University of Texas at Austin School of Nursing faculty, students and staff are committed to helping those affected by Hurricane Katrina. More than 100 volunteers from the school rushed to volunteer as evacuees arrived in Austin. Here are two of their personal stories.
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By Marilyn Pattillo
Friday, September 2, 2005
Phone call from Emergency Operation Center City of Austin requested that 10 nurses and 23 administrators were needed immediately to help set up and staff a sub-acute unit at the Palmer Events Center in anticipation of 30 busloads of Hurricane Katrina evacuees from New Orleans, Louisiana. A call for volunteers from the University of Texas at Austin School of Nursing netted more than 100 faculty, retired faculty and student volunteers.
My first briefing to volunteers:
Rule #1:“Never pass up the opportunity to eat.”
Rule #2: “Never pass up the opportunity to sit down.”
Rule #3: “Never pass up the opportunity to use the bathroom!”
We were among the first to respond and were instrumental in setting up cots, a temporary pharmacy and infirmary units for cardiac, pediatric, respiratory and general medicine care. A sub-acute unit was needed to care for patients who needed hospital care but were not critically ill enough to be admitted as an inpatient. Area hospitals did not need to be inundated. The anticipated busloads did not appear. We were to stand-down until the morning when evacuees were to come by plane.
Saturday, September 3, 2005
By Saturday morning, the Austin Convention Center was opened to shelter the 5,000 evacuees arriving by plane, cars and buses. The School of Nursing provided nurses and nursing students to help with triage and providing care to sheltered population.
Among the first evacuees needing attention that I saw was a 46-year-old woman who suffered from panic attacks and extreme anxiety. She was dehydrated and had not had her medications for at least five days. She was wearing the same clothes since her evacuation from her home in New Orleans six days before. She confided to me that she thought she had a urinary tract infection.
This was an understandable consequence to the lack of potable drinking water, bathroom access, clean clothes and high stress. She was one of the many who expressed anxiety, fear, despair and hopelessness. Some were confused, disoriented and had trouble concentrating or remembering things. I believed that the stress worsened her chronic conditions. She had been on medications most of which she could not remember what they were or how much she was to take. She had no records. The only consolation was that she had a male friend who helped her keep from “falling apart totally.”
The American Red Cross recognizes four phases of emotional recovery following the impact of a disaster. Communities respond similarly:
Time frames for each phase may vary greatly. Austin was in the heroic state. We, along with the rest of the nation, felt numbness, shock and even elation that now we can do something to help. When the evacuees arrived, it was obvious that survivors were in the honeymoon phase. Previously, they had banded together to save themselves and each other. Heroically they survived the lack of water, sleep and food. Now, they felt were beginning to feel safe and were grateful to the Austin community.
The University of Texas at Austin School of Nursing has been active in preparedness and planning since the events on 9/11. Dean Dolores Sands, concerned about the readiness of faculty and students, provided needed leadership to ensure a baseline knowledge base for both faculty and students on disaster preparedness and response. A disaster nursing elective was offered and an ad hoc committee comprised for selected disaster trained faculty constituted a core that could be called in the event of a major disaster. Since 2002, the School of Nursing participated in mass casualty trauma community and mass immunization clinic drills. For the Katrina disaster, Dean Sands provided top-down authorization for the School of Nursing to be helpful as volunteers to the community.
Thirty planes arrived in Austin full of evacuees, many of whom were sick, dehydrated and in need of medical attention. Some graduate nursing students and faculty helped set up temporary first- aid stations and identified evacuees that needed to be triaged for additional medical help and support. By the end of the day more than 3,000 evacuees were placed in cots. Many had questions about their medications. We were most worried about the effects of being without diabetic, antihypertensive, cardiac, anti-depressants, and anti-psychotic medications. A young 28-year-old man did not want to leave his mother who had a stroke and was unable to care for herself. We convinced him that we would watch his mother while he took his shower and changed into some fresh clothes.
I was so impressed with how the families stayed together and would watch over each other. I also was concerned that there were some individuals (disabled and elderly) would have to walk almost one-half block in the convention center to reach the rest room.
The make-shift showers were even further away.
