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ED nurse Mona Diefennbacher, RN, right, and Therese Rymer, RN, NP, both from a California disaster team, helped triage hundreds of people waiting for help at the New Orleans airport after Hurricane. Katrina.
PHOTO BY MIKE MILINAC
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‘We Are Saved’
In the wake of Hurricane Katrina, nurses specially trained in disaster response were among the first to arrive at New Orleans’ airport-turned-emergency room.
byJanet Boivin, RN
Lying on a stretcher and covered with an Army-green wool blanket, 77-year-old Addie Bolden just wanted to make a phone call to her niece, Barbara. She didn’t care about her own physical condition, not even after walking about 25 blocks in “dirty, stinking” water from her flood-ravaged New Orleans home with another niece by her side. She just wanted her relatives to know the two of them were safe.
Finally someone handed Bolden a cell phone. She placed a call to her niece while disaster nurses began caring for Bolden’s physical needs.
“Hello, Barbara? I’m at a hospital set up in the airport. That’s where I am,” she told her niece. “We’re saved; we’re saved.”
On Sunday, seven days following Hurricane Katrina’s fury, Bolden and her niece, who is disabled, were plucked by boat from the floodwaters and taken to Louis Armstrong New Orleans International Airport.
The airport was one of the first locations where people found shelter immediately following the hurricane. Men, women, children, the sick, disabled, and the elderly arrived at the airport on their own or were brought by ambulance and other modes of transportation.
They arrived by the hundreds but long before any organized medical or disaster assistance could reach them. In their makeshift airport shelter, there was no electricity, no air conditioning, no running water, no food — nothing but a floor for comfort.
Nurses from California, Texas, and Florida who were members of the Federal Emergency Management Agency’s Disaster Medical Assistance Teams (DMATs) were some of the first health care personnel to arrive at the airport. What they found shocked even the most disaster-experienced of the nurses.
“We looked at each other and said, ‘Oh, my God,’ ” say Ron Wagner, RN, CRNA, and Maurice Brazil, RN, FNP, from DMAT Florida-3.
The smell of urine and feces was overwhelming, the nurses say. Elderly people transported from nursing homes lay on the floor in their own waste. Patients from a psychiatric facility were left at the airport without their psychotropic medications.
The heat was relentless. There was barely enough space for the DMAT personnel to walk between patients. Nurses from DMAT Cal-4 from San Diego entered the darkened airport around 2 AM Wednesday, accompanied by police escort. They began to organize the chaos.
“I’ll never forget this,” says critical care nurse Joann Florez, RN, CCRN, from DMAT Cal-4. Florez works at Sharp Memorial Hospital in San Diego. “Some people hadn’t eaten in days. It was so hot; everybody was just sweating,” she says.
Therese Rymer, RN, NP, the team’s deputy commander, called the nurses’ airport experience the “ultimate nursing challenge.” Rymer is the director of emergency preparedness and response at the University of California San Diego Medical Center (UCSD). “We had minimal equipment and patients who needed urgent medical and nursing care,” she says. “Everybody was using their skills to
the maximum.”
In four days, Wagner says approximately 15,000 evacuees passed through the airport. DMAT personnel provided medical and nursing care to some 3,500 individuals, though Wagner concedes the teams lost track of a precise number during the hectic height of the evacuation. Patients seen at the airport, he says, had a range of health needs — from the delivery of babies to the dialysis of patients with kidney disease to the care of newly postoperative patients to the needs of the dying.
“The first two days consisted primarily of triaging and organizing patient flow,” says Rymer. “At one point it was such a massive effort we were only taking red- and yellow-coded patients [those with the most urgent medical needs].”
The teams arranged plastic-sided tents into different medical areas, such as critical care, intermediate care, and minimal care. IV bags were strung to tent poles with tape, rope, or wire — whatever was available.
DMAT Cal-4 member Valerie Domino-Snyder, RN, who works at Inter Care Scripps Mercy Hospital in San Diego as a step down nurse, cared for a hospital patient who had had recent surgery on his cervical spine.
“We were able to give him his IV antibiotics every six hours,” she says.
Certified nurse-midwife Robbie Prepas from DMAT Cal-4 says she had never cared for so many pregnant women during a disaster, most of whom had not been receiving prenatal care.
Her midwife skills were put to the test, she says, when a woman pregnant with twins arrived at the airport. Prepas’ examination found the mother completely effaced and in active labor. She called for an ambulance to take the woman to the nearest hospital. Ten minutes into the ambulance ride, Prepas helped the mother deliver the first twin.
But when the midwife began to deliver the second twin, she felt feet, not the baby’s crown. Prepas says she had never delivered a breech baby.
“I screamed at the mom to push,” she says. The mother managed to deliver the baby, but he was floppy. Prepas says she gave the infant blow-by oxygen and he pinked up. The twins weighed about five pounds each.
Chaplain Mark Reeves, also from DMAT Cal-4, helped people at the other end of the life span. It was his job, with the assistance of nurses and physicians, to ease the discomfort of those who were dying.
“Even if they were expected to die, we wanted to make them as comfortable as possible,” says Reeves.
At one point, approximately 80 patients at the airport were not expected to live. Reeves comforted family members if they were present and prepared the bodies of those who had died for viewing by their families.
About 21 patients died, says Reeves, who works for UCSD and the San Diego County Medical Examiner’s office.
Rymer says when the most critical patients were evacuated from the hurricane-stricken area to the airport, health care personnel reassessed individuals expected to die and treated those who had at least a chance to live.
Florida nurses Wagner and Brazil, seasoned by many hurricanes in their own state, arrived at the airport Wednesday afternoon. Wagner helped supervise the offloading of patients from arriving helicopters. Brazil acted as transportation officer, overseeing movements of buses, ambulances, and fixed-wing aircraft.
According to Wagner, who has his own CRNA practice, DMATs from around the country had moved forward to encircle New Orleans before the catastrophe, waiting for Hurricane Katrina to blow through and watching in which direction she moved.
DMATs waiting west of Louisiana were able to reach New Orleans first, says Wagner. Each 35-member team, made up of a cross-section of medical personnel, was accompanied by trucks containing the supplies and equipment typically needed to respond to a disaster.
Once news of the DMATs’ arrival at the airport got out, patients began arriving nonstop, says Rymer. At one point, there were 36 helicopters on the ground with their engines running, waiting to drop off more evacuees — alive or dead — before returning to recover more survivors. The helicopters brought pets as well as patients.
“There was a endless stream of helicopters,” says Rymer.
A concerted effort to evacuate every person out of the airport began Friday. Aircraft of all sizes from the commercial sector and the military began loading their cabins with evacuees and transporting them to more suitable shelters or health care facilities around the country.
DMAT nurses working the day shift awoke Sunday morning to find the throng of people they had left in the night shift’s hands were mostly gone. During the night, airport services personnel and workers contracted by the U.S. Forestry Service had cleaned and disinfected the airport as best they could. The air no longer reeked of feces and urine.
On Sunday, evacuees were still being brought to the airport but not at the same frantic pace. Louisiana nurse Greg Walden, RN, was caring for a homeless man in the triage area on Sunday. She worked at Touro Infirmary in New Orleans and remained on duty there during the hurricane until flooding caused complete evacuation of the hospital. Earlier in the week, Walden had been helping evacuees in another location in Baton Rouge. She now says she has no plans to leave New Orleans.
“I love this city,” she says. “I want to be part of the rebuilding.”
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