There’s a Storm Comin’

Hurricane Sandy, which hit the Eastern seaboard, packed quite a punch, defined as being one of the most disastrous storms to hit the area in recorded history. A call for help had been summoned from the Somerset County (NJ) Office of Emergency Management. This area previously had dealt with Hurricane Irene, which cut off access to healthcare for many families. Hurricane Sandy was approaching fast and had combined with a significant low-pressure area to create what was considered a perfect storm. As the hurricane was expected to hit land, so would a high tide, as well as a full moon.

Hackensack University Medical Center (UMC) was prepared for just such an event by training staff from different disciplines to work on the New Jersey-Mobile Satellite Emergency Department (NJ-MSED) and when the call for help came, HackensackUMC was ready to respond. I received a phone call from Bruce Gelotte, director of respiratory care at HackensackUMC on Saturday night, saying we were going to Hillsboro, NJ, on Sunday morning with the NJ-MSED.

Early Sunday Morning
Unsure of the conditions we were going to be faced with and how many days we would be away from our families, I packed the supplies that the mobile asset coordinator advised should be in my Go-Kit. A Go-Kit consisted of rain gear, boots, personal hygiene supplies, several articles of clothing, a flashlight, a sleeping bag, a pillow, sneakers, scrubs, some food, etc.

Although we were trained to respond with and work at disasters, one never really knows what you will need to do or even whom you will be working alongside. The chances that I would be utilized for many other functions above and beyond those of respiratory care were significant.

The training I received for this task consisted of setting up the NJ-MSED, which is a 43-foot high-tech trailer with expandable sides and seven critical care beds. The NJ-MSED can be configured to accept additional patients by using chairs, interconnecting with a second NJ-MSED and/or a Mobile Operating Room. Combined with the clinical expertise of our medical staff, we had capabilities of providing care ranging from advanced life-saving measures to treating minor lacerations, all of which were expected from a hurricane of this magnitude.

The staffing for the NJ-MSED consisted of a mix of professionals, which included an emergency medicine physician, two adult emergency registered nurses, two pediatric emergency registered nurses, two respiratory therapists, two X-ray technicians, two biomedical equipment technicians, one physician assistant, several security officers, as well as a paramedic and a senior mobile asset coordinator. All NJ-MSED staff was expected to take on additional responsibilities that may have been necessary to ensure that those patients affected by the disaster were taken care of.

As Sandy’s path and strength remained uncertain, we set up in a community that had a history of being cut off from local hospitals due to extreme flooding. It was determined that utilizing a church gymnasium was the safest interim alternative for both patients and staff. Equipment and supplies were then transferred from the NJ-MSED vehicle to the building.

From the moment we arrived in the gymnasium, we worked like well-oiled machines by following the rehearsed plans and the detailed logistics provided by the NJ EMS Task Force. The task force has experience with logistical support functions and had participated in the NJ-MSED exercises and training. Logistical support included food, sleeping, hygiene, resupply of fuel, communications and Incident Command. The task force was also able to procure various resources from a local grocery store. The logistical support was vital to assuring that we were prepared for the unexpected. Preparing the “gymnasium hospital” was not part of the NJ-MSED training and required a great deal of collaboration and interagency cooperation.

All the equipment and supplies, which are readily available in a fixed hospital setting, are not as easily available when turning a gym into a patient care area. We ran electrical lines in order to set up generators, arterial blood gas analyzers, and all the other medical equipment that needed to be available at this makeshift hospital.

Setting up patient care stations proved to be a monumental undertaking, as we had to work within the confines of the church gymnasium. We set up these patient-specific stations capable of caring for patients with routine ailments such as asthma and COPD, as well as ventilated patients. This was in addition to potential trauma patients that a storm of this magnitude could produce. It was vital to consider the logistics of placing electrical equipment and oxygen around these specialized care areas.

