i g h t b y m e while I triaged. S p e c i a l t h a n k s to all t h e p o l i c e officers a n d t h e U.S. marshals, b e c a u s e w e could n o t h a v e c a r e d for t h e p a t i e n t s w i t h o u t them. W o r k i n g w i t h n u r s e s from St. T h o m a s H o s p i t a l a n d t h e Ohio DMAT t e a m w a s rewarding and we instantly developed a camaraderie. D i s a s t e r a s s i s t a n c e p e o p l e c a m e from all over t h e U n i t e d States, on federal a n d s t a t e levels. Finally, t h e d a y of d e p a r t u r e arrived: S e p t e m b e r 25, 1995. On t h e w a y h o m e , a flight a t t e n d a n t h e a r d w e h a d c o m e from g i v i n g m e d i c a l a s s i s t a n c e to t h e v i c t i m s of H u r r i c a n e Marilyn. She a s k e d m e h o w I felt. T h e only w o r d t h a t c a m e to m i n d was, "peaceful".
Contributions for this column should be sent to Susan Moore, RN, MS, CCRN, CEN, 5400 Iroquois Circle, Reno, NV 89502; phone (702) 328-5 726.
Our Way o f Meeting Your N e e d s
E N A offers you t h e o p p o r t u n i t y to n e t w o r k w i t h m e m b e r s in your speciality. If you w o u l d like m o r e information a b o u t ENA's S p e c i a l I n t e r e s t G r o u p in your a r e a of interest, p l e a s e c h e c k t h e a p p r o p r i a t e b o x b e l o w a n d r e t u r n this form to: Emergency Nurses Association Professional S e r v i c e s 216 H i g g i n s Rd. Park Ridge, IL 60068 Rural [~ U n i f o r m e d s e r v i c e s [~ A d v a n c e d n u r s i n g p r a c t i c e
[~ U r b a n [~ D i s a s t e r p r e p a r e d n e s s
Name Address City/State/Zip Code ENA member:
Nonmember
MEMBER NUMBER
December 1996 633
aturday, S e p t e m b e r 16, 1995: "Can you deploy?" A s a m e m b e r of t h e Boston D i s a s t e r M e d i c a l A s s i s t a n c e T e a m (DMAT), this is w h a t I really w a n t e d a n d w h y w e h a d b e e n training. Now, t h e t i m e h a d c o m e . It w a s for real. C a n I r e a r r a n g e m y life? H o w long would we be gone? I had many apprehensions. S o m e w e r e selfish. Could I t o l e r a t e t h e lack of h o m e comforts? Would I c a t c h a d i s e a s e from t h e lack of s a n i t a r y s e r v i c e s a n d f l e s h w a t e r ? I w a s a n e w ED n u r s e m a n a g e r . Would this j e o p a r d i z e m y job? M y family a n d c o - w o r k e r s rallied a r o u n d me. I w a s r e a d y a n d e x c i t e d to go. Sunday, S e p t e m b e r 17, 1995: w e left for St. T h o m a s . T h e flight w a s b u m p y a n d noisy. T h e s k y w a s b e a u t i f u l blue; t h e c l o u d s w e r e well defined, w h i t e , a n d b r e a t h t a k i n g . I e v e n s a w a rainbow. This magical journey had truly begun and I was awestruck. Finally, w e w e r e flying over t h e Virgin Islands. E v e r y t h i n g looked so peaceful, d e s e r t e d , a n d d e v a s t a t e d . O v e r t u r n e d aircraft could b e s e e n at t h e airport; t h e y looked like toys. T h e airport roof w a s b l o w n off. Debris a n d w a t e r d a m a g e w e r e e v e r y w h e r e . It l o o k e d like a b o m b h a d e x p l o d e d . E v e r y v e h i c l e h a d b r o k e n w i n d o w s , a n d m a n y w e r e overturned. Boats w e r e s c a t t e r e d on t h e roadway. St. T h o m a s , a s I k n e w it from a v a c a t i o n , no longer existed. T h e d e v a s t a t i o n w a s o v e r w h e l m i n g . H o w w o u l d this island ever recover? I w a s s u r p r i s e d to s e e so m a n y p e o p l e at t h e airport, j u s t w a i t i n g to b e t a k e n off t h e island. T h e t o u r i s t s a n d local p e o p l e looked e x h a u s t e d . All w e r e v e r y friendly a n d a s k e d w h o w e were, t h e n t h a n k e d u s for c o m i n g to