How nurses can become the liaisons before, during, and after natural disastersMarch 16, 2018
M. Hollis Hutchinson, RN MSN JD, and a National Council Licensure Examination Strategist at Dallas Nursing Institute, has been a nurse for approximately 40 years. After the catastrophe of Hurricane Harvey, the Texas native reflects on how the nursing industry can continue to be instrumental in treating patients and their neighborhoods affected by natural disasters.
When Hurricane Harvey made its catastrophic appearance in August of 2017, the tropical storm left behind 40 to 61 inches of rainfall in southeast Texas and southwest Louisiana. It also triggered flash flooding in parts of Arkansas, Kansas, and Tennessee from August 31 to September 1.
I have been a Texan all my life, and I’ve seen many major disasters both within Texas and in the surrounding states. The people I knew of responded the way they always do: Those with experience of coastal storms took the warnings seriously. Those without experience chose to stay and see for themselves, or they listened to local experts and heeded their advice.
With a vast knowledge of such challenges, the local authorities put previously established plans into effect. Volunteers geared up to respond with courage and kindness. The healthcare industry went into high gear. It sounds like a political slogan, but Texas really is a state of mind, and I have always been proud of how a disaster brings out the best in us. Professional nurses are uniquely positioned to be leaders in the health care industry during these emergency situations. They are adept at assessment and well versed in holistic care, and used to rolling up their sleeves and digging in.
When dependency on technology goes wrong
Hurricane Harvey was the nation’s first major hurricane—Category 3 or stronger–landfall since Hurricane Wilma struck South Florida in October 2005. The Washington Post reported 82 deaths as a result of Harvey.
Today’s nursing programs incorporate a vast array of technological tools—and they should. Technology has changed the face of healthcare in astounding ways, and is poised to dazzle us again with the new frontiers of stem cell and personalized medicine. But nursing still focuses primarily on human beings. It is the personal care that makes the difference, especially in a crisis.
Nurses love our tools, but both new and established ones need to be able to function without the Internet, calculators, and IV pumps. As water rose inside some of the surrounding buildings, nurses throughout the state were not able to depend on these devices to treat their patients. There were reportedly 77 boil-water notices in effect, 19 water systems down, and 31 wastewater systems offline after Harvey. Texas residents, and especially nurses, should know how to prepare for such challenges: to stockpile bottled water and fill the bathtub with water; to make sure the batteries are fresh in the flashlights and weather radios; to have reference books available; and to be comfortable doing math using only a pencil and paper.
Making evacuation practices a requirement for new nurses
Disaster drills already include mass casualties and, in many states such as Texas, tornado drills. I remember one year when I was taking part in a drill of this nature at Dallas/Fort Worth International Airport. We played the part of casualties of a plane wreck, and the organizers parked a plane on the runway to act as the site of the crash. I asked whether we could be allowed to open the emergency doors on the plane, deploy the slides, and come down them, with the idea that it would be useful to have done that evacuation once in a non-life-threatening situation. That idea was rejected because someone could get hurt, and the liability risk outweighed any possible benefit in that scenario.
You may hear the same objection in any practice-evacuation scenario in a hospital, but treating practices like real-life scenarios helps when a real evacuation occurs. The one hospital evacuation I was in was fire-related. I was working in the ICU on the third floor when we were informed of the fire and told it was getting closer. None of our patients could be evacuated safely so we were told to stay where we were and trust the firemen. It was a scary afternoon.
The problem with practice-evacuation scenarios is similar to other evacuation drills. It’s difficult to know what exactly to do in a crisis situation when it’s happening, and with practice evacuations not allowing you to take more sophisticated risks, questions still linger. So is the liability risk really outweighting a possible benefit in the long run? There’s an argument for both sides. But what nurses can do in the meantime is to be more cognizant of safety exit routes, best safety practices for patients who cannot independently leave the hospitals on their own, and consciously pay attention and memorize what instructions the firemen give even before a situation such as this occurs. Too often, evacuation drills can be viewed as out of sight, out of mind. It couldn’t hurt to have practice drills within teams even outside of the more widely announced routes.
Finding a liaison who nurses can trust
Nurses, as change agents, can go far beyond the role of an employee following orders. They can become disaster experts, functioning as educators, media contacts, and lobbyists.
In a perfect world, every community would have a health care resource person acting as liaison to Federal Emergency Management Agency (FEMA) and its ancillary organizations. Nurses are perfectly positioned for that role. With a well-coordinated network, the entire state could be covered, ready to respond at a moment’s notice with maps of the area, noting where those needed assistance live, emergency communication plans, call lists for those with rescue boats or vehicles, and other rapid-response resources. As nurses and good neighbors, we heave a wealth of knowledge to pass on even after we leave the hospital doors.
A disaster on a level like that of Harvey is always a challenge, but it’s no surprise that nurses such as ourselves can make a difference. My heart continues to warm at the pictures of human beings, both volunteers and professionals, hauling supplies to the stricken counties and pulling, rowing, and carrying those in need out of danger and into the waiting arms of nurses everywhere. God bless them all.