Within the Convention Center medical triage—staffed with physicians, nurses, emergency medical technicians and laboratory technicians—helped identify and document evacuees needing extra assistance and care. Throughout the course of seven days the numerous volunteers from the School of Nursing provided either triage, psychological first aid in the general population area, and/or nursing care to those in “assisted living.” Nursing students interviewed, obtained vital signs, helped with showers, and provided first aid and psychological first aid. Many I felt were suffering in silence and could be easily overlooked. Depression or not wanting to complain hampered their ability to care for themselves and get needed resources.
Twin babies, born premature five months ago, one had a cerebral shunt, were admitted to the shelter at 3 a.m. one morning, the family finally being reunited after being separated for at least a week. It was nursing assessment and judgment that determined their level of care. Although the conditions were crowded in the shelter, they were most safe with their family in a sturdy crib donated by an Austin family.
In the medical triage area where most of the nursing faculty and students worked, fatigue, exhaustion, gastrointestinal distress, wound care and worsening of chronic conditions were the most common complaints of evacuees. Most were treated at the Convention Center, some were taken to surrounding hospitals. The most significant achievement, I believe, was determining who among the evacuees needed prescription medications such as insulin, anti-hypertensive and other cardiac medications and anti-depressant medications. Records were lost and most of the time, evacuees could not remember nor did they know what medicines they were on or how much. School of Nursing volunteers made frequent rounds and identified concerns for shelter staff to solve. For example, children were all given hand sanitizers and reminded to wash their hands frequently. We also complained that serving salty burritos almost every day did not help much controlling blood pressure.
The need to identify those with special needs became evident from the outset. Survivors and family members most likely to experience adverse reactions were those who were at risk even before the disaster, that is, the poor, the elderly, the disabled and/or those who had been living alone.
Monday, September 12, 2005
Presently, evacuees are being placed in the community or families are picking them up. The next phase, disillusionment phase, may become more prominent, as the reality of how their former life has changed, separation from families, being uprooted from ancestral homes, and realizing that disaster money being offered will eventually run out. The enormous drain of reserve—evacuees, responders, the communities in general—can take its toll. Volunteers, caregivers and evacuees have experienced physical and emotional stresses of the experience. I have seen anxiety, frustration, sleep disorders and displaced anger among responders and evacuees alike.
The continued outpouring of support from the Austin community will lessen the impact of the disillusionment phase. Presently, the public health nursing students under Carol Gaskamp and Trish O’Day are working with the City of Austin/Travis County Health Department to follow-up with evacuees in Austin. They are to concentrate on the possibility of infectious disease outbreaks that usually occur in the post impact and recovery stages of a disaster. Students will follow evacuees at group housing and assist to organize activities to eliminate or mitigate existing health hazards.
Students will learn that public health nurses integrate community involvement and knowledge about the entire population with personal, clinical understandings of the health and illness experiences of individuals and families within the population. They translate and articulate the health and illness experiences of diverse, often vulnerable individuals and families in the population to health planners and policy makers, and assist members of the community to voice their problems and aspirations. Public health nurses are knowledgeable about multiple strategies for intervention, from those applicable to the entire population, to those for the family, and the individual. Public health nurses translate knowledge from the health and social sciences to individuals and population groups through targeted interventions, programs and advocacy (American Public Health Association).
In Katrina, mass casualty scenario was the norm. It was physical and death casualties in New Orleans and psychological and secondary casualties in Austin. Nursing faculty, mobilized to help in Austin, had to exercise great local leadership and discerning judgment in assessment and triage or patient condition for priority care as well as to provide care and treatment in a mass care environment. The School of Nursing helped staff to provide the over 4,000 evacuees medical triage, treatment, shelter and reassurance at both the Palmer Events Center and the Austin Convention Center in the course of 10 to 14 days.
The last stage is reconstruction when the intensive emotion of emergency response and life saving are replaced by a sense of acceptance and emotional reappraisal of relationships and lives. The School of Nursing will also be changed. School staff, faculty and students responded admirably. There is now an awareness of what it means to be ready and to respond. From top down, the support has been incredible. The City of Austin has mentioned several times, how crucial the assistance of the School has been. Thank you all for the wonderful work!
