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New Challenges for Nurses

Bennett, Marsha, DNS, APRN, ACRN; Porche, Demetrius, DNS, RN, APRN

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Journal of the Association of Nurses in AIDS Care: January-February 2006 - Volume 17 - Issue 1 - p 1-2
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As Katrina was approaching as a Category 5 hurricane, the New Orleans community knew this was the hurricane that had been discussed for some time that would wreak havoc on our historic city. For years New Orleans residents joked about living in a “soup bowl,” until Katrina made it a reality. The poor, those without transportation, and the elderly, infirm, homeless, and disadvantaged were trapped in the city as waters rose. Many doctors and nurses remained, working in the hospitals and shelters. For the first 3 days after the hurricane, these health care providers were giving the best quality care possible without ancillary services, adequate personnel, lighting, or air conditioning, all while working long hours.

Katrina presented the health care community with one of the greatest challenges of all time. Nurses have historically worked under adverse circumstances and are known for getting the job done while providing compassionate quality care. Katrina forced the nursing community to learn another set of skills during this disaster. Here is a snapshot of nurses' experiences during this hurricane and the some of the skills needed to provide patient care under such duress:

  • Power was out all over the city, and hospital generators were running only emergency equipment such as intravenous pumps, ventilators, and monitors. By the third day, the fuel supply was very low with no immediate rescue in sight. Nurses had to find alternate sources of fuel, which presented itself as gasoline in the cars parked in the parking garages of the area hospitals. So nurses learned the skill of breaking into cars and siphoning gasoline to provide fuel to keep the generators running for a few more precious hours.
  • The communication infrastructure was destroyed during and in the aftermath of Katrina. Land lines and cellular phones did not work. The only viable means of communication were text messaging and two-way communicators (walkie-talkies). There was little to no communication with first responders or other emergency crews. Nor was there means to know what was going on in and around the city. Hospital personnel did not have communication with city, state, or federal authorities or other emergency relief workers capable of providing guidance, direction, and support for rescue efforts. The rescue efforts were occurring in a communication vacuum. During this time, nurses learned to persevere with their evacuation efforts while facing unknown risks and not knowing what would be encountered next. Despite the lack of coordinated and planned patient rescue, nurses successfully evacuated patients.
  • Communication efforts were complicated by rumors. Snipers were said to be shooting from rooftops at helicopters evacuating patients. Murders and rapes were being reported as occurring in city shelters. Hundreds of dead bodies were reported to be floating in the streets. Hospitals developed “rumor boards” to communicate with staff and patients and restore some sense of reassurance. During the height of fear surrounding the rumors, nurses remained calm and continued the evacuation process. Later, many of these frightening rumors were confirmed.
  • Evacuations occurred from rooftops. Without enough power to run the elevators, nurses and other staff were challenged with physically carrying patients in wheelchairs and on stretchers up six or more floors. Once on the rooftop, nurses were faced with the dilemma of keeping these fragile and ill patients adequately hydrated, safe, and calm in the 100-degree-plus heat of day and night. Evacuations via helicopter were continuous until all patients were transported to the designated Federal Emergency Management Agency medical management centers. Nurses learned how to perform triage on the appropriate patients with each evacuation to ensure that the maximum capactiy of each flight was reached within weight and space requirements. Nurses were among the last health care providers to be evacuated.
  • Nurses were challenged with keeping groups of fragile and ill patients hydrated, safe, and calm in the sweltering heat. Nurses were challenged to provide comfort measures with minimal supplies, and they responded with creative interventions. Towels were torn and soaked in ice water and placed around patients' heads and necks to keep them cool. The few nurses on the rooftops assessed each patient frequently and provided them with drinking water and what little food remained.
  • The success of hydrating the patients on the rooftops presented the new challenge of providing them with a means to urinate. Nurses procured bedside commodes from the hospital rooms and discretely placed them behind pillars or between cars on rooftops of parking garages.
  • Intravenous infusions were initiated by starlight, with nurses holding flashlights between their teeth. This required the maximum amount of hand, eye—and mouth—coordination.
  • Oxygen supplies ran out. Nurses took turns performing manual bag ventilation for hours until patients could be evacuated. The nurses learned how to provide adequate ventilation without unduly fatiguing themselves, all the while reassuring and keeping the patients calm.
  • Nurses were involved in preserving life at all levels. Valuable stem cells and embryonic tissues were saved as nurses learned the new skill of topping off embryo and stem cell tanks with liquid nitrogen.
  • The sustenance of life was reduced to flavored gelatin and crackers. Although there were no medications to administer, nurses distributed the meager rations of available food. Patients and staff shared this diet for the days preceding their evacuations. Nurses learned the humble value of dining on rooftops under the stars with patients to sounds of distant gunfire.

There are many other stories, at least one for every nurse who stayed and helped patients; we have presented only a few. These experiences are examples of the endurance and courage displayed by nurses. We salute nurses in the New Orleans community for what they accomplished during this extraordinary event. Knowing the role and actions of nurses during this crisis has engendered a greater sense of dignity and camaraderie in our profession. We have never been more proud of our peers.

©2006 Association of Nurses in AIDS Care