HurricanesKatrina and Rita

Lessons Learned

Texas Nurses Answer the Call

Debra Edwards, MS, RNCTexas Education and Distance Learning Coordinator

Emergency Preparedness and Response BranchTexas Department of State Health Services

Objectives

• Differentiate the response role of nurses in Texas related to Hurricanes Katrina and Rita.

• Analyze lessons learn and provide recommendation to enhance the nurses’ response to hurricanes in the future.

Emergency Management + Public Health

• Focus on point of integration– National Incident Management System (NIMS)

• NIMS Compliant

• Applicable to all hazards

– Incident Command System (ICS)• Management Concept

• ICS Structure

– State Emergency Management Plan• Annex Radiological Emergency Management

• Annex H Health and Medical

Integration • NIMS

– Command and Management– Preparedness– Resource Management– Communication and Information Management– Supporting Technologies– Ongoing Management and Maintenance

Incident Commander

Logistics Finance/AdmPlanningOperations

•ICSSafety Officer

Liaison Officer

PI Officer

Thank You Texas Nurses

At the first sign of need nurses did not

hesitate….

A Look Back

Katrina

8/29/05

Louisiana near New Orleans

Cat 4

Multi states declared

disaster areas

Rita

9/24/05

Texas near Sabine Pass

Cat 3

17 counties were declared disaster areas

A Comparison

KatrinaShelters were concentrated in larger cities and affiliated with city and county jurisdictions

Nurses RoleCollective group of nurses

providing services

InfrastructureEmergency Management

System

RitaShelters were concentrated in

smaller cities with a larger number of unaffiliated shelters

Nurses RoleOne or two nurses providing

services

InfrastructureDisconnected from the

Emergency Management System

Partners

• Texas Nurses Association– Ready Texas Nurse

• Establish after 9/11

• Statewide

• Nationwide

• Texas Medical Association– Medical Society

• Locally

Ready Texas Nurses

Katrina Rita

Number of Request 53 360

Areas of Deployment Dallas, Houston, Forth Worth,

New Orleans, Austin, Garland, San Antonio, Texarkana

Nacogdoches, Lufkin, San Augustine, Newton, Tyler, Manor, Livingston, Shelby, Waco, Bryan, Austin, Woodville, etc.

Ready Texas Nurses

Katrina Rita

Location of Deployment

Shelters both official and unofficial,

hospitals and clinics

Shelters both official and unofficial,

hospitals and clinics

RN 125 133

LVN 5 29

Nurse Practitioner 5 6

Ready Texas Nurses

Katrina Rita

Nurse Assistant 0* 60*

Physician 53* 27*

Physician Assistant

5* 7*

*Other systems or databases were utilized to fill request

Resource Management

Katrina Rita

Mental Health 5* 5*

Social Workers 0* 7*

Pharmacist/Tech 10/30* 4*

EMT/Paramedic 0* 3*

*Other systems or databases were utilized to fill request

Ready Texas Nurses

Katrina Rita

Specialty Requested Medical Surgical, Emergency Room,

OB and Gyn, Intensive Care,

Pediatric, Neonatal, and Psychiatry

Medical Surgical, Trauma, Emergency Room, OB and Gyn,

Intensive Care, Neonatal, and

Psychiatry

Resource Management During Event

Katrina Rita

Volunteer Database Texas Nurses Association (TNA)

Texas Medical Association (TMA)

Texas Pharmacy Association

(TPA)

Texas Department of State Health Services

(DSHS)

Texas Nurses Association (TNA)

Texas Medical Association (TMA)

Texas Pharmacy Association

(TPA)

Texas Department of State Health Services

(DSHS)

Scope

• Health and Medical Resources – The number of nurses who support the health and

medical functions to address natural and man-made events can not be measured…..

