Five Days at Memorial Epilogue – Module 15

1. What did Dr. Evans learn from Hurricane Katrina to help her navigate the dilemma of the six power outlets? What questions remain?

Dr. Evans had to use NY guidelines in how to allocate ventilators in a severe respiratory pandemic using a scoring system that estimates how severely ill someone is. She had to make an ad hoc committee that could help make the decisions about which 50 patients get to use the six outlets in case all the other outlets had no power due to an outage during the storm. It was not a role for one person, and it had to have professionals that were ethnically sound to make these decisions. They needed to have a transparent process that they could describe if they were taken to court. They made their decisions about which patients on a list would get to use the outlets within two hours. There are two problems that remain since Katrina, one is communicating to patients and families about triage decisions. And two is, they did not think about informing families when it came to who would be able to use the ventilators connected to the six outlets, even though the families had a right to know.

2. Put yourself in the shoes of Sheri Fink in NYC as Hurricane Sandy draws near. What changes took place in disaster planning post Hurricane Katrina? What remains unaddressed? Why? How does this story impact your feelings about the AMA?

As for hours before Hurricane Issac in New Orleans, Fink saw the Ochsner Baptist was fully evacuated. North Shore ILJ Health System company were offering help to all their hospitals in the area unlike what Tenet did not do for its hospitals during Katrina. Fink was “dismayed” when staff had never thought of what to do when the backup plan failed, and the power went out. The AMA is still not providing guidelines and guidance on what to do in the event of natural disasters and how to protect medical workers who must work through these storms.

3. Analyze the strengths and weaknesses of Maryland’s approach to disaster planning. What does Fink mean when she says that “Sometimes individual medical choices, like triage choices, are less a question of science than they are of values” (465)

Maryland’s approach to disaster planning is community based. Maryland health professionals seek input from the general population based on values to find the solution to triaging patients in an emergency. This design has flaws – the first flaw is poor neighborhoods which surround Johns Hopkins have little trust in medicine. Another flaw is, there are too many valued opinions from the public making it hard to find the best framework for the emergency triage system during a natural disaster. There were concerns about who would be picked to go last to be rescued in an emergency triage situation – if all the old went first, the young in society would suffer without guidance and if all the young went first, society would die out.

4. How does this story impact your feelings about the AMA? The justice system?

This story does not impact my feelings about AMA, only that AMA needs to create more guidelines on what healthcare workers can do during natural disasters and every area in the US needs to have a seriously fail proof prepared plan for what to do in a natural disaster. The story does not impact my thoughts about the justice system. If the AMA had guidelines for palliative care that took into consideration emergency medicine in natural disasters which resemble battlefield conditions, Pou, Landry and Budo would never have gone before a grand jury in the first place. Justice was served in the case of Pou, and it did not fail her. It did fail the families of the dead patients because the families did not testify before the grand jury in Pou’s case. This led to families being able to sue in civil suits against Pou, Landry and Budo.

5. Do you agree with the statement by Roger Bernier, “I’m not sure we believe in democracy in America” (469) Why or why not?

I agree with Bernier because our country should utilize public opinions when making public policies in healthcare. America is supposed to be built on democracy and there are times when government and experts praised by the government make the policies for the public (and not so much the public making the decisions). Our first amendment right is freedom of speech – Americans should be able to speak their minds in a democracy, especially when it comes to our own public opinions for healthcare policies.

6. It seems that no policy can replace swift thinking and a steady stream of hope in a crisis. To quote Fink, “Life and death in the immediate aftermath of a crisis most depends on the preparedness, performance and decision making of the individuals on the scene.” (468) How can your education prepare you for making the right decisions in such a situation? What wisdom does this book offer? What will you do with it?

Fink’s quote is discussing emergency triage regarding her own great uncle and his experience. He had his DNR removed after being hospitalized on a ventilator because he wasn’t ready to die yet. In his case no matter how prepared he was, he used his own swift thinking and it led to him spending more time with Fink before he died. It still depends on the individual to decide when they want to die and what will happen when they are faced with a situation that will lead to death.

I hope my nursing education will prepare me to communicate effectively and make the right decisions with the best knowledge in an emergency. This book gives me the wisdom of what not to do as a healthcare professional during a natural disaster and shows me the mistakes that were made before, during and after Hurricane Katrina.

• This topic was modified 1 year, 1 month ago by Carrie Anne Weeks.
• This topic was modified 1 year, 1 month ago by Carrie Anne Weeks.