ED in the Aftermath

Hospitals have a hurricane plan in Florida. The employees of the hospital are split into two teams: Team A, and Team B. Team A reports to work about six hours before the storm begins and remains at work until the storm has passed. Team A is divided into a day and a night shift, and they sleep in unused rooms of the hospital for the duration. Team B reports to work once the storm has passed, and works shift work until the hospital returns to normal operation. Team B gets to go home when they are not actually working.

There are benefits to both teams. Team A gets paid for the entire time they are there, and even though the rate of pay is lower while you are sleeping, you ARE still getting paid to sleep. Even when Team A is actually working, there isn’t really much work to do, as no one comes into the emergency department during the storm. During Hurricane Milton, there were 98 nurses on Team A, and they had a total of 12 patients.

Team B gets to go home when their shift is over, but your home may not have power, and the hospital is usually really busy. You definitely earn your money. There are no mid shifts on the hurricane teams- there is only Day shift (7 am to 7 pm) and Night shift (7 pm to 7 am).

The team you are on is up to you. In March of each year, they ask everyone what team they would like to be on for that hurricane season. I would rather be home caring for my wife during the storm, so I always select team B.

Team A reported to work at 7 am on Wednesday. They stayed at work until Friday morning at 7 am. That’s when Team B came in. I was on Team B days for Hurricane Milton. I was assigned to the Red zone, and I got the three lowest numbered rooms: room 4, 5, and 6. Since they are the lowest numbered rooms, you have two jobs- you support the nurse assigned to the three trauma rooms and take care of the sickest patients.

Let me tell you, there was a lot of sick people in the aftermath of Milton. On day one, every sedentary 50-something year old man who was trying to clear storm debris found out whether or not his heart was healthy. I had a parade of middle aged men who reported the same complaints- “I was working outside, cleaning up, when all of a sudden, I got dizzy, cold, and broke out in a sweat, then my chest and left arm started hurting.”

I sent half a dozen patients to the PCU on day one. I was slammed with unstable cardiac patients with high troponin levels who had to be Heparinized. The very first patient of the day had been clearing storm debris and felt tired, so went inside the house to lie down. There was a generator running in the garage. When the wife went inside, she found him lying on the floor, gasping like a fish. He didn’t make it. His CO levels in his blood weren’t really elevated, so it looks like a heart attack from exertion. Hurricane related death.

I went home exhausted, got home at about 8 o’clock, and was in bed asleep by 8:45.

Then came day two. That day was stroke and sepsis day, on top of the heart attacks. Some of the high points:

• I had one patient who was on four different drugs for the heart attack she was having, and I took her to the ICU with a central line, heparin, amiodarone, and pressors running. I was glad to get rid of her, she was taking a lot of effort to care for.
• Then there was the nursing home patient who pulled out his G tube during the hurricane.
• There was a woman who came in complaining of a headache, dizziness, and vomiting since Wednesday night. At first I wondered why triage sent her to my rooms, but they must have had a hunch. Her head CT showed a large area of infarct (dead brain) in the rear of her brain. She had a stroke during the hurricane, but didn’t come in until it was to late to give her TPA. The damage is permanent.
• A guy who was working in his yard when his 4 pit bulls who were overstimulated from all of the activity decided to use him as a chew toy. He had over 40 puncture wounds, including his cheek being ripped open to the point where you could see his teeth while his mouth was closed. They also tore off his right ear, and tore a 3 inch gash in his right thigh. The man’s brother came in an hour later to tell my patient that he had shot all 4 dogs because he couldn’t get them under control.

Most of the day, our 100 room department had only 30 or 40 patients. So, at 3:30, admin decided to send a quarter of the nursing staff home to save money. I took over one of the trauma rooms, so that I had Trauma 3, 4, 5, and 6 as my rooms. At 4 o’clock, all hell broke loose. I went from having 2 patients to having 4 in less than 15 minutes- with one of them being my sickest of the day:

A woman who was in septic shock that came to me unresponsive with a Lactic acid level of 3.4 and a white blood count of 24. Her blood pressure kept dropping- at one point to as low as 72/50. Her rectal temperature was 96.4 degF. Cold sepsis as it is called, is a very ominous sign. Patients in cold sepsis are frequently on death’s door, especially when they have a low blood pressure. She got three IV lines, 3 liters of lactated ringers, as well as the antibiotics Vancomycin and Rocephin.

I got her stabilized, but then she started shitting watery diarrhea every 5 minutes. I had to stay late to help night shift clean her up. I also earned points with the night shift by inserting the Flexi Seal for them. If you don’t know what that is, it’s a plastic tube you stick up a person’s ass, and it directs fecal matter into a bag. Ah, the glamorous side of nursing that no one tells you about.

So I got home from day two at about 9 pm, and was in bed by 9:30. I slept in on Sunday.

That’s it for my work journey from Hurricane Milton.