I feel I should warn you that there are parts of this story that may be disturbing but not graphic. It is about how a medical team worked together to treat their disaster victims.
In the 1970’s there was one night I will always remember. At the time I had three months experience as a nurse in a 5 bed ICU/CCU unit. The unit was part of a small two wing, one floor community hospital near New Orleans.
On the way to work every day I drove over a long bridge over the Mississippi River to reach the community hospital. From the top of the bridge the view was often spectacular. A sunset could be fully seen, as well as three huge oil refinery towers looming above the flat land near the curves of the Mississippi River.
A Disaster, not a drill!
Early on the evening of my last day off from work, my husband was watching the news when he urgently called me into the living room. There I heard the announcement calling for all available medical staff from any hospital to report to my hospital. There had been a disaster and it was not a drill!
There had been an explosion at one of the three oil refinery towers. This explosion had caused several enormous metal plates from the top of the tower to cave-in down the middle of the 30 story structure. An explosion happened before or after this event with resultant flames and people trapped, burned or killed. There were twenty injured and eleven immediately killed from the falling plates of the building, I found out later.
What else could I do?
I was compelled to do what I could, even though I had only worked in ICU/CCU for a few months. I would do the best I could. I felt totally unprepared for the sight of only two towers instead of the usual three as I topped the bridge. The reality of it all began then.
I arrived on my unit within an hour. All the bodies and body parts were brought to our small emergency room for identification. Though our hospital was very small compared to the huge hospitals like Charity, Oschner, or others, it was the closest facility to the conflagration in that structure. There were three victims who needed help fast! Only so much could be done at the site of the disaster.
Preparing the patients
Our unit was to care for three men, who had burns and would be developing respiratory problems from the chemicals and smoke they inhaled. The Emergency Department was busy receiving patients, assessing and triaging victims.
The operating room (I believe) was the site of debridement of wounds and removal of burned on clothing, ashes, and chemicals under sedation or anesthesia. The entire hospital staff and those who came to help were instantly put to work preparing for or caring for the victims.
What and how much do we need?
We began assessing our supply of intravenous normal saline, ringers lactate, plasma, blood, and other intravenous solutions. We knew we would need supplies from other hospitals too because our small hospital had only so many supplies instantly available.
An accounting was made of emergency medicines, narcotics, tracheotomy procedure trays, tracheostomy care kits, burn care kits, central and arterial line insertion kits, sterile gowns, gloves, surgical masks and all of the supplies necessary to care for the patients. At the time we had no idea how many patients would be coming to us.
The monitors and IVs were plugged in and ready
We soon learned that we would receive three men with burns and smoke inhalation. Bags of IV fluids were hung on the IV track above each bed and on poles, ready for intravenous fluid replacement lines, arterial lines and central venous lines to be inserted in each patient for monitoring.
The trays necessary for inserting these vital lines were opened and covered to protect their sterility until the patients arrived. The special plug in modules to monitor our patients’ hearts, pulses, central venous pressures, arterial pressures and oxygen levels were inserted in the cardiac monitor over each bed.
Ventilators were readied by respiratory therapists at each bedside. Suction gauges and canisters with tubing were all set to be used. We were as ready as we knew how to be.
So much tragedy
Word spread quickly in our small hospital of the horror and suffering which could be heard, seen and smelled in the Emergency Department. Families had to come to identify their loved ones.
The emergency department and EMS staff were a special kind of people to witness the horrible carnage and grief they witnessed that night. I must say that I am thankful I did not work in the Emergency Room. The sight of the three men who were brought into my unit was enough for me to handle.
A multitude of doctors descended on our unit
Soon our three patients were wheeled into our unit on our special ICU beds from the Operating Room. Each patient had several doctors working on them at one time.
Because of smoke and chemical inhalation the traumatized airways would swell from inflammation preventing breathing. So one doctor stood at each patient’s head, performing a tracheotomy, cutting into the trachea just below the larynx (or voice box) to keep the airways open and inserting, the airway tubing to give access to the oxygen and care the patients would need.
Another doctor was at each patient’s side inserting a long catheter with three ports through which the intravenous fluids could be run in rapidly through a large central vein, the subclavian or jugular, whichever could be accessed most quickly.
These central lines and their monitors were necessary to allow for large quantities of fluids and blood to be given to compensate for fluid/blood loss from the burns and to monitor body fluid levels to prevent dropping blood pressures, dehydration, kidney failure, shock and other disease processes after severe burns.
Blood could also be drawn from these life lines, saving the patients from multiple sticks with needles for laboratory work . Especially when there might not be many sites for blood draws or regular IV fluid to be administered.
Another doctor was inserting an arterial line in each patient’s wrist or groin for arterial blood gases to assess each patient’s requirements for respirator settings. The blood gases could change quickly with any of these patients. Arterial lines also allowed constant monitoring of the patient’s arterial blood pressures. Alarms could be set to notify us of any drops in blood pressure or pulse.
Then there was a doctor collaborating with the other doctors writing orders to cover the procedures being done to save these men’s lives. The orders included the intravenous fluids, laboratory work to be drawn, urinary catheters inserted for urinary output monitoring, wound care orders, narcotics for pain, antibiotics for prophylaxis against infections, respirator settings and so many other facets of care.
A gigantic team effort
Respiratory Therapists were there for each man to make ventilator adjustments and deliver respiratory treatments to try to accommodate any rapid changes in the men’s ability to breathe and to prevent infections and further damage.
Lab technicians were available to run any specimens to the lab. The pharmacy brought medicines as ordered and planned for future doses. Material Supply increased the stock of sterile sheets and sterile gowns, gloves and surgical masks, requesting supplies from other hospitals. Housekeeping mopped up any spills, kept the trash bags empty and made sure there was a good supply of linens. Everyone worked together.
We nurses had our own tasks
We nurses tried to keep up with the orders, have everything available as much as we were able. I remember I held a retractor as one doctor performed a tracheotomy. Each patient practically had two nurses following doctor’s orders for them throughout the night.
Each patient’s blood pressure, pulse, respirations and temperature were checked frequently and recorded along with the other readings available on the monitors.
Kidney function was evaluated by urinary output and blood chemistry levels. We all worked tirelessly to save these men’s lives.
A long night
Once the life saving and monitoring work was in place, wounds were further evaluated and some form of burn treatment cream was applied. Then we worked the rest of the night just caring for and monitoring our patients, fulfilling our duties, and following pages of orders as the night progressed.
Many of us worked 16 hours or more that night. But once report was given to the next shift, we nurses had to record what was done for our patients by us, and generally by the doctors, and therapists. Most of us had to use the physician’s orders and our scribbled notes to record, the events and care given that night. Sadly my patient did not live through the morning.
After probably two months of stabilizing treatments, burn care, done with sterile technique and excellent nursing care the original two patients were transferred to a rehabilitation hospital. The burns and scarring had been severe but one of the younger men actually came back to see us about six months later. His hands had been badly burned and swelled so much that there was nerve damage. But he was walking, talking and his face had not been badly burned.
What an amazing team effort!
That night I saw the amazing work of the medical team and hospital staff to save at least two of the three men we cared for. I have no idea where the other less severely injured victims were taken. All I cared about were these three men. My life was changed after that night. A new love and admiration grew for those of my field and those who worked together that night to save these men.