Disaster Planning: Learning From The Past, Preparing For The Future
Beth Ulrich, EdD, RN, CHE

It’s been a year since hurricane Katrina. With the 2006 hurricane season upon us, it’s a good time to look back and reflect on what experiences with Katrina and the aftermath taught us. Learning from events in our lives is important, and Katrina certainly left us with a lot of lessons learned. Even the most prepared hospitals and dialysis units were unprepared for the veritable siege that followed Katrina. And the after effects of Katrina were ultimately felt across most of the country as the people of the Gulf Coast sought shelter and employment.

We asked ANNA members to tell us about their Katrina experiences and what they had learned. The stories, both heartwrenching and heartwarming, contained many similar themes.

A New Definition of “Prepared”
People on the Gulf Coast prepared for Katrina as they had prepared for hurricanes for years – pack the car, dialyze all the patients ahead of time, secure the units, etc. But Katrina was not a typical hurricane and, when the levees broke in New Orleans, things went from bad to worse. Kathy Ellis, from Ochsner in New Orleans, sent us a list of what she and her colleagues learned about how to better prepare in the future.

• Always plan for the worst case scenario...Pack heavy.
• Plan for heat. Bring lots of baby powder and a personal fan.
• Expand the list of items needed...including thong sandals to wear in the shower, soap, and feminine products, gum, and breath mints, to name a few.
• Consider a satellite phone since nothing else will work. Learn to text-message since that was first way communication came to some.
• Be sure to have a back-up generator connected to the RO system. (Ours [Ochsner’s] wasn’t on a generator but we had a 10,000 gallon tank that lasted while we were without power.)
• Get phone numbers of friends/relatives where employees (Team B) will evacuate. (Ochsner’s disaster plan calls for a team of first responders [Team A] and a second team that will relieve the first team after the initial days [Team B]).
• Bring entertainment (personal DVD player, music, games, books etc.) - Anything that works off batteries, and bring plenty of batteries too.
• Bring a camera to capture all the events and share.
• Keep 2 weeks stock on hand during hurricane season.
• Be sure the biomed position is part of Team A.
• Preprint all phone numbers of key agencies, i.e. ESRD Networks, dialysis units, hospitals, etc. to have on hand at each computer.

Making the Best of Things
Nurses are known for their abilities to make the best of even the worse situations and of being able to find what they need to care for their patients regardless of the obstacles, but Katrina was a challenge for even the best of us. Nurses in many units described dialyzing patients virtually around the clock in the days and sometimes weeks following the hurricane. Units across the Gulf Coast region were pushed to and often beyond their limits, but the patients got what they needed. And they got not just the dialysis care or their medications. Nurses found them clothing, food, and shelter. Nanci Parish from Picayune, Mississippi described having to find fuel for their generators (someone siphoned fuel from a truck for them), finding food for patients, and using the local radio station to find their patients and to communicate critical information. Sheila Baimbridge from Texas City told us about her and her colleagues helping to reunite patients who had been separated from their family members.

Working Together
Nurses also talked about the deeper connections that were formed having gone through this disaster together. Kathy Ellis described it well, “The most remarkable experience was not the insufferable heat, or even the scarcity of food, or any of the various clinical challenges we faced. It was the amazing, collective bond that transcended departments, positions, and ethnic differences. We were part of history, suffering together, and serving together.”

Part of working together was also taking care of each other. One nurse from Mobile noted the many adjustments that people had to make in their personal lives and the need to have patience. Many nurses were separated from their families and had no home to return to. Others, not directly affected by the hurricane, worked to near exhaustion.

Communication & Information
One of the biggest frustrations during events like Katrina is the lack of information when normal communication options aren’t working. Nurses in the direct path of Katrina recommended having many redundant communication technologies and strategies because it’s unknown which will function at any given time.

National organizations also found a key role in communication and information post-Katrina. ANNA helped connect nurses, patients, units, volunteers, etc. and administered a $100,000 grant from Amgen to provide financial assistance to individuals who had been directly impacted by the hurricane. The entire nephrology community came together to take care of its own in a way that can serve as a model for others.

Learning From The Past, Preparing For The Future
These are but a few of the many lessons learned from the experiences with Katrina, but they can serve to stimulate discussions about how we better prepare for disasters in the future. This disaster emphasized the need for longer-term plans (3 days of supplies and staff may not be enough), the need to place more emphasis on caring for the nurses themselves, and the need to be more self- sufficient.

Over the past 5 years, since the attacks of September 11, 2001, we have learned much more in theory about preparing for disasters such as biohazard events. Yet there’s always at least some degree of denial that it will happen to us and that denial can result in not being as prepared as we need to be. September 11 and the aftermath of Katrina taught us that we must all be ready for the unexpected all the time.

Beth Ulrich, EdD, RN, CHE
Editor
E-mail: BethUlrich@aol.com