On September 7, 2017, Hurricane Irma was bearing down on Florida. The Orlando Veterans Administration Medical Center Home-Based Primary Care program (OVAMC-HBPC) had 364 veterans enrolled. Some were oxygen dependent. Some were ventilator dependent. All were complex-care cases. The nurse manager and HBPC program director needed to make some critical decisions, fast, about how best to help their patients.
The VHA-HBPC program was designed to serve veterans with complex chronic disease; the average patient has > 8 chronic conditions. Currently, about 140 VHA-HBPC programs nationwide serve almost 38,000 veterans, according to the researchers reporting in the CDC’s Preventing Chronic Disease.
Luckily, 2 years before Irma, OVAMC-HBPC had joined an innovative project using geographic information system (GIS) maps for emergency planning and response.
The mapping project has trained staff members at 30 VHA-HBPC programs to use VHA’s Portal for ArcGIS mapping software. The project was designed so that any member of the VHA-HBPC staff, including staff providing direct care, could make maps tailored to their local program’s needs. The maps are layered, incorporating patient data, location of emergency services, and environmental threats, such as storm surges. At OVAMC-HBPC , a nurse care manager (RNCM) trained as the mapmaker.
As Irma approached, the RNCM/mapmaker created maps showing the locations of vulnerable patients, such as those near the coast, synthesizing information from the GIS maps and other sources about the storm’s path, wind force, patient location and level of vulnerability, and areas with high likelihood of power outages.
The map of the oncoming storm was a powerful tool. The RNCM said, “The map made me realize that it was real and it was going to come.”
Armed with information, the care team set to work on the emergency response. For instance, the RNCM/mapmaker facilitated the sheltering-in-place of a patient with brittle diabetes mellitus by educating the patient’s daughter on the impending risk. The daughter bought a generator to run the air conditioning and a small refrigerator to keep the patient’s insulin cool. The mapmaker also convinced the family of a patient with chronic obstructive pulmonary disease and congestive heart failure that they needed to evacuate to the OVAMC hospital.
OVAMC also facilitated the transport of VHA-HBPC patients to its hospital, including 2 who were admitted to the intensive care unit. Because of the team’s advanced planning and the use of GIS, only 23 of the 364 patients needed to be sheltered at the hospital. No patient deaths or injuries were attributed to the hurricane.
The mapping project was funded by the Veterans Administration Geriatrics and Extended Care Strategic and Transformational Initiatives.