By Maureen E. Davis
There was an amazing outpouring of volunteers on Sept. 3 at the Austin Convention Center in Austin. I went not knowing what I would be asked to do but willing to help in any way that I possibly could. When I think back to that night, I remember most each of the people who I care for that night and what it meant to them my being there. I hope that each person who volunteers knows how much his or her presence and caring means to the evacuees. I did a variety of jobs that night and each person that I met had a story.
I signed in at triage. Medical personnel who volunteered were going to triage first and signing in there. I then went to the shelter area, where the faculty of The University of Texas at Austin, School of Nursing and the student nurses were working to assist people who had been through triage and through registration and were now sent to the “Shelter” to have basic needs met. We set up a nurse’s station in the shelter and brought supplies from the various donation areas and the triage area to the shelter.
We began by walking up and down the rows of cots and airbeds asking people if they were okay and if they needed anything. We distributed antibacterial hand wiped to parents to clean the children’s hands. With so many people, especially children, we wanted to keep the germs at a minimum.
I met a young man who was taking care of his mother. He had settled her in a cot and was looking for a blanket. His mom was wheelchair bound and had left side paralysis from a previous stroke. We brought a blanket and settled his mom comfortably on her cot. I then asked him what he might need. He said, “I would like to take a shower, but I cannot leave my mother. What if she needs something?” I told him that I would stay with his mom until he came back from his shower. We covered mom’s eyes with a washcloth as the lights in the room were so bright and she wanted to sleep. I sat next to her watching her sleep and a young man about 40 years old came up to talk to me. He had just come from taking his shower and was putting on a brand new T-shirt from the donation pile. He wanted me to listen to his story. The story he told was of leaving home and going to the Superdome in New Orleans. The place was so crowded that he and his family decided to take their chances and go back to their home. They were eventually picked up by a boat and taken to the New Orleans airport and then transported by plane to Austin. He had not had a bath in days and he only had the clothes on his back. After a good meal and a shower he said that he was feeling pretty good. He was overwhelmed by the welcome he received in Texas.
I continued my rounds of the cots, speaking with people and handing out tissues and listening. One woman spoke of not having had her medications for bipolar disorder and high blood pressure for five days. This was a common theme and that night a pharmacy was brought into the convention center and people were told it would be open at 6 a.m. the next morning to fill prescriptions. All the physicians and nurse practitioners were given prescription pads.
People started to recognize we could help with their minor injuries. It seems the cuts and scraps they received walking through the water were not evident to them until their basic needs were met. One man had a leg wound that was cleaned with peroxide and bandaged. We advised a tetanus shot in the morning at Palmer Auditorium. Another woman’s son came to the nurse’s station looking for help for his mother. His mother was in survival mode for five days and did not think about the fact that she had lost her shoes, was walking through water and then on hot pavement. When I came to her cot and she lifted her feet I could see the bottoms were burned and blistered. Some of the blisters had broken. She, too, had eaten and had a shower. I cleaned the bottoms of her feet. Coated the burns and blisters with triple antibiotic ointment and then had her lay down on her cot. I went to the clothing donation area and found three or four pairs of socks and brought them back to her cot. I did some wound care teaching and gave her some supplies and told her to have someone dress her wounds after every shower and then to put on a clean pair of socks.
I continued making rounds giving out antibacterial hand wipes and bottles of antibacterial gel as well as teaching parents the importance of hand washing for themselves and their children before eating and after toileting. I was asked to go to triage to transport a lady in a wheelchair to the shelter. This lady was causing a little fuss in triage because she had about five bags or satchels filled with all she had left of her home. She was taking up two or three chairs and she did not want to be moved without her belongings. Her dress was covered with dirt and the look on her face was very sad. I got a cart and loaded up all her belongings and we started off toward the shelter area. When we entered the large shelter area, she glanced at the big screen T.V. across the room. A report of the hurricane damage was being broadcast and she started to cry. She said, “That’s my home and there is nothing left of it.” As I directed her to the registration area, I listened, let her cry and then tried to focus on the good things. She was now safe and shortly she would have food, a shower and a bed. We talked about her family and she mentioned the fact that she knew that they were safe.