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1. Rescue efforts intensify when the generators fail, as nurses must ventilate patients by hand. The death count rises and so does the heat. What key decisions kept people alive in this chapter? Which decisions resulted in death?
The key decisions were made by Tenet Healthcare – the parent hospital in Dallas, Memorial’s Incident Command Center “survival mode”, and Coast Guard (who were called in by the Governor of Louisiana) to help evacuate patients, In charge doctors on their own made key decisions for their patients regardless of risks (neonatal babies) and families of love ones (patients) made key decisions (reneg. of DNR orders) to keep people alive in this chapter.
One key decision was made by Tenet Healthcare. They had to give the go ahead for evacuating Memorial and New Orleans area hospitals and they were told that Memorial had to wait for the National Guard. Tenet would eventually contact other hospitals to take patients from Memorial (evacuation sites – where patients go) when they were told OK by National Guard and State Government authorities. This was all in emails by Michael Arvin (and Bob Smith) and Sandra Cordray (emergency communication manager for Memorial) after she sent many MAY DAY emails to Tenet that Memorial was desperate to get help to evacuate their patients. They were determined to make sure the helistop worked and could air transport air evacuations. Atlanta Medical Center was already to help evacuate patients and Tenet Healthcare in Dallas would not let Atlanta Medical Center help until the National Guard got fully involved. This happened in Chapter 4, but it led to key decision making for keeping patients alive in Chapter 5.
Another key decision was by Memorial Incident Command Center which included Susan Mulderick, Karen Wynn, and staff doctors such as how to safely evacuate the hospital since it was not functional for patients now and which patients were the first to be evacuated (on the morning of August 31st – the hospital backup generators failed – the air conditioners no longer blew cold air but warm heat – hospital systems already failed). Memorial Incident Command also decided how to get patients to the helipad and when to do it. They did not want to evacuate the night of August 30th into August 31st when visibility was poor, staff were exhausted, and it was very dangerous to be climbing upstairs with patients to the helipad. By this time, the elevator to the garage to the helipad did not work due to failed backup generator power so they brought the patients through a hole in the wall in the maintenance room. The other side of the hole took the patients one by one to the garage and the stairs up to the helipad.
And In charge doctors themselves made key decisions to keep patients alive – the first patients to be evacuated were 16 neonatal babies on ventilators by neonatologist Dr. Gershanik. Dr. Gershanik took the sickest Baby Boy S with him on a rescue chopper. He used an ambu-bag to keep the baby alive. Helicopter after helicopter rescued neonatal babies (with nurses using ambu-bags on babies) who needed immediate care. All the babies made it out alive.
And the Governor of Louisiana made a key decision too, by bringing LTJG Shelley Decker from CG emergency command to help evacuate patients on CG helicopters. Decker’s right-hand man – Michael Richard, Auxiliary CG volunteer wanted the most critical patients evacuated first when he found out that 52 Life Care patients were not evacuated right away. Memorial wanted priority for their patients first to be rescued.
In the chapter too, families made key decisions to keep their love ones alive. Families of patients changing their minds and getting doctors at the hospital to reneging their love ones DNRs so they would be rescued and prioritized to be rescued. Not everyone made it out alive as Gina Isbell a Life Care nurse tried to bring a Life Care patient to be evacuated and the patient needed a ventilator to stay alive – she used an ambu-bag to help the patient breathe and he still did not make it to a rescue helicopter on the helipad. It was a decision that resulted in death when the intention was for the patient to get evacuated and survive.
2. Who was the man with the boats calling for rescue in the middle of the night? Why were pets brought to the hospital? How is The Cloverleaf an important part of this story?
The man calling for rescue in the middle of the night was looking to steal supplies or goods from families and patients and staff in Memorial. The best way to steal was to cause chaos in the middle of the night while everyone slept and get everyone to believe that rescue really was happening then and there. Everyone was already exhausted and the guy showing up made it worse because it was a hoax, and it caused a lot more worry for everyone about being rescued.
The Cloverleaf is a SARBOO – Search and Rescue Base of Operations – aka lily pads – the goal was to have a set up to collect patients and people who needed rescuing when the Coast Guard dropped them off. It was patch of dry land off Interstate 10, but it was a disaster because it was not organized at all. People were dropped off on grass, but there was no triage, no medical supplies, no water and food, or clothing and blankets for those in need – it was a drop site for helicopter after helicopter of rescuers. The Cloverleaf (highway interchange) was also the place Mark LeBlanc and his wife Sandra drove to so they could get on airboats and find a way to get to Memorial to rescue Mark’s mother Vera and her sitter. Sandra was an EMT paramedic, and she got herself and Mark volunteer badges to get into emergency medical sites – SARBOO aka The Cloverleaf (highway exchange) or Lilypad.
3. When Mark LeBlanc enters the hospital to save his mother he is taken aback by the tone of resignation among the staff. Is he just viewing the situation from an outsider perspective, as someone who did not spend the past 48 hours lifting patients to the helipad for rescue, or does he have a point?
On pages 118-119 Mark LeBlanc and his wife Sandra got a distressed phone call from the bedside sitter for LeBlanc’s mother Vera LeBlanc – the sitter told LeBlanc about Life Care patients – nurses were “freaking out” and patients were dying and there was nowhere for the dead to go. The sitter wanted Mark LeBlanc to see how horrible it was in Life Care and to rescue his mother and her from this mess. On page 132-135 Mark LeBlanc is viewing the situation from the outside to start, and he and his wife didn’t understand who was helping evacuate Life Care and why was the hospital campus last priority to evacuate. LeBlancs decided to help Diane Robichaux (Life Care nurse) who needed their cellphones to get emergency ambulances to pick up Life Care patients like his mother in certain locations after being airboat rescued to the locations. Mark had a point too; because the hospital might have been in survival mode, but it should not have stopped being in treatment mode. His mother needed IV fluids and antibiotics and the hospital could not provide that level of care at that time.
4. Did the priority system for evacuating patients fit within accepted triage practices? Why or why not? Is a utilitarian approach the best? If not, which approach do you think is superior? Discuss the difficulties inherent to practicing triage medicine. Which approach is best for Organ Sharing?
The Ranking System was not an acceptable triage practice as it allowed those patients ranked as rank 1 as non-life-threatening patients who could be evacuated easily as first to go. Rank 2 were worse off patients but could be evacuated by helicopter with staff help – they were second to go, and rank 3 were the DNR patients who were on ventilators and machines to stay alive in Life Care. It would be harder to save Rank 3 patients since they were worse off, required such a high level of care and deemed the last priority to go. It was not the best system or approach at all to getting all the patients to safety and keeping them alive. The goal of the ranking system had been to speed up the evacuation and get patients saved quickly. It did more harm than good because many Life Care/Rank 3 patients died.
As for organ sharing, which is disaster triage-based practice, the sickest patients who were less likely to survive are top priority for organ transplants. And health professionals were more for systems which allowed directing organs to patients who would most likely medically benefit from getting the transplants. The doctors had to come up with an allocation of organs for transplanted patients that suited all – just and efficient organ transplant list. Page 140-141
2. Why were pets brought to the hospital?
The pets were brought to the hospital before Hurricane Katarina hit. These pets belonged to the staff and families at the hospital. They were kept in pet crates in a hospital garage. The staff and families began to worry about how the pets were going to be rescued since the airboats won’t take pets.
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