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Bariatric Evacuation Proves Challenging for Providers

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While they tracked the path of Hurricane Irene, the leadership team of New York’s SeniorCare EMS (SCEMS) knew that their call volume would be affected. So on Thursday, Aug. 25 at 8 p.m., after New York City Mayor Bloomberg ordered for the evacuation of all health-care facilities in low-lying areas—zone A—be completed by 8 p.m. the following day, the team activated an emergency response plan.

An Emergency Operations Center (EOC) was established, and an emergency meeting of all supervisors was called on Thursday at 11 p.m. to strategize the evacuation of the contracted facilities in Irene’s path. As requests for evacuations came in from multiple facilities in the evacuation zone, SCEMS dispatched a supervisor to each facility to act as an on-site coordinator to ensure the safe and efficient transfer and tracking of patients.

Operations began at 8 a.m. on Friday morning and continued for the next 36 hours. SCEMS predicted the Brookhaven Rehabilitation & Health Care Center would be the most challenging facility because it contains the largest bariatric unit in the state. More than 30 bariatric patients located on three floors needed to be evacuated. Two Brookhaven supervisors and six SCEMS logistics staff members were assigned to supplement the eight bariatric ambulances assigned to transport the 30 patients.

Evacuation Begins
On arrival at the facility, one supervisor was posted in the lobby to coordinate the staging and departure of ambulances, and another supervisor went upstairs to evaluate and triage the patients. One of the first patients that needed transport presented a logistical problem because he required transport in a prone position due to his weight. In addition, the bariatric stretcher needed to be operated from the lowest position because it couldn’t handle the weight of the patient in the elevated position. A special Hoyer lift was used to place the patient on the stretcher, and six crew members were able to safely monitor and lift the patient into the ambulance.

Many of the other patients were apprehensive about leaving the facility because they hadn’t been outside in quite some time. While the team moved one patient to the staging area, the patient asked the crew to stop for a moment. When the crew asked why, the patient said, “I haven’t been outside in four years. I just want to feel the rain on my face for a few minutes.”

Another source of concern for some patients was the possibility that they would be dropped. Their average weights ranged from 500–700 pounds, with the heaviest patient weighing 1,005 pounds. All patients were reassured that SCEMS had the necessary manpower, skill and compassion to safely transport them. Each patient was packaged with his or her medical chart, medications and belongings for the 42-mile trip to a temporary facility in Long Island.

Conclusion
Overall, SCEMS successfully evacuated 435 patients from 13 skilled- nursing facilities, five adult homes and two hospitals—in addition to responding to non-evacuation-related emergencies and regularly scheduled transports—in a little more than 30 hours.

After the hurricane passed and most New Yorkers went back to their normal activities, the SCEMS team was only halfway done. All the patients that had been evacuated needed to be returned to their original facilities. SCEMS returned 323 patients to their facilities over the next three days.
They credit proper planning and appropriate staffing for their success. SCEMS is pleased to report that no staff suffered any injuries during the operation, and no adverse incidents were reported.

Lessons Learned
The key lesson SCEMS staff learned was the importance of setting up an EOC as soon as possible and appointing a dedicated controller in the communications center to manage resources for the event and on-site coordinator at each facility. This allowed regular operations to continue business as usual while efficiently managing the evacuation.

Another lesson learned was the necessity of a good notification system to notify and recall staff members who were off duty in order to increase the amount of available units. This proved most valuable at Brookhaven, where, due to the number of bariatric patients, senior staff knew they could use all the manpower they could get.
 

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