Sunday Night Briefing
At this point, the storm still hadn’t picked up; nevertheless we were receiving information from the logistics team about a potential patient surge. The outside area around us had to be surveyed to make sure it was safe in case a helicopter needed to land, being mindful of safety.

Communication systems as well as a shelter for displaced families not needing medical attention were being set up in order to make sure the limited resources we had were available for people who were in need of them.

The Waiting Period
Throughout Monday the biomed technicians worked hard to provide us with television monitors so we would be able to see what was going on in the surrounding areas. We could not tell how severe the storm was, being that we were in a safe haven and somewhat removed from the magnitude of the situation.

The church pastor was extraordinary, providing us with whatever he could offer. He assured us we were setup in the ideal location for an area that has historically been hit hard by storms and floods. In the past, the population needs of the area had been less than adequate and we were already being thanked by residents and local officials just for being there, ready to serve them as needed.

Hurricane Sandy Arrives
The winds had picked up; the arcing of downed wires could be heard in the distance and intermittently it would turn the night sky into what seemed like day. We were now running on backup emergency power.

So far, one audibly wheezing asthmatic came to see us from the shelter, as she had no power to run her nebulizer.

Not knowing if or when we would have a secondary team to relieve us, each team member took sleep and work shifts to ensure adequate staffing for this 24-hour operation.

Monday 9:58 p.m.
A fire rescue squad arrived at our door after making several unsuccessful attempts to reach a hospital. The original ambulance was stuck in the mud and the fire squad came in as the secondary means of transporting an expectant mother. We were now in full operational mode, donning our scrubs and ready for whatever came our way.

The physician administered aide for this soon-to-be-mother. We did not know how this would play out, whether we would be delivering this baby or not. This mother was having frequent contractions; we utilized the portable ultrasound machine to ensure an adequate heart rate of the fetus. This delivery was further complicated due to the prematurity of the infant. A phone call to her obstetrics physician had been made for consultation and the NJ-MSED physician managed the patient. The nurses continued working on placing IV lines as the respiratory therapist prepared for the care of the baby. Unsure of the final outcome, we had an ammunition of resuscitation equipment for this unplanned delivery.

The team worked well together to ensure quality care. After the mother’s water broke, which was around 10:30 p.m., we knew we were going to have to deliver this baby in the gymnasium. Having identified where supplies were placed, our team relied on each other with clear and positive communication. The interdisciplinary team procured tasks above and beyond their scope of practice to stabilize, monitor and ensure comfort and safety of the patients. The team was still uncertain on how long we were going to have to keep this field operation active due to the storm hitting its peak.

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At 11 p.m., the baby was born. The newborn was temporarily moved from the mother’s cot to his own cot and newborn care began. The biomed technicians put together an insulated blanket to ensure the baby’s warmth. A transport team was put together with the help of the EMS task force and their up-to-the-minute knowledge of the available route to the closest hospital capable of accepting the newborn child and mother. Soon after this joyful event, off went the mother, father and child. The emergency staff and NJ-MSED technology most certainly contributed to the successful outcome.

This was only one of the many miraculous patients we had seen, where we were able to provide life-saving measures in this disastrous time of need. People lost so much, and even while writing this one year after the super storm, people are still without electricity, heat and water; some people’s homes have been destroyed completely. It was gratifying to know that we were there to provide the community with support for their medical needs, because without that, they may not have been able to get back on their feet and revitalize their lives and communities.

Being a respiratory care practitioner is more than just administering nebulizer treatments and shift work – everyone must realize we are a valuable resource to the healthcare community and our knowledge and experience plays a vital role. It may just be that we are put in this position for that one patient, at that one time, where we can truly make a difference in the quality of life for that one person.

Jason Steinfeld is staff therapist at Hackensack University Medical Center, Hackensack, NJ.

Thanks to Joseph Feldman, MD, Herman Morchel, MD, Chinwe Ogedegbe, MD, Gary DelMoro, and all who have contributed to the review of this article, as well as HackensackUMC’s relief efforts to Hurricane Sandy’s devastation.

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