Hurricane Matthew: Stories from the Front Line

Beginning as a tropical storm 35 miles southeast of St Lucia on Sept. 28, 2016, Hurricane Matthew explosively intensified as it tracked across the Caribbean Sea. Matthew became a hurricane 190 miles northeast of Curaçao on Sept. 29. It ultimately achieved Category 5 intensity the following day, the first hurricane of that intensity since Hurricane Felix in 2007. Hurricane Matthew wrought widespread destruction and catastrophic loss of life during its journey across the western Atlantic, including parts of Haiti, Cuba, Dominican Republic, the southeastern United States and the Canadian Maritimes. More than 1,600 estimated deaths have been attributed to the storm, which also caused damage estimated in excess of $10.5 billion. Although Matthew was initially projected to make a direct hit in the Palm Beach area, and wreak havoc up the Florida Coast, as the storm approached, it veered eastward a few degrees. This lucky turn meant that Matthew was not as devastating as predicted, although part of the downtown area of communities such as St. Augustine and Jacksonville were flooded. Before and during the storm, hospitals in these coastal Florida communities transferred patients to our facilities in Gainesville and Jacksonville. Thus, as Hurricane Matthew battered the Florida Coast, faculty and staff at our Gainesville and Jacksonville campuses pulled together to overcome many challenges. These are some of their stories.

UF Health North (Jacksonville)

While UF Health North stood strong during the storm, inside its walls employees worked tirelessly to keep patients healthy, happy and safe. Ginny O’Quinn, an X-ray Technologist at UF Health North Radiology, began preparing for Hurricane Matthew early, knowing she would be at work rather than at home with her loved ones. “I prepared ahead of time, so I had my family taken care of by Wednesday. I was at ease and I felt totally safe here knowing my family was safe and I was in a safe place,” she recalled. O’Quinn spent most of her elongated shift — from 9 a.m. Thursday to 10:30 a.m. Saturday — performing X-rays in the emergency room. She says they saw numerous patients involved in auto accidents during their own disaster preparation errands. Later, as hospitals in Camden County, Georgia, began closing, patients were evacuated to UF Health North for safety. As expected, O’Quinn and her fellow staff members also saw a major influx of patients in the ER after the storm began to dissipate. “Immediately after the storm had passed, it started getting crazy right away, with people up on their roofs. It’s like they were waiting on that moment for the meteorologists to say ‘OK, it’s passed,’ and everyone started flowing in,” she said. What O’Quinn says she remembered most was the feeling of togetherness. Not only did staff members unite to provide continuous care, they also ate meals together and took turns sleeping so everyone could stay rested. “It was a lot of teamwork,” she said. “It was a small team and it was almost like a sleepover.”

UF Health Jacksonville

While power remained intact throughout the storm at our hospital facilities in Gainesville, there was a power outage at the Pavilion hospital tower in Jacksonville, which ran on generator power for several days during and after the storm.

In some respects, George Thomas, an Employee Relations manager with UF Health Jacksonville Human Resources, played the role of hotel manager and front desk clerk during Hurricane Matthew. “This was our first time having to facilitate sleeping arrangements for staff,” said Thomas, who’s been at UF Health Jacksonville for more than 15 years. “We definitely had to be creative.”

Thomas worked with others to arrange sleeping space for staff who stayed overnight to work during the storm. The lodging component was an extension of HR’s “manpower pool” responsibility in making sure the hospital had adequate staffing Thursday through Saturday.

HR placed overnight employees primarily on the second and third floors of the Clinical Center. Spaces included conference rooms, the cath lab waiting room and a vacant space that once housed the Quality department. Staff also slept in the Ambulatory Care Center. Employees were given hospital mattresses or “egg crate” pads, while some brought their own blowup mattresses, pillows and blankets to make the experience as comfortable as possible. Thomas said everyone who needed to stay had a place to sleep as well as showers and dressing rooms.

While the sleepovers were a success, Thomas said HR is now looking for ways to improve the efficiency of the process in the event of future disasters.

“There were a lot of lessons learned. It was an interesting experience. We worked through it and did what we could to ensure staff got the rest they needed to provide the best care possible for our patients.”

