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Internal Disaster

Those aren’t words you want to hear over the loudspeaker of your place of employment.

The alarm sounded, but although it’s usually cleared within a few moments, this time it just kept going. Ding. Ding. Ding. What the heck was going on? The rumors filtered down over a matter of minutes. A doctor who had been on the Floor In Question came down to ICU with stories of patients being evacuated. Huh? If patients are being evacuated, why are you down HERE telling us about it instead of up there? We thought he was full of it, trying to pull our collective legs.

But then we heard the announcement, and it cemented everything he’d said. We were having an Internal Disaster. “This is not a drill.” Soon, we heard our charge nurse’s Vocera chime in: “Please have all evacuation litters and chairs ready to go when the transporters come for them.”


This was real! A real, live emergency! An honest-to-goodness-break-out-the-red-safety-binder-and-look-up-what-to-do-in-an-internal-disaster emergency! Not being one to miss such excitement, I asked my charge nurse if I could go and help out. I’ve never been in a situation like that, and I wanted to see what was going on. She said that would be okay – so I went and asked 2 fellow nurses to watch my patients while I was gone and they agreed.

Off I went to the stairwell. On my way there, I encountered other employees going the opposite direction – out. They didn’t look panicked and weren’t in a hurry, but it was a little disconcerting. If they weren’t up there helping out, why would they need me? But I went anyway, and ran into Someone In Charge. I asked if I could help out and she directed me where to go. (Yes! I get to go!) When I got to that floor, they had already evacuated it laterally across the hall. I discovered that patients were being moved on litters and evac chairs down 2 flights of stairs. There were beds and people wrapped in blankets everywhere. There was no panic, no distress among patients. They were just sitting there calmly waiting their turn to be carried down the stairs.

It was decided to evacuate another part of the floor as well, so I went to help with that. When everyone had been carried off, I went back to where I started. I saw that a nurse was helping a very elderly lady go from a wheelchair to an evac chair. Since the lady looked unsteady, I supported her until she got settled. Right as I was turning around to see if someone could carry her down the stairs, the nurse I’d been helping said, “Ready?” As in… “Are you going to help me carry her down now?” I looked around, but saw no one else that wasn’t already doing something, and I felt like I was holding things up, so… I helped her carry that woman down 2 flights of stairs.

I am very sore. Very very sore. My back feels just fine, but my arms and shoulders hurt. I’m positive that I did not sustain an actual injury (in fact, no one had), but those muscles had not been used for such an activity, ever. The patient wasn’t heavy by any means, but navigating around tight corners was a little harrowing. We set her down in the hallway of the unit we were evacuating people to and someone hurried over to “check her in.” People were going around with lists of names and checking them off when the patient was accounted for.

After that, another nurse and I went back to CCU to get portable monitors so that we could hook up the patients that had been on heart monitors. When we returned to the floor, we found that everyone had been accounted for. Care plans were being printed off and matched to each patient. Patients had been told to keep their own charts, and as I walked down the hallway, I noticed little old ladies in chairs clutching their charts as though they were life preservers. I guess they took instruction well :-)

We went patient to patient, assessing those with heart conditions for chest pain from the excitement and assessing those with respiratory problems for their oxygen levels. There were lots of portable oxygen tanks around, and there were people constantly looking at how full each tank being used was.

Someone from the kitchen brought up cases of bottled water, which I was SO thankful for. Eventually, the Floor In Question was secured, but not deemed habitable just yet. So we faced the task of moving patients around to empty beds on other units, and opening up overflow units to accomodate the rest. Housekeeping was called to clean beds that had been left behind, and they came out in full force. I’ve never seen so many Environmental Servicers at one time, in one place. Beds were cleaned and re-sheeted faster than we could move them.

Finally things started to really settle down. The patients on surrounding floors that had been evacuated went back to their rooms. The others were placed in overflow units. I went back to my unit 2 hours after I had left it and tried to focus on my patients. There was a debriefing session that afternoon where we were told exactly what happened. We went over the things that went well, and there was time to go over what we learned for next time. The Voceras were invaluable. You could get hold of anyone, anywhere – no phones necessary. One thing I’d like to share with other healthcare workers out there that may be faced with a similar situation, though: Although there were patients that could walk, some had a really hard time navigating the staircase in all the commotion. They kind of held up those that were carrying patients down. It might be best to go ahead and carry everyone to avoid this problem. It all seemed to go fast to me, but maybe the slower patients were already evacuated by the time I arrived.

I am so proud of my hospital. There was absolutely no panic, just efficient and expediant work. No one sustained injuries, and no patients had untoward effects. Although some patients were sent to the ER, it was for the closer monitoring that they could provide (CCU had NO beds available to do this). Although we have drills to practice this sort of thing, we never actually haul the patients out of their beds and down the stairs during those times, so this was a true test. It could have been a lot worse, but luckily, it wasn’t.

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So what was the emergency?

Well… I’m going to decline to say. I don’t know if there’s going to be any kind of liability associated with the incident. I don’t want the terms to be searchable over the internet.
Ya know?

Hey! You are MY HERO! So great of you to volunteer to go up there and help. I know that you made everyone feel safer (nurses as well as patients!). I’m sorry You are sore…perhaps you can get a massage from the “travelling Masseus). I’ll carry your bravery with me in my heart while I am gone! You’re the best!

Good to know that hospitals really can handle that type of emergency without incident to patients! Guess all those procedures and planning pay off!

I hope you folk are trained in how to carry people on chairs down stairs – I mean, I do it for a living, but at least I got some training in it first. When I was nursing, pushing people around on trolleys and shifting them fromone to the other was about my limit of ‘lifting & shifting’.

But for there to be liablity, harm must have come to a patient, which you stated there was none. So no liabilty. Oh wait, this is America, with our fine legal system and legal professionals.

Oooo, those are not fun. We had two small fires in an under construction addition at the hospital I work in last year. We evacuated the nearest patients because it’s better to be safe than sorry. Like you, no patient injuries and some lessons learned. I think we need to consider the vocera thing though…

We have just implemented Vocera. Some love it others hate it. I would love to talk to your IT staff about the implementation.

Can you email me about it?

great story… they really need to start a nursing show like ER or Scrubs, centering on these kind of experiences (jazzed up of course). Maybe you should come up with the pilot!

fun story: it’s so much better for having a good ending!

As someone who has spent a fair amount of time hauling people around in stair-chairs, I can empathize with the soreness factor. Getting a 300 lb. patient up to their 3rd-floor walkup post- dialysis is about as much fun as your can have working a BLS truck. Unless it’s 90 degrees. Then it’s even better.

semi-related: I’m a long-time lurker, first time commenter. I love your blog; we need more quality nursing blogs in the medical blogosphere. Keep up the awesome work!

So, what brought you to the hospital today?

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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