Georgia hospital hit by F3 tornado — post-op patients, others evacuated
OR conducts immediate procedure, then patients triaged in hallway
Many outpatient surgery managers are prepared, at least to some extent, to respond to a disaster in their communities, but what do you do when your facility is the disaster?
The new operating room director at Sumter Regional Hospital was at home after 9 p.m. March 1, 2007, when the F3 tornado struck Americus, GA. Although Midge Schuster, RN, BSN, had no power, she received a call from an out-of-town friend who had seen on the news that the hospital had been severely damaged and that all nurses and physicians in the area were requested to report. Although Schuster lives about a five-minute drive from the hospital, it took her 45 minutes to arrive there. Susie Fussell, BSN, RNC, VP of nursing at Sumter Regional, had the same experience. "We were weaving through debris, streets lights, street signs all hanging down, and power lines," she recalls. "It was just unbelievable."
The area surrounding the hospital had been devastated, and two people died in a residence directly behind one of the hospital buildings. When Schuster finally arrived, she went in through the emergency department, which was the only lighted area on the exterior, she says. "My first sight was that the ED doors were blown wide open, and there was debris all in the hospital," Schuster says. Branches, dirt, grass, and leaves had been thrown through the air into the facility, she says.
The hospital had declared a Level 3 disaster and was being evacuated, due to the instability of the building. The hospital had one side that was collapsing; additionally, it had lost part of the roof, had many windows blown out, and was flooding. Seventy-five cars in the parking lot were toppled on top of each other.
The surgical hall was lined with five patients just out of surgery that day, but no cases were going on when the tornado hit. In the hall's other direction, the wall was leaning at a 45-degree angle, Fussell says. "I thought, 'Oh my God, this place is coming down,'" she recalls. "I said, 'We've got to get these people out of here.'"
Triage ended up in OR hallway
Triage was relocated a couple of times as the building become increasingly unstable. Ultimately triage ended up being conducted in the OR hallway flowing into the ED. This part of the building was protected by being partially below ground level. Staff members were calm and comforted patients, Fussell says. "We were in ankle-deep water, with water pouring over our heads and down stairwells," Fussell says. In the middle of those dismal circumstances, staff members were carrying inpatients down stairwells on mattresses, she says. "Everybody was all business."
Schuster went immediately to the OR, which is her disaster station. When she walked in, emergency patients and inpatients already were triaged and lined down the hallways and into the OR. In the OR, all the rooms were flooded, but there was one functional OR and one cystoscopy room, she says. Because Fussell and the ED staff were warned about the tornado a few minutes before it hit, all patients were moved into interior hallways and away from windows. Subsequently, there were few serious injuries inside the facility from the tornado. There was one immediate surgery that had to be performed on a visitor who needed a finger amputated due to a door that had slammed on it. Schuster started that procedure but was able to phase in other nurses as they arrived.
Schuster worked as the "leg person" of triage to line up all the patients and get them evacuated. Anyone with a strong back joined members of the fire department and emergency medical services in moving patients, Fussell says. Post-op inpatients on the third floor were of a particular concern because they had just completed surgery that day, she says. Those patients needed pain medications after they were moved to triage. Amazingly, the pharmacy operated during the evacuation. The staff used the old-fashioned "runner" system to obtain medications, Fussell says.
Schuster obtained supplies, managed the hospitalist physician who was overseeing the triage, and matched up patients with hard copies of their records before they were evacuated. All the patients had a nurse at their side, and many had a physician there as well.
Many staff and area physicians showed up, with their identification badges on, to assist. "We had to know who was in there," Fussell says. Area ambulances responded, as well as a school bus for ambulatory patients, and 53 patients were evacuated to area hospitals. Because the hospital has not fully implemented an electronic records system, staff members were able to send hard copies of the patients' records with them. Two people stood outside the door where patients were being evacuated, and they verified armbands, patients' names, their chief diagnoses, and where they were going. Because power was out, that information was recorded manually with pen and paper. The evacuation took about three hours.
Here's what they learned
As in any disaster, there were lessons learned. One is to be prepared for the unthinkable — that your facility will be hit by a disaster — by developing an internal evacuation plan, advises Schelly Murray, RN, BSN, nurse manager and ER clinical coordinator.
Another lesson involves the internal wireless phones and cell phones. They were working initially, but most eventually were unusable, Fussell says. "Two-way radios would have been most useful," Murray says. Additionally, Murray had difficulty supervising the triage and patient flow because she was constantly bombarded with questions. "There was so much help on top of me, it was difficult to organize," she says. Additionally, she struggled to make her voice heard and to get people's attention above the noise and chaos. Murray says, "We needed a megaphone."
The hospital could have used additional security, Fussell acknowledges. "Everyone wanted to help and was coming in to help," she says. Murray was faced with directing patients and volunteers. "Eventually, we put volunteers in a waiting room and told them to await instructions," she says.
The police were shorthanded in trying to keep roads clear and manage traffic, Fussell says. When Murray requested help so that she could direct the triage and patient flow, the police requested backup help from the Department of Natural Resources (DNR), who sent a game warden. "He stood behind me to keep people away from me," Murray says. People couldn't hear Murray to follow her instructions, she says. "That was one of the biggest obstacles," Murray says. The game warden, who was more than 6 feet tall, repeated Murray's instructions over her head when she couldn't be heard.
After the evacuation was complete, approximately six men from the DNR performed a final check of every room on every floor to ensure no one was left behind.
Surgeons, cases are relocating
The tornado not only devastated the hospital, but also destroyed several surgeons' offices. They are relocating, as needed, to other locations, including other doctors' offices.
In terms of the hospital, Schuster initially feared that everything in the OR might be lost, due to water damage. "I could visually see anesthesia machines with water dripping down on them," she says. After she was able to walk through the unit a few days later, she realized that most instruments and many double-wrapped supplies were in good condition. "The central supply area and the core [used for storage] didn't receive direct water damage," she says.
In the immediate future, Schuster is meeting with two area hospitals to discuss the possibility of continuing surgical cases at their sites. Also, the hospital is considering setting up a temporary two-room OR in Americus, but that facility would take four weeks to set up, sources say.
In hindsight, the hospital staff responded wonderfully to the disaster, Fussell says.
Even though the hospital had never drilled for an internal disaster, every staff person knew his or her role, sources say. Previous disaster drills were a significant help, they add. Murray says, "They gave us a game plan on how to evacuate internally, because they were about handling massive amounts of patients."
Fussell agrees. "They might have not done it just by the book, but they knew someone had to track every patient as they were transferred, and they knew all hands had to be on deck to evacuate," she says. "We practice and we practice all the time, I'm telling you. When you get so panicked and in the midst of chaos, it takes that practice, because it becomes what you do instinctively."
(Editor's note: To see photos of the tornado damage, go to www.sumterregional.org and click on the hyperlink for the disaster photos.)
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