In the Radiology department, preparations for Hurricane Matthew started days prior to the storm’s arrival with a special meeting called by Barry McCook, M.D., chair of radiology, to identify the physicians who would stay to ensure adequate coverage during what could potentially be a direct hit by a Category 3 hurricane. According to Daniel Siragusa, M.D., a professor of radiology, “he presented not only the coverage plan, but also information on how to prepare for an extended overnight stay since many had never experienced a hurricane of this magnitude.” In addition to Dr. Siragusa, three other faculty members — Inbal Cohen, M.D., Chris Klassen, M.D., and Savas Ozdemir, M.D., — were stationed in the hospital. “There were also three very calculated shifts of residents, ensuring not only adequate coverage throughout the storm, but also guaranteeing compliance with ACGME hourly duty requirements,” he explained. “I would like to commend the efforts of two senior residents, Steve Beasley, M.D., and Matthew Jenson, M.D., who volunteered to work the first shift as they had already implemented their own hurricane plans with their families. This set an incredible example of teamwork right from the beginning.” Dr. Siragusa said a team composed of supervisors, nurses and technologists made an “interventional radiology campground” inside the department. Those who did not reside in the IR campground made their own overnight accommodations with sleeping bags and other comforts of home in their offices, call rooms and resident call quarters. “Radiology services went very smoothly, and those individuals involved in the care of our patients over the period of the storm were a tremendous team. I have never been so proud to be part of a group of medical professionals who stepped up to a challenge as ours did during Hurricane Matthew,” he said. Nurses are the heart of health care. This was never more evident than during Hurricane Matthew. “In times of need and stress, humans demonstrate what they are made of, and I am proud to share that our team really displayed their best colors,” said Ileana Martinez, R.N., nurse manager, Pavilion. During their 24-to-36-hour shift, nursing and other staff worked in many roles in addition to nursing. In the Pavilion, for example, Lillian Robinson, clerical associate, 5 South, started the planning process for a staff of 24 by arranging the supplies and organizing the forms and logs that were used for every patient. William Holy, patient care associate, 5 South, and Marcus Hollins, clerical associate, 5 South, assisted Robinson with making the sleeping arrangements for employees who stayed on-site to work through the storm. As staff was arriving, David Rodriguez, clerical associate, 5 North, and Marcus ensure the accommodation process was in order. When spaces quickly filled up, Adam Megill, patient care associate, 5 South, got extra beds from the basement and rearranged recliners to ensure everyone had a place to lay their heads. “The team even scoured the building for working appliances to use to keep meals, for both patients and staff, properly stored after the power went out,” said Martinez. In addition, the group served as back-up relief for other areas that did not have as many team members. While sacrifices were made by all, Jackson Bonnet’s, patient care associate, 5 North, passion and dedication for the patients and team stood above the rest when he completed his shift despite losing two relatives in Haiti to the storm. Like many nurses in Jacksonville, Tara Balsamo, R.N., who works in the UF Health Jacksonville Trauma Center, prepared to head into work Thursday, Oct. 6; however, this time was different. Instead of a 12-hour shift, Balsamo packed her bags with essentials for an extended stay, depending upon the severity of Hurricane Matthew. “I brought food and water from home on Thursday and planned to work until Saturday evening,” she said. Since precautions had already been taken and preparations made well in advance of the storm, staff members were confident that operations would run smoothly. The Trauma Center wasn’t as busy during the storm as Balsamo anticipated, so employees were able to relax once their shifts had ended. This allowed for team bonding during off-shift hours. Balsamo said morale was high and everyone was willing to help out wherever necessary. She assisted in the Medical Intensive Care Unit part of the time. “Activity picked up throughout the hospital once the storm had passed, especially in the Trauma Center,” she said. “We saw many patients injured from cleaning up damage caused by the hurricane.” Balsamo’s first hurricane experience since joining UF Health Jacksonville turned out to be a successful event, she said, thanks to team bonding and the atmosphere created by the hospital leadership team. Other support services were also proactive in their planning. The UF Health Jacksonville Respiratory Care department divided two 12-hour shifts into three eight-hour shifts to ensure there was adequate coverage during the storm. The concern of Mark Conner, respiratory therapist, was always his patients. “Our patients really depend on us because you have to breathe to survive,” said Conner. “We were able to provide all of them with their treatments on schedule. We didn’t have any complaints.” Conner worked a double shift Friday, Oct. 7 and was the charge respiratory therapist from 7 a.m. to 11 p.m. He made sure there was enough staff to monitor the roughly 125 patients under their care at the time. “We really pulled together and chipped in that weekend. Everything went really smooth,” he said. Respiratory therapists manage the ventilators in the ICU, perform the pulmonary function tests that are used to diagnose lung disease, and deliver respiratory care throughout the hospital and in the emergency room. They also spend time educating chronic lung disease patients about their conditions and the medications used to treat them. “The only thing we didn’t do that day was assist with transports,” Conner said. “We didn’t have any elective transports because we didn’t know if and when we would lose power.” Prior to the storm, Respiratory Care pulled out all of the extra ventilators in case there was a disaster during the storm. They made sure all of the equipment was calibrated and the batteries were fully charged. “No one was really nervous during Hurricane Matthew because we were prepared for whatever blew our way,” Conner said. “Fortunately, the storm was not as bad as we expected it to be.”