help St. T h o m a s . Before m y m i s s i o n h a d e v e n b e g u n , I felt a d e e p p e r s o n a l r e w a r d . Our first n i g h t there, w e h a d to s l e e p at t h e airp o r t b e c a u s e our s a f e t y c o u l d not b e e n s u r e d . Stories of looting a n d t o u r i s t s b e i n g a t t a c k e d w e r e circulating. I b e g a n to feel a p p r e h e n s i v e ; w a s this g o i n g to b e safe? I w a s frustrated, b e i n g in t h e m i d d l e of d e v a s t a t i o n b u t not y e t b e i n g a b l e to help. On t h e other hand, I was excited, anticipating the unknown. T h e n e x t d a y w e w e r e e s c o r t e d to St. T h o m a s
S
Patricia Normandin is a staff nurse, Emergency Department, Winchester Hospital, Winchester, Massachusetts. Reprints not available from author. J Emerg Nuts 1996;22:632-3. Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/9/77999
632
Volume 22, Number 6
Hospital. T h e w e a t h e r w a s beautiful. S e c u r i t y police escorted us down devastated roadways, blocked w i t h trees, live electrical wires, debris, a n d boats. The t o p t w o floors of t h e h o s p i t a l a p p e a r e d to b e b l o w n o f f - - w i r e s , debris, d i s h e v e l e d l a n d s c a p e w e r e s c a t t e r e d all around. T h e h e a t w a s extreme. It h a d a n eerie q u i e t n e s s .
W e w e r e flying o v e r t h e Virgin I s l a n d s . E v e r y t h i n g looked so peaceful, deserted, and devastated. Overturned aircraft c o u l d b e s e e n at t h e airport; t h e y l o o k e d like toys. T h e airport roof w a s b l o w n off.
T h e h o s p i t a l w a s d e v a s t a t e d . It w a s w i t h o u t air c o n d i t i o n i n g a n d water, a n d h a d s u s t a i n e d m u c h damage. Stagnant water and debris were scattered t h r o u g h o u t t h e building. T h e p u n g e n t , u n p l e a s a n t odor is one t h a t I will n e v e r forget; it w a s n a u s e a t i n g . T h e h o s p i t a l s e e m e d too quiet. Only t h e loud e m e r g e n c y g e n e r a t o r could b e heard. T h e e m p t i n e s s of t h e h o s p i t a l e n t r a n c e , hallways, a n d lab a r e a w a s eerie. I w a s in c h a r g e of triage. We w e r e e x t r e m e l y b u s y t h e first f e w d a y s - - w e s a w a p p r o x i m a t e l y 900 p a t i e n t s d u r i n g our stay. D e p e n d i n g on t h e chief s y m p t o m , s o m e p a t i e n t s w e r e a b l e to b e t r e a t e d a n d d i s c h a r g e d b y t h e t r i a g e nurse. T h e first d a y I w a s alone in triage, b u t after that, it v a r i e d from one to three nurses and an emergency medical technician. We all w o r k e d 16-hour shifts t h e first few d a y s b e c a u s e it w a s so busy. During t h e first few days, t h e t r i a g e a r e a h a d no electricity, light, or phone. I w o r k e d b y flashlight. I l e a r n e d to a d a p t quickly a n d u s e d t h e few r e s o u r c e s t h a t I h a d available. It w a s v e r y r e w a r d i n g b e c a u s e I w a s able to i n c o r p o r a t e all m y n u r s i n g k n o w l e d g e . T h e r e w e r e no p h o n e lines in service. The Boston DMAT t e a m b r o u g h t its o w n c o m m u n i c a t i o n s y s t e m , w h i c h involved p o r t a b l e p h o n e s . It w a s e x t r e m e l y
Normandin/JOURNAL OF EMERGENCYNURSING
difficult to call h o m e b e c a u s e e v e r y o n e on t h e i s l a n d w a s t r y i n g to call out. E v e n t h o u g h I w a s w i t h a l a r g e g r o u p of friends, b e i n g in t h e e x t r e m e heat, not e a t i n g or s l e e p i n g well, a n d w i t n e s s i n g this c o m p l e t e d e v a s t a t i o n of a b e a u t i f u l i s l a n d m a d e m e feel v e r y lonely, a n d I w i s h e d I w a s b a c k h o m e .
