Tours of Duty

The Hospitalist. 2005 November;2005(11):

November 1, 2005 | The Hospitalist

On Wednesday, Sept. 21, dozens of state-provided ambulances cycled through the main entrance of UTMB’s Galveston branch to transport patients to hospitals in Texas cities, including Austin, Tyler, and San Antonio. The patient evacuation was the first in the university’s 114-year history.

Westward Bound

Some Hurricane Katrina evacuees found their way to Galveston, Texas. Two physicians on the faculty of the University of Texas Medical Branch (UTMB) at Galveston, Janice Smith, MD, and Donna Weaver, MD, worked in a Red Cross clinic assembled in a Methodist church’s indoor racquetball court.

Like hundreds of others, Dr. Smith responded to the call for volunteers early in the process to help the 300 evacuees. She says that there were many bureaucracies, and their nurse-coordinator handled them all well. In terms of challenges, “Every few hours, policies and procedures would change,” says Dr. Smith. “There was no interclinic communication, and roles were unclear. Although it was emotionally difficult seeing patients who had lost everything, that was the easy part compared to dealing with constant change.”

Dr. Weaver, who is codirector for Center for Training in International Health and teaches the Practice of Medicine course at UTMB at Galveston, responded to a request to describe her previous experience in one word: “Nicaragua.”

She often volunteers in Nicaragua (as does Dr. Smith) and in rural U.S. communities they open clinics in people’s homes. Dr. Weaver says the “organized disorganization” of a pharmacy stocked with samples, borrowed supplies and equipment, and no lab facilities created a situation in which physicians had to rely on medical clinical skills. People came with nothing, and medical records were unavailable. The medical history—just what the patient could tell them—was the cornerstone of treatment.

“The low-tech physicians did well,” she says. Listening skills became key. Dr. Weaver intends to reinforce that lesson with her students.

Both physicians could identify gaps that would have been nice to fill. Dr. Smith said that having an on-site dentist would have helped the many people suffering from toothaches. She also appreciates geographic prescribing differences more now, and would have liked to have had a pharmacist there to tell them what certain drugs were or suggest therapeutic alternatives. Dr. Weaver said privacy was at a premium—a situation that was uncomfortable for providers and patients alike. As each day passed, more barriers and walls were rigged to try to improve privacy.

Lessons for Hospitalists from the 2005 Hurricane Season

Identify a reliable transportation system and early in the emergency ensure your loved ones are safe.
Anticipate evacuating hospitals early, transporting the sickest first—when seriously disrupting conditions are predicted. This means writing dozens of concise transfer summaries, and leading the team to identify what parts of the medical record must be copied, and what supplies, medication, and equipment must accompany the evacuee.
Encourage hospital leaders to create a plan to help employees after patients are evacuated.
Instruct community-based patients to bring ample medication (perhaps a month’s supply) and copies of medical records if possible.
Know your communication, water, or power failure work-around systems.
Acknowledge the “changing theater” of disasters and help other employees cope. Review how the Health Information Portability and Accountability (HIPAA) regulations address disaster. (A good overview is available at www.hhs.gov/ocr/hipaa/EnforcementStatement.pdf.)
Seek continuing education in disaster mental health counseling.
Develop polished listening skills so a patient’s verbal history and physical conditions can guide care if necessary.
Consider what security needs might be under extreme conditions.
Anticipate ample donations and an influx of volunteers and create policies to respond to them.