Public Health, Mental and Behavioral Health, Emergency Management, Acute and Long Term Care Facilities

All disasters are local…DSHS, DADS, DARS, DFPS, HHSC, etc

Your Experience Counts

• Group Activity– What successes did you observe during:

• Katrina• Rita

– What challenges did you observe during:• Katrina• Rita

– What are your recommends to close the gaps or challenges you identified:

• Katrina• Rita

Successes

• The Nurses– Willingness to volunteers

• Texas Ready Nurse System – Established and functional

Successes

• Two hurricanes in 30 days…– Texas Nurses Responded

• Over 3,000 RNs and LVNs answered the Texas Ready Nurse call– 1700 were registered prior to the event.

– 1350 registered with TNA or DSHS during the 30 day.

– TNA documented 500 nurses were deployed…79 sent to special needs shelters in East Texas following Rita landfall

– Local Response• Countless other worked long hours volunteering or fulfilling employer

obligations.

Texas Nursing September-October 2005

Closing the Gap

We need to build upon what is working well ……………..

…………..Identify challenges, roadblocks and gaps

Implement and integrate strategies to close gaps………….

………………….revise and test plans

Challenges

• Governance and Infrastructure Management– Unclear roles and responsibilities

• Local• State• Federal 72% of the shelters did not know how to link to their EOC

Challenges

• Volunteer Management– Identification and deployment of resources

• Database management– Affiliated vs. unaffiliated

• What is the system and how will the system be activated?• Tracking the deployment of resources

– Federal reimbursement

Challenges

• Risk Management– Safety of the individual

• Liability• Training• Transportation into the “hot zone”

Challenges

• Quality Assurance– Uncoordinated services and processes

• How do we get the resources to where they are needed– Volunteer is needed– Not turned away

• Mechanism for requesting nursing resources– Who can request resources– Emergency management system vs. another process– Utilization of technology

» Web EOC

Challenges

• Funding and Financial Support– Sufficient human and financial resources to maintain the system

• Long term, short term• Sustainability of system

– Start-up, maintenance, and surge capacity

Challenges

• Communication System– Lack of a formal communication strategy

• SOC, DDC, EOC, shelters, etc.– Multiple points of contact

• Emergency management , public health, community based, faith based, etc.– Disjointed points of communication

• Multi points of contact for he same information

Toward the Future

To Address Incidents of national significance in the future we must…

Reinforce and utilize the emergency management model to…..

Recommendations

• Identify and close gaps as soon as possible• Integrate and incorporate changes into agency and

community plans– Requires a strong communication plan

• Redefine and establish processes that include partners……not exclude– Associations, CBO, Private and Public Partners

• Connectivity to all resource databases– Central command center– Background checks

Recommendations

• Volunteer Recruitment and Retention– Resources management

• Exercise plans from a local, regional and statewide perspective including all response partners– Although all response is local, plans must be

integrated to respond quickly when local resources are depleted

Recommendations

• Ensure volunteers are trained– Identify skill sets, standardized courses, training,

actual and realistic need of volunteers and type resources

• Financial support is critical to sustain a system to deploy nursing volunteer during a event

Gaps Missed

Don’t forget……………..

After Action Reviews (AAR)

DSHS- Public Health Response

• Litaker Group– Preparing the AAR for DSHS Report due by

• April 1, 2006

Evacuation of Hospitals and Nursing Homes

• Hospital and nursing home administrators are often responsible for deciding whether to evacuate patients from their facilities

• State and local governments can order evacuations of populations, but health care facilities may be exempt from these orders

• Hospitals and nursing homes administrators stated they evacuate only as a last resort and that emergency plans are designed primarily to shelter-in-place

• Administrators consider several issues when deciding to evacuate or shelter in place:

• Availability of adequate resources

• Risk to patients

• Availability of transportation to move patients and of receiving facilities to accept patients

• Destruction of the facilities or community’s infrastructure

United States Government Accountability Office, 2/16/06

Hurricane Evacuation Issues

• Recommendations– Command control and

communications

– Evacuation of people with special needs

– Fuel availability

– Traffic flow

– Public Awareness

Governor’s Task Force on Hurricane Evacuation Issues 2/20/06http://www.governor.state.tx.us

Thank You