Lessons from the disaster zone – twice over

1 December 2012

Dr Frances Hughes doesn’t court disasters but they have a habit of finding her. The former chief nurse was in New Jersey on a Fulbright scholarship studying post-disaster lessons when Hurricane Sandy hit. FIONA CASSIE reports on her latest literal lesson.

Frances Hughes may have been tempting fate. On her last study trip to New York she was in Manhattan the day the twin towers fell.

That disaster led to her return more than a decade later to study post-disaster lessons – just in time for the deadliest hurricane to hit the US east coast in more than 50 years.

Hurricane Sandy destroyed thousands of homes, forced three Manhattan hospitals to evacuate, and killed 131 people in eight states – including 37 in battered New Jersey where Hughes was staying. It knocked out cell phone towers and cut off power to millions, leaving the elderly and ill trapped in high-rise apartments with lifts out of action.

“There’s huge lessons in all this,” says Hughes. The predicted super storm hit hardest one of the world’s most sophisticated cities, New York. “But still, back-up hospital generators fail and you have nurses right in the thick of it – carrying babies and equipment down flights of stairs.”

“They (the US) are prepared at one level, and on another level, they are as vulnerable as a developing country.”

As a mental health nurse, Hughes always had an interest in psychosocial support in times of vulnerability but says being on the ground for 9/11 was instrumental in her taking a greater personal and professional interest into post-disaster response.

She went on to be commissioned, with Australian colleague Margaret Grigg, by the World Health Organisation to write international guidelines for nurses on coping with post-disaster mental health issues. The pair also ran a series of workshops for New Zealand nurses after the Canterbury earthquakes.

Late last year, just before taking up her current post as Queensland chief nurse, she won a senior Fulbright scholarship to study post-disaster lessons for health professionals in the United States. This saw her end up in New Jersey in time for Sandy’s arrival and gave her the opportunity to observe some lessons first-hand.

“One of the big lessons for me is you need to constantly do scenarios and role plays with staff – not just about clinical techniques about how you deal with casualties but things like evacuations and how you manage in situations without power and communication technology.”

“It sounds basic but you’ve got to do the simulation,” emphasises Hughes. “As otherwise, staff are absolutely flawed when they don’t have that technology.”

Gun-toting vigilantes

Post-Sandy she found herself in her own “action research” project in a New Jersey community without power, long queues for petrol and milk, and the unsettling feeling that if you went door-to-door offering help, you might be confronted by a gun-toting vigilante worried about looters.

Ironically, she started her autumn study tour in the northern parts of New York with the aim of avoiding snow and blizzards – there she had found good examples of pastoral care to critical nursing and medical staff in the event of snow cutting off communities.

She had also been south to hurricane-prone Florida to visit the University of Miami, which specialises in disaster management – including training the military – from natural disasters to bio-terrorism and bombs.

“It was stunning stuff … in retrospect, I thought these were the kind of systems that New Jersey needed.”

These systems included the development and training of nurses in specialist and very efficient triaging of disaster casualties.

Florida’s “reserve” health professionals, who are credentialed, trained and ready to be called on to work in the hospital system if a disaster strikes, also impressed Hughes. Like our army territorials, they get paid to train and paid if deployed, and there is a real time database, so at any one time, the health system knows how many reserves can be called into action (see sidebar about a new New Zealand initiative).

It was on her return to the New York region that she got caught up in Hurricane Sandy – the former Wellingtonian says the noise of these winds made her experiences of southerly storms fade into the background.

Post-Sandy, she talked with a Kiwi friend working with the New York Community Nursing Service about the struggle to care for renal and palliative care patients stuck in high-rise apartment buildings without power, with often the only contact being the nurse ready to climb flight after flight of stairs by torchlight.

The biggest lessons to be learned, she believes, are from the hospital evacuations, and she has established links with nurses from the affected hospitals to help inform her ongoing research (full hospital services are still not expected to be restored at Manhattan’s main public hospital Bellevue until February and only slightly before that for NYU Langone Medical Centre’s Tisch Hospital).

Hughes says the evacuations – some in the middle of the hurricane – showed that one just can’t be prepared enough. “It’s not the place to learn by experience.”

It brought home to her the need for New Zealand and cyclone-and flood-prone Queensland to ensure it has good basic training for nurses in disaster management and a good core of nurse leaders with postgraduate-level training in the roles needed, from coordination to counselling, when a disaster strikes.

Meanwhile, her Fulbright scholarship will see her returning to the States in February, where she will attend the third ever national symposium on hospital disaster response – including evacuation – which was already scheduled before Sandy but has now “taken on a whole new flavour”.

Her second trip has been scheduled in the American winter and includes trips to post-Hurricane Katrina New Orleans, Memphis, the tornado-prone Kansas, and finally, San Francisco. Here’s hoping that fate doesn’t provide any more opportunities for action research.

NZ seeks nurses for disaster volunteer database

Nurses willing to volunteer in disasters both here and across the Pacific Islands are being invited to register for New Zealand’s new Medical Assistance Team (NZMAT).

The NZMAT volunteer database is seeking to create a pool of appropriately skilled and experienced nurses, doctors, paramedics, allied health, and logisticians who can be deployed by the Ministry of Health if and when needed.

The first official NZMAT training course is scheduled for April next year. Volunteers are being sought from across the health spectrum, including emergency medicine, surgery, paediatrics, primary care, public health, and mental health. The volunteer database follows more than 800 health sector staff volunteering to help out after the 2009 Samoan Tsunami, with all the applications having had to have been manually sifted to find the skill sets required.

The Ministry says registration does not automatically mean selection for training or deployment, but pre-registered and appropriately trained staff are the most likely to be deployed to an emergency, either domestically or within the south-west Pacific.

More information about volunteering for NZMAT is available at the emergency management page of the Ministry of Health website www.health.govt.nz

You can register for the volunteer database at: https://volunteerhealth.org.nz