When a cyclone struck a rural ED, it eradicated power, cell towers, and internet
;)
Figure: Cyclone Gabrielle, New Zealand, cell towers, internet, communication, hurricane
FigureDay One: Cyclone Gabrielle
Cyclone Gabrielle struck rural Gisborne, New Zealand, on Feb. 13. No one came to the ED that day except one person who had had a chronic achy toe for two years. Why come in during a cyclone?
The din of furious winds and pounding rain were otherwise all the activity our anxious but unoccupied ED saw. At 1 a.m., after my shift, I struggled to drive home through sideways rain and winds gusting at 75 mph. Then, the entire city went black. My headlights gave muted illumination through the pounding downpour. The problems had officially started.
Day Two: Everything is Down
The hospital had generator power, but the rest of the city had none. The cyclone had eradicated power, cell towers, internet, and multiple water mains. The two main bridges were significantly damaged, and flooding had damaged numerous buildings. In the immortal words of Scooby-Doo: Ruh roh.
Without communication, ambulance traffic stopped because no one could call them. Paramedics drove around town and assisted anyone they found requiring help. Helicopters checked on the numerous houses spread up and down the coast. The ED could not contact anyone, and we sent out people to various addresses as needed.
Day Three: Still No Communication
We're emergency physicians, so we improvised. Without internet and cell coverage, consulting specialists required ingenuity. On-call physicians checked in regularly. Most stayed in the ED or gave their address for someone to come get them. The on-call OB/Gyn just lived at the hospital.
No internet meant no past medical records, no files, and no looking anything up online. We had stacks of books from the library to double-check dosages and the like.
Getting from place to place in town remained difficult due to flooding.
Day Four: Nothing Back On
As a rural ED, we usually fly out patients requiring specialty services we lack. Without communication, sorting out logistics became difficult. Fortunately, helicopters came in regularly, and we discussed cases as they returned.
Before the cyclone hit, we assembled a list of high-risk patients (on dialysis or home oxygen, for example). We secured satellite phones, and we continued with damage control while crews worked around the clock fixing the broken infrastructure.
Day Five: Minimal Communication
We utilized semi-functioning beepers to stay in contact with other physicians. Pharmacies had limited hours, and patients could only pay in cash with the internet not functioning, so we simply gave full prescriptions to patients.
Helicopters kept arriving. We had no idea what surprises the helicopters had inside. We only found out after they came through the door.
After my shift, I woke up at 3 in the morning to my phone buzzing like crazy with dozens of emails and announcements. I had internet! I quickly sent a message to my family. After four minutes, everything stopped working again.
Day Six: Overnight Shift
Patchy power returned for the majority of the city. Most people had limited water due to multiple broken water pipes. Water conservation warning signs could be seen everywhere. The mayor engaged the local newspaper to print a special edition that went to every household. Our ED director continued to keep us updated by driving to everyone's house.
I used the satellite phone to call the hospital about my patient while working an overnight shift. The consult services from the receiving hospitals understood our circumstances. I stood in the dark on our helipad while I communicated with them. This was the only place the satellite phone had reception.
The good news: The helicopter got my patient out. The bad news: They had to turn around midflight due to weather. The patient was eventually flown out via airplane and did fine.
Day Seven: Limited Internet
I went into my shift a couple of hours early after I learned the bridges were going to be shut down for construction. When I got to the hospital, I found that limited internet had been established.
Game. Changer.
We could now look up old records, medications, and access forms of communication. I connected my phone and realized I had more than 60 messages waiting for me, which was low compared with others.
We still had no ambulance traffic because we lacked cell coverage. The helicopters continued with well checks on thousands of citizens. We admitted patients who had lost everything and had nowhere to go.
We learned some areas had been hit significantly harder than we had been, and they still lacked power, water, and communication.
Day Eight: A Semblance of Normality
With communication back, the ED felt close to normal. The community still required significant recovery. Several water mains required fixing. Internet and power remained spotty in areas, but transferring to outlying areas became much easier.
Lessons Learned
Having medical apps that did not require internet helped tremendously. Be sure to download something similar if you know a hurricane, cyclone, or other horrible event is approaching.
Preparation is key, as is staying flexible. We had lists of high-risk patients, which helped crews check on them after we lost communication.
Have addresses and phone numbers of everyone you may need. Our ED director literally drove to every emergency physician's house multiple times to keep everyone as updated as possible.
Remain patient and positive, and be willing to go the extra mile. For many of us, though, that's just another day in the ED.
Dr. Brandtis an emergency physician currently working in New Zealand (after 12 years in Michigan). Read his blog and other articles athttp://brandtwriting.com, follow him on Twitter@brandtwriting, and listen to his humorous ED podcast, EpineFriends, which can be found athttp://apple.co/3d9Nco2. Read his past EMN columns athttp://bit.ly/EMN-BrandtsRants.