UF Health Shands Hospital

In the days leading up to the storm, the number of patients on UF Health Shands Children’s Hospital Pediatrics Unit 44 decreased as physicians rescheduled surgeries and safely discharged patients. The unit leaders were faced with a choice: temporarily cut back on staffing or offer up the vacated space for patients from other units. Marie Kasprow, M.S.N., ARNP, Pediatrics Unit 44 nurse manager, as well as her team, chose to stay and help. Preparations began after the 7:45 a.m. bed meeting on Wednesday. The team received confirmation that patients from hospitals on Florida’s east coast were being transferred to UF Health Shands. Current patients would need to be moved to free up bed space for those being evacuated. On Thursday, seven adult patients were transported to the pediatrics unit. “My team and I understand the responsibility our hospitals have to this community and to the state of Florida,” Kasprow said. “We had resources available to meet the health care needs both of our current pediatric patients and those we received from other units — we were pleased to be able to help.” The staff coordinated with UF Health Shands Supply Chain Services, the UF Health Shands Pharmacy department and other teams to receive the necessary equipment and supplies. They met with families of their pediatric patients to let them know about the changes, then worked with experienced adult nursing and clinical teams to help care for the incoming patients. “I’m extremely proud of my team,” Kasprow said. “My nurses not only had to handle the day-to-day, shift-to-shift pediatric care responsibilities, but they were also helping with adult patients. They did a fantastic job and it was truly an interdisciplinary team effort.” Erika Meyer, R.N., a nurse on the Medical Intensive Care Unit 11-4, worked the Thursday night before the hurricane, and then came back in at 11 a.m. Friday. Meyer and four others slept on blankets on a conference room floor until they started work on Friday evening. The biggest challenge was absorbing an influx of patients from hospitals in Flagler County and coastal Georgia. Making room in the 24-bed unit was very much a balancing act: Caring for the existing ICU patients while being flexible enough to accommodate the medically fragile new arrivals from more storm-battered areas. “We were absolutely slammed with patient arrivals. It was one right after another,” she said. Everyone in the unit pulled together to providing seamless patient care despite the influx of patients. It got quite challenging at times: Other hospitals use different methods for determining drug doses, meaning the Shands staff had to make quick, accurate calculations to assure the continuity of medications “We were putting all these new IVs in everyone and trying to switch everyone over to our medications and dosing calculations. It all worked out OK, but it was definitely a busy and challenging night.” The ICU staff also had to be prepared for the arrival of patients who use ventilators at home. For them, a power outage can be fatal. Careful planning and coordination kept the ICU at capacity, with some patients being downgraded and moved to an intermediate-care unit. “We made accommodations for every patient who needed to be in the ICU,” Meyer said. As she became aware of the approaching hurricane, Diamond Rudder, R.N., left her cats and headed for UF Health Shands Hospital. While the many trees surrounding her home worried Rudder, she also knew that focusing on the influx of ICU patients was crucial and her most immediate concern. “Everyone was stressed about their homes, yet we knew we still had to do our job,” she said. That spirit of teamwork is what held the ICU staff together as they took on the challenge of coping with waves of arriving patients, she said. About 10 patients were brought in from coastal hospitals in northeast Florida — enough to account for nearly half of the ICU’s beds. Some of those patients arrived with different equipment such as intravenous pumps and tubing, adding another challenge to a busy shift. Everyone pulled together, and Rudder said it felt good to know that any patient overflow could be accommodated because nursing staff members in an intermediate-care unit also have ICU training. When she first arrived to work, Rudder said that she knew it was going to be a different kind of night when she spotted hospital staff carrying sleeping bags and pillows. “Everywhere you looked, there were people in pajamas,” she said. “It shows how committed everyone is to our patients at UF Health Shands. You have to be dedicated to sleep on a hard floor.” These are just a few of the many stories that comprised the response of UF Health’s dedicated faculty and staff to the needs of our patients during Hurricane Matthew. Working as teams that made moment-to-moment adjustments in a changing and uncertain environment, everyone pitched in as needed and got the job done. The Power of Together, David S. Guzick, M.D., Ph.D. Senior Vice President for Health Affairs, UF President, UF Health