D u r i n g t h e first f e w d a y s , the triage area had no electricity, light, or p h o n e . I w o r k e d b y flashlight. I l e a r n e d to a d a p t quickly and used the few resources t h a t I h a d available.
St. T h o m a s n a t i v e s h a d d i f f e r e n t s a y i n g s . Specifically, t h e o n e t h a t I will n e v e r forget is t h e s y m p t o m of "nail chuck." P a t i e n t s w o u l d c o m e to t r i a g e a n d say, '3 h a v e a nail chuck." With t h e a c c e n t , it s o u n d e d like " w o o d c h u c k . " It totally c o n f u s e d m e
ENA Special Interest Groups
at first, b e c a u s e all I could t h i n k was, "What is a w o o d c h u c k d o i n g in St. T h o m a s , a n d w h y are t h e s e p e o p l e c o m i n g to tell m e a b o u t it?" A little a s s e s s m e n t c l e a r e d it u p - - t h e p a t i e n t w o u l d r e m o v e a shoe, a n d h e or s h e h a d s t e p p e d on a nail. M a n y t i m e s I felt s c a r e d . I w o u l d g e t a police officer a n d h e w o u l d s t a n d r i g h t b y m e while I triaged. S p e c i a l t h a n k s to all t h e p o l i c e officers a n d t h e U.S. marshals, b e c a u s e w e could n o t h a v e c a r e d for t h e p a t i e n t s w i t h o u t them. W o r k i n g w i t h n u r s e s from St. T h o m a s H o s p i t a l a n d t h e Ohio DMAT t e a m w a s rewarding and we instantly developed a camaraderie. D i s a s t e r a s s i s t a n c e p e o p l e c a m e from all over t h e U n i t e d States, on federal a n d s t a t e levels. Finally, t h e d a y of d e p a r t u r e arrived: S e p t e m b e r 25, 1995. On t h e w a y h o m e , a flight a t t e n d a n t h e a r d w e h a d c o m e from g i v i n g m e d i c a l a s s i s t a n c e to t h e v i c t i m s of H u r r i c a n e Marilyn. She a s k e d m e h o w I felt. T h e only w o r d t h a t c a m e to m i n d was, "peaceful".
Contributions for this column should be sent to Susan Moore, RN, MS, CCRN, CEN, 5400 Iroquois Circle, Reno, NV 89502; phone (702) 328-5 726.
Our Way o f Meeting Your N e e d s
E N A offers you t h e o p p o r t u n i t y to n e t w o r k w i t h m e m b e r s in your speciality. If you w o u l d like m o r e information a b o u t ENA's S p e c i a l I n t e r e s t G r o u p in your a r e a of interest, p l e a s e c h e c k t h e a p p r o p r i a t e b o x b e l o w a n d r e t u r n this form to: Emergency Nurses Association Professional S e r v i c e s 216 H i g g i n s Rd. Park Ridge, IL 60068 Rural [~ U n i f o r m e d s e r v i c e s [~ A d v a n c e d n u r s i n g p r a c t i c e
[~ U r b a n [~ D i s a s t e r p r e p a r e d n e s s
Name Address City/State/Zip Code ENA member:
Nonmember
MEMBER NUMBER
December 1996 633