Rescue & Vehicle Extrication

Coordinated Response Delivers Specialized Medical Resources During Hurricane Florence

“Leading our community to outstanding health” isn’t just the mission of New Hanover Regional Medical Center (NHRMC), it’s a motto that every team member lives by. Never was this more evident than in the early morning hours of Sep. 14, 2018.  

As the eye of Hurricane Florence approached Wilmington, N.C., NHRMC EMS coordinated their responses to 9-1-1 calls with the Joint Command Center (JCC) that included fire department leaders from the city of Wilmington and New Hanover County.

Around 3 a.m., sustained wind speeds began exceeding 50 miles per hour, which is when NHRMC EMS ceases responding to 9-1-1 calls. During this “shutdown phase,” 9-1-1 calls received by the Public Safety Communications Center (PSCC) are triaged by NHRMC staff until such time that the sustained winds allow for safe emergency vehicle responses.

A Frantic Call

Just after 7:00 a.m., the PSCC received a frantic 9-1-1 call: A large tree had fallen on a house, entrapping a family. Recognizing the gravity of the situation, a call was placed to the JCC. Following a risk assessment, a four-wheel drive response vehicle was dispatched with two paramedics, one of whom was a special operations paramedic trained in extrication and providing medical care in enclosed spaces.

What normally would be a three-minute response took 15 minutes, as the team had to navigate around flooded roads and downed trees, they arrived shortly after Wilmington Fire.

By this time, the eye of Hurricane Florence was beginning to make landfall, with winds ranging from 70–100 miles per hour.

Once on scene the special operations paramedic found a large oak tree had fallen over the corner of the house crushing two walls and pinning a patient.

The Wilmington Fire Department worked to stabilize the tree with cribbing and airbags, to prevent the tree from falling further while the special operations paramedic assisted with removing heavy debris from the confined space.

After several large branches were removed, additional stabilization became necessary. This was completed while the special operations paramedic coordinated with Indiana Task Force 1 to determine the best method for accessing the patient in order to initiate patient care.

An ambulance was requested to the scene and the paramedic again made a request for specialized resources.

A VitaLink Critical Care Transport ambulance responded with a complete trauma team from NHRMC, marking the first time a trauma team had been taken into the field on board VitaLink, as there was a potential need for field surgical intervention.  

After four hours of scene management the patient was extricated.

Lessons Learned

An after-action was completed within the JCC and within NHREMS following the hurricane and several items were highlighted.

This coordinated response throughout the hurricane was only successful because all key public safety leaders were in one JCC. Having everyone together allowed a simultaneous risk assessment to be completed by each service line (fire, EMS and police) and share their results before acting as a synchronized public service in their response.

Leaders identified that if one service line had responded vs. another (e.g., fire but not EMS) during the “shutdown phase” that the mixed messages to citizens could have been disastrous.

Since Wilmington is a hurricane-prone coastal town, the public services have written plans for JCC operations and annually complete tabletop drills to test coordinating responses during hurricanes. Regular practice led to successful coordination during this event.

NHRMC EMS immediately made their EMS chaplain available to all the paramedics as well as other public safety providers who responded, in order to provide emotional support and critical incident stress management.

It was also identified that having a special operations paramedic with specific training in confined space patient care was essential to this incident’s success. It was noted that special operations paramedics require an incredible amount of additional training and that it’s a necessary component to a comprehensive EMS system. It’s unlikely that there would have been a response during the “shutdown phase” of the hurricane without having a special operations paramedic.

It’s noteworthy that NHRMC EMS regularly plans for extended disasters such as hurricanes. Several protocols and standard operating procedures are in place that define the disaster-related coordinated chain of command, risk assessments, and the timing for and coordination of “shutdown phase.”

An opportunity for improvement that was identified in the after-action was that the development of standardized criteria for considering a field surgical team response should include the types of calls when a team may be requested. In addition, it was identified that preplanning the staff for a field response team is essential, including a checklist of supplies to be taken into the field.

Conclusion

Overall, this coordinated response during the most intense portion of Hurricane Florence was an incredible success due to the careful planning of all of the public safety personnel in Wilmington.

It’s important that anytime EMS responds to a high-intensity and low frequency call that an after-action review be completed and that both highlights and opportunities for improvement are identified.