Eye of the Storm
During Hurricane Isabel, nurses put patients, co-workers first to provide care to a community under siege

By Scott Williams
October 13, 2003

Alice Ferguson, RN, traveled 94 miles round-trip during Hurricane Isabel to visit a bedridden, high-risk obstetrical patient. Driving in heavy rain and high winds, she watched trees crash to the ground and waves lap over the sides of the bridge across the James River.

"The whole way over there I kept thinking, 'This is crazy, why am I doing this?' " To make matters even more frightening, Ferguson brought her daughter along because she didn't want to leave her at home alone.

"The whole time I'm thinking, 'Not only am I going to get myself killed, I'm going to get my 12-year-old daughter killed as well,' " said Ferguson, a home care nurse with Sentara Home Care Services in Virginia Beach, Va.

So why did she venture out into a hurricane instead of playing it safe at home or, better yet, evacuating farther inland where the hurricane couldn't reach them?

"Because I had to," she said. "When you're a nurse, your patients come first."

Isabel struck the Outer Banks of North Carolina about noon Sept. 18 before heading north through North Carolina and Virginia.

Along the way, it killed at least 30 people, carved three new inlets through Hatteras Island, downed thousands of trees, cut power to about 2 million customers and caused hundreds of millions of dollars in damage.

Through it all, nurses and other health care professionals left spouses and children at home, put themselves in harm's way to help patients and co-workers, and slept at hospitals and other health care facilities.

Roberta "Bert" Salmon, RN, director of quality and patient care at The Outer Banks Hospital in Nags Head, N.C., arrived at work at 7 a.m. Sept. 17 and remained until 4:45 p.m. Sept. 19. She said she slept a total of 7½ hours.

"We were very busy prior to the hurricane just getting everything battened down and protected in case we did have leakage, in case we did have any damage to the hospital," she said. "We attempted to protect as much of our equipment as possible."

Power of planning

The Outer Banks Hospital is the only hospital on North Carolina's Outer Banks, which is made up of barrier islands between the Atlantic Ocean and a series of inland waterways referred to as "sounds." The 19-bed hospital, which opened March 19, 2002, is designed to withstand winds of 150 mph.

Because the hospital was directly in the hurricane's path, administrators decided to evacuate patients to other hospitals two days before the hurricane struck and keep its emergency department open.

As the storm approached, Salmon and others wrapped computers, telemetry machines, ultrasound machines and other huge pieces of equipment with plastic from 6-foot-wide rolls, like the kind used on construction sites. They also covered telephones and desks and put some items in trash bags.

"I even went next door to the grocery store and bought Ziploc bags for some of our small items," she said.

The hospital invoked its hurricane plan Sept. 14 and followed it step by step, Salmon said. Each day, the hospital met certain goals prescribed by the plan, and in the end, everything turned out well.

Still, there's nothing like a real-life experience to highlight problems with your disaster plan. Salmon said the experience helped them to identify ways to improve the plan for the next time a hurricane or other disaster strikes.

Their food, for instance, was kept in the command center instead of the cafeteria and having all that traffic in the command center made it more difficult to communicate with people on the outside. Salmon also said next time she'll make sure to have a medical/surgical unit nurse on hand to help out.

"We had (emergency department) nurses and a labor-and-delivery nurse, but a (medical/surgical unit) nurse would have served us well in getting the unit back up where it was ready to accept patients again," Salmon said.

Those who stayed-about 40 in all-included the emergency room staff, nurses, registration secretaries, physicians, a radiologist, a radiologist technician, an operating room team and staff members from administrative, clinical and facilities services.

The hospital switched to generator power during the afternoon of the storm because facilities staff worried that power fluctuations would harm their equipment. The hospital lost telephones and air conditioning during the storm and discovered that cell phones and pagers were of no use to them either.

"Many of our physicians were tied to pager systems … and we would be paging physicians and not getting a response," Salmon said. "We found out later that the towers themselves were down and the messages were not getting to physicians."

During one urgent situation, the hospital tried to page a physician and received no response. They then tried calling his office-the phones had begun to work again-and when they received no answer, Salmon took matters into her own hands. "I went to his office and beat on his windows until I got his attention," she said.

Salmon said some employees had a difficult time getting to work after the storm because of flooding and debris blocking roads, but she said no one refused to work before, during or after the storm.

