Georgia hospital hit by F3 tornado — All patients evacuated to area hospitals
Ambulances, bus used as building becomes increasingly unstable
Most risk managers are prepared to respond to a disaster in their communities, but what do you do when your facility is the disaster?
An F3 tornado struck Americus, GA, after 9 p.m. on March 1, 2007, and the hospital was directly in the path of harm.
Susie Fussell, BSN, RNC, vice president of nursing at Sumter Regional Hospital, was at home that night when she received a call from the house supervisor about extreme weather heading toward the hospital. Fussell oversees risk management at the hospital.
"I told her to get patients away from the windows," she recalls. "I told her to get the babies out of the nursery and give them to their mothers." The nursery has a large amount of glass, she says.
Fussell told the house supervisor to call each unit and tell them that if patients were next to windows they should be moved close to walls. Next, Fussell called the CEO, who called the house supervisor on her mobile phone. While they were speaking, the tornado hit the area around the hospital, and the house supervisor's phone went dead.
As severe weather affected Fussell's house, she moved to a hallway and covered herself with sofa cushions. Soon after, Fussell received a call from her administrative secretary who was visiting a patient at the hospital. "She said, 'We need help. It's bad," she says.
Although Fussell lives just outside the city limits of the small town, it took her approximately 45 minutes to reach the hospital. "It looked like a bomb had gone off in the downtown area," she says. "We were weaving through debris, streetlights, street signs all hanging, power lines. 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. However, there were few serious injuries among hospital patients, visitors, or staff.
There was debris in the hospital, including branches, dirt, grass, and leaves, and patients were everywhere in the hall. The building was not structurally sound. 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 administrative board room was the designated place for the disaster command center; however, that room was completely demolished by the tornado. Instead, key hospital personnel met in front of the pharmacy area. "We knew there had to be some point to gather," Fussell says. "We were never truly able to do a lot of formal gathering, but we kept in touch via cell phones and wireless phones to key players."
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 says. "I said, 'We've got to get these people out of here.'"
Decision: Evacuate, with ED nurses doing triage
The hospital declared a Level 3 disaster and was evacuated. It was decided that two ED nurses would triage patients from the entire hospital. Schelly Murray, RN, BSN, nurse manager and ER clinical coordinator, had the role of evacuator.
Triage was relocated a couple of times as parts of the building became increasingly unstable. Ultimately, triage ended up being conducted in the OR hallway flowing into the ED. That area of the hospital was partially below ground level and had only cosmetic damage.
Staff members were calm and comforted patients, Fussell says. "We were in ankle-deep water, with water pouring over our heads and down stairwells," she says. In the middle of those dismal circumstances, staff members were carrying inpatients down stairwells on mattresses into the ED, she says. The situation was chaotic, Fussell acknowledges, but even so, there was order. "Everybody was all business," she says.
One immediate problem in the ED was that gases were leaking and needed to be cut off. The plant director notified Fussell that ventilators were needed immediately. The house supervisor already had assessed that no ventilators were available, and she had deployed portable oxygen tanks.
Everyone with a strong back joined members of the fire department and emergency medical services in moving patients, with the critical care patients being brought down first. There were few serious injuries inside the facility from the tornado. However, the five postoperative inpatients on the third floor were a particular concern, 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 send people to the pharmacy to obtain medications, Fussell says.
Murray had all patients lined up in single file in this order:
- critical care unit patients;
- postoperative patients;
- a patient in labor;
- general med-surg patients;
- psychiatric patients. All of the psychiatric patients were stable and ambulatory, Murray says.
Many staff and area physicians showed up, with their identification badges on, to assist. "We had to know who was in there," Fussell says. Each patient had a nurse at his or her side, and many had a physician there as well.
In the midst of the evacuation, the ED staff stabilized and transported five patients having symptoms of heart attacks and one gunshot wound. "Emergencies continue, regardless of your conditions," Murray says. Also, one employee went into false labor, she says. "You have to be able to triage your own employees," Murray says.
Getting patients out the door
Murray was familiar with area hospitals, so she made decisions about where to evacuate individual patients based on their diagnoses. For example, the most critical patients were sent to the largest hospital in the area. A small nearby hospital with one floor unit received stable nursing home patients.
