Flood Warning | ENA Connection November 2022

In late July, a series of thunderstorms led to deadly river flooding across eastern Kentucky / Photo by Kentucky National Guard

Flood Warning Unexpected weather disasters this summer in Eastern Kentucky drive home the importance of emergency planning and practice

By Matt Hanley ENA CONNECTION CONTRIBUTOR

16 | November 2022

I

n the hollers of Eastern Kentucky, rain is part of the landscape. Hollers are the valleys between all the hills, and the only flat land is at river bottoms — so these areas have flooded for centuries.

“We prepare for floods, but I don’t think anybody really expected this valley to get this much rain,” said Dale Morton, MSN, RN, EMT, executive director of emergency, & transfer services for Pikeville Medical Center in Pikeville, Kentucky. “There wasn’t anything that threw a red flag about this storm.”

On the night of July 27, two thunderstorms collided and unloaded. Two feet of rain fell over four days, causing extraordinary problems. Homes were wiped away. Thirty-nine people were killed.

Dale Morton, MSN, RN, EMT

The floods challenged the region’s emergency departments in unprecedented ways. Despite the challenges, many found their preparedness held up.

“Eastern Kentucky is resilient, stubborn. We’re all family, all neighbors,” said Andrew Maxwell, BSN, RN, emergency department director for Hazard ARH Regional Medical Center in Hazard, Kentucky. “I could not believe how the nursing community pulled together. I can’t talk about it without getting goose bumps.”

Eastern Kentucky is resilient, stubborn. We’re all “family, all neighbors. I could not believe how the nursing community pulled together. I can’t talk about it without getting goose bumps.

”

— Andrew Maxwell, BSN, RN

From the moment Maxwell woke up that day, his phone was dinging. He headed for work — normally a one-hour drive.

About a third of the way there, he reached the bridge he crosses every day. It was under 6 feet of water. Then the phone stopped dinging. Cell service was out.

‘Everything Is applicable’ The ENA Emergency Management and Preparedness Committee meets monthly to review policies and procedures. With members across the country, its wide geographical representation allows it to hear from teams that face many different emergency situations—from floods to terrorist attacks. Committee members stress the importance of the entire ED staff knowing how to access the basic plans: Know who you will notify first, what steps you have to take and how you will move and track patients.

These initial steps can be used for almost any basic disaster plan, said Angie Lee, MSN, RN, CEN, NDHP-BC, chair of the committee.

Angie Lee, MSN, RN, CEN, NDHP-BC

“Everything is applicable — at least in the beginning,” Lee said.

Planning Ahead Sixty miles away, Morton got his first alerts the new-fashioned way: Facebook. People were sharing photos of small creeks flooded beyond belief. Morton knew all that water was headed for his community.

He opened the Crew App and started a roll call.

As they drove to their separate EDs, both Maxwell and Morton were working through the same problems. This wasn’t going to be

a single-rush event like a car accident; this would play out over days. They started to calculate what staff could get there immediately, who should come in later and where to put patients. It took Maxwell two-and-a-half hours to drive to work. The rotation that should have left at 7 p.m. the night before had volunteered to stay. Two people scheduled to work couldn’t get in; eight others volunteered. With power and internet down across the area, they couldn’t reach anyone else.

A Kentucky National Guard flight crew aid in flood relief eff orts on July 29 / Photo by Kentucky National Guard

When it comes to emergency preparedness, hospitals plan, practice and drill over and over. There will always be things one learns along the way. Lee remembered Hurricane Sandy flooding a New York City hospital’s basement, disabling their backup generators.

Emergency nurse Andrew Maxwell, BSN, RN, found swift water crossing a road near his hospital, Hazard ARH Regional Medical Center

“It takes not just an emergency department but an entire hospital system to respond to a disaster,” she said. “During a disaster, you may be asked to do something outside your role but not outside your scope of experience. Being prepared doesn’t have to be a specialty.”

Emergency planning used to take place in silos. No more, Lee said. Now it’s all about collaborative drills that go ena.org/connection | 17

ed bring Kentuck y State Police help Medical l iona Reg ARH to ents pati Max well rew And by to Pho / ter Cen

beyond the hospital; police, EMT and others observe and participate. Close coordination across diverse teams is essential in a disaster.

Lee recommended having enough supplies on hand for staff and patients to shelter in place for 72 hours, if needed.

‘It Broke your Heart’ When Maxwell arrived at his hospital, few patients had been able to make it to the hospital. The team readied supplies and lined the hallways with beds. The National Guard called, asking for the weight limit of the hospital’s helipad. No one was sure, so the hospital arranged for landings across the street.

The Black Hawk helicopters brought people who’d been in rushing water for hours.

“Head to toe, they were just beat to hell,” Maxwell said. “It looked like someone had whipped them with barbed wire.”

There were hypoxia cases whose oxygen machines had shut off when the power went out. Some were dead on arrival.

“Every single one of these patients were trauma alerts,” Maxwell said. “I’ve never seen anything like it in my life.”

One of the first to arrive at Morton’s ED was an elderly woman who had been rescued from her attic, where she’d been sitting in water. The team piled blankets on her. Still, she kept asking for something warm.

“It just broke your heart,” Morton said.

A Kentucky National Guard crew aids in flood relief efforts on July 29 / Photo by Kentucky National Guard

18 | November 2022

Points of Pride As patients arrived, so did a call from a nursing home that needed a place for 52 patients. Morton was fortunate; a portion of his hospital was being repaired.

Bring ’em over, Morton said.

A bus — driven by the town’s mayor — pulled up with patients, many without medication or records. Pikeville ended up housing the nursing home residents for three days.

Both Morton and Maxwell learned lessons along the way.

Because nearly all the patients had been in the water, they needed tetanus shots. The Hazard ED eventually ran out and switched to the tetanus, diphtheria, pertussis vaccine.

An extra supply of tetanus shots and knowing the helipad weight limit will be a part of future emergency plans.

They’ll also look into whether Hazard Medical Center can have an independent cellular network.

The floods brought new problems, but the team met the challenge. At some point, Maxwell realized patients were ready to be discharged but had nowhere to go. Their homes had washed away; they had no clothes and no vehicle.

The hospital staff collected about $6,000 from their team and friends, buying plenty of socks, underwear and other essentials at a local store.

“We wanted to preserve some kind of dignity for these people who had been through so much,” Maxwell said.

During the worst of it, Maxwell kept telling his team: We’re soggy and moist, but we’re here. We practice for this, he said. You’re ready.

“If we had not taken emergency management as seriously as we did, we would have been overrun,” Maxwell said.

“You have to have a plan and back up to your back-ups.

Then you’ll be able to execute your plan smoothly. If you’re going to boil it down to one line, it’s the old Boy Scout adage: Be prepared.”