"Because we are a small hospital, everybody knows everybody, so you wanted to come and help your friend," she said. "We've worked very hard to get this hospital running and they were not going to let something like a hurricane keep us from operating."

On the run

The staff at Sentara Nursing Center-Currituck in Currituck, N.C., had no choice in the matter. Currituck County ordered a mandatory evacuation and that meant evacuating 95 elderly residents to three different facilities, said Ruth Vinson, RN, director of nursing at the center.

The nursing home is on the mainland in the northernmost county in North Carolina. It overlooks scenic Currituck Sound and eventually would find itself in the path of Hurricane Isabel.

"We didn't have any prior knowledge that it was going to be a mandatory evacuation," Vinson said. "We had to go into crisis mode and hurry up and get everybody together."

Although the staff practices fire drills on a regular basis, it had never practiced evacuating the facility, Vinson said. With Hurricane Isabel only 24 hours from landfall, the center called on vans and ambulances to transport residents. Eighty-three were taken to Sentara facilities in Norfolk and Virginia Beach, while 12 medically acute patients were taken to Albemarle Hospital in Elizabeth City, N.C.

"We took an enormous amount of supplies and equipment," Vinson said.

Those supplies included oxygen concentrators, pumps for those who needed tube feeding, bulky medicine carts for dispensing medicine and supplies, toiletries, clothes to last several days and enough medicine to last a week.

"Sometimes, we'd have to put one medicine cart in one van and one in another because they are big pieces of equipment," Vinson said.

Those transferred to the hospital in Elizabeth City continued to be hooked up to oxygen and feeding tubes. "The ambulance people are used to that sort of thing, so that wasn't any problem," she said.

Vinson, who went to the Norfolk facility, said they kept their patients separate from those at the Norfolk center and the staffs didn't intermingle except at mealtimes. The center had several empty beds available because it's in the process of reducing its licensed beds and they had not been removed yet.

"We did have a little bit of a problem because the Norfolk facility is a large facility," Vinson said. "Working under pressure without much sleep and without regular meal breaks was quite a challenge to all of us." The biggest stress nurses and others felt was being away from their homes and families during the hurricane, Vinson said.

Home away from home

Children's Hospital of the King's Daughters in Norfolk, Va., handled part of that problem by letting employees bring their children to work with them, said Robin Doyle, RN, vice president for nursing. The hospital has a day care center in a separate building. The staff there moved into the hospital to care for employees' children for 2½ days.

"That way, the employees felt a lot more comfortable being in the building," said Doyle, who has worked at the 187-bed hospital her entire 26-year career. "We ended up providing child care for about 60 children of our employees."

Doyle said the hurricane's approach coincided with a disaster planning task force meeting scheduled for Sept. 15, three days before the hurricane struck. The task force devoted the meeting to planning for Hurricane Isabel. By the time Isabel hit, the hospital had seven days of medical supplies, including linens, 10 days of drinking water and five to seven days' worth of food.

"One of the things we did a little bit differently this time was we actually went out and bought some cots," Doyle said. "We had to make use of conference rooms and things that are not necessarily well-suited for getting a good night's sleep."

Doyle said the hospital made sure it had enough people on hand to cover a full shift with about one-third as many more people on hand in order to rotate people between duty and rest. The hospital began restricting staff to the hospital Sept. 17, meaning they weren't allowed to go home.

"If I had a nurse scheduled to be here and work a day shift on Thursday and a day shift on Friday, I required her to spend the night here on Thursday night," Doyle said, "because I couldn't guarantee if she went home on Thursday night that she could get back here on Friday morning."

Some complained about the situation, but Doyle said she couldn't let people leave until she had assurance from police and fire department personnel that it was safe to be on the streets and that she would have enough people coming in to care for patients.

She said some employees found the hospital more comfortable than their own homes. Some went without electricity for two weeks and Doyle said many packed up belongings and returned to the hospital, where they had showers, washers and dryers and air conditioning.

Salmon of The Outer Banks Hospital said the staff handled things exceptionally well and with few complaints, other than growing weary of the chicken salad sandwiches that dietary services prepared before they left.

"By Friday afternoon, we were sitting around the table discussing what our first meal would be after we left the hospital," she said.

Contact Scott Williams at scottwilliams21@msn.com