Because Sumter Regional had not fully implemented an electronic system, staff members were able to send each patient's full record with them when they evacuated.
As each patient reached Murray, she yelled, "What's wrong?" "I didn't want to know their history," she says. "I wanted to know the immediate problem."
At least two staff members stood outside the door where patients were being evacuated at all times, and they verified armbands, patients' names, their chief diagnoses, and where they were going. "People were going to get away from you, so we always had two or three people keeping that list," she says. (See other lessons that they learned, below.) Because power was out, that information was manually recorded with pen and paper.
No one can prepare completely for a disaster such as the one that hit Sumter Regional Hospital in Americus, GA, on March 1, 2007. The hospital was severely damaged by an F3 tornado, and it evacuated all patients. The experience left many lessons for the staff to share. One is to be prepared for the unthinkable — that your facility will be hit by a disaster — by developing an internal evacuation plan. Another lesson involves the internal wireless phones and cell phones. They were working initially, but most eventually were unusable. Schelly Murray, RN, BSN, nurse manager and emergency department clinical coordinator, says, "Two-way radios would have been most useful." 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. The hospital could have used additional security, acknowledges Susie Fussell, BSN, RNC, vice president of nursing at Sumter Regional Hospital. "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. Murray struggled to make her voice heard and to get people's attention above the noise and chaos, she says. "That was one of the biggest obstacles," she says. "We needed a megaphone." When Murray requested help from the police so that she could direct the triage and patient flow, she learned they were shorthanded trying to keep roads clear and manage traffic. The police requested backup from the Department of Natural Resources, which sent a game warden. "He stood behind me to keep people away from me," 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. |
Two of the ambulances at the hospital were damaged by the tornado, although one of those was usable. Area ambulances responded, as well as a school bus for ambulatory patients, and 53 patients were evacuated to area hospitals. (See story on hospital that accepted patients, below.) The evacuation took about three hours.
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.
After an F3 tornado severely damaged Sumter Regional Hospital in Americus, GA, and led to an evacuation of all patients, Phoebe Putney Memorial Hospital in Albany, GA, was designated as one of the accepting hospitals. During the evacuation, Phoebe Putney accepted 45 patients, which included inpatients and emergency patients from Sumter Regional. When Sumter Regional announced the evacuation, Phoebe Putney implemented its disaster plan, according to Todd Braswell, RN, BSN, MS, CEN, director of the Emergency Center at Phoebe Putney. "We began looking at our census to determine who could be transferred and what beds were available," he says. A few patients were discharged from the ED, he says. Inpatient areas were asked to perform an assessment and determine which staff members could assist in the ED. From the time Phoebe Putney was notified, it was two hours before the first patient arrived from Americus, which is about 60 minutes away. Sumter Regional notified Phoebe Putney of what type of patients were being sent. EMS brought patients who were on stretchers through the ED, but they didn't stop, Braswell says. "We had a ready bed waiting for every inpatient transfer," he says. "It made tending to emergencies easier." A bus brought a large group of ambulatory patients, he says. They were triaged in the EMS dock intake area, Braswell says. "We would route them to the appropriate areas: inpatient, ER, or the admit/discharge unit [ADU] for the walking wounded," he says. Normally the ADU functions Monday through Friday as a holding unit. The night of the tornado, it was staffed with nurses from the inpatient areas and the Emergency Center, plus a physician who responded to the call for help. Each inpatient transfer was assigned to a physician. "It was fairly seamless," Braswell recalls. The night was not without challenges, however. In setting up the command center, staff callback was a problem, Braswell says. "Due to the weather in Albany, it was dangerous for some to come in," he says. "But we decided to handle it with the staff in-house. Forty-five is not an overwhelming number." |
Next on the agenda was the establishment of a treatment center in the town. Someone suggested First Baptist Church, which already was set up as a Red Cross shelter. "I called the pastor, and he said you can have my church," Murray says.
The hospital was unable to update its web site with information about the evacuation because it lost its communication ability, but it had a contract with a service that was able to take on that responsibility.
In hindsight, the hospital staff responded wonderfully to the disaster, Fussell says. Even though the hospital had never drilled for an internal disaster, all the members of the staff knew their role, sources say. Previous disaster drills were a significant help, they say. 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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