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Trusted Care brought order to chaos after Hurricane Maria

  • Published
  • By Peter Holstein
  • Air Force Surgeon General Public Affairs
Soon after hurricanes struck the Caribbean and southern U.S. in the fall of 2017, Air Force medics deployed to the island of St. Croix in the U.S. Virgin Islands and brought along their Trusted Care culture to help evacuate patients safely and effectively from the storm ravaged island.

“The first day on the ground was chaos,” said Col. (Dr.) Elizabeth Anderson-Doze, the branch chief for Flight and Operational Medicine at U.S. Air Force Air Mobility Command, and a member of the team that deployed to St. Croix. “The island’s hospital lost power, so they were sending us extremely ill patients with no organization. After the shock of the first day, I knew that we had to organize our team, and restoring Trusted Care was the right way to do that.” 

Anderson-Doze was part of a 22-person team of Air Force and joint personnel that deployed to St. Croix for 10 days following Hurricane Maria. They arrived September 23, just three days after the powerful category 5 storm passed. Her team, deploying from the 375th Medical Group at Scott Air Force Base in Illinois, set up an En Route Patient Staging System at the St. Croix airport.

“We had sick patients and families desperate to get off the island for care,” said Anderson-Doze. “Busloads of patients began arriving from the hospital right away. It was hysteria. One patient started coding [cardiac arrest] less than an hour after we arrived. He fell off his chair and stopped breathing. There was no rhyme or reason as to which patients the hospital sent us, no consideration to their medical condition or needs.”

With patients streaming in to evacuate, Anderson-Doze knew her ERPSS team needed to take a step back and get things right. Their job was to prepare patients for aeromedical evacuation to the U.S. mainland, and ensure that anyone who got on the plane was in good enough condition for the flight.

“Some of the patients the hospital sent were people injured in the storm,” said Anderson-Doze. “The emergency room stayed open on generator power, but the hospital had limited ability to admit patients.”

Other patients were in the hospital with serious illnesses or disabilities before the storm struck. Others were dialysis patients, who could not get the lifesaving treatment with the power down. The task of assessing their medical needs and preparing them for transport began with reestablishing Trusted Care culture.

“We managed to evacuate 20 patients that first day, and we were expecting more starting at 0730 the next morning,” said Anderson-Doze. “That night, I talked with the ERPSS team leader. We agreed that if things didn’t improve, we were either going to kill a patient or have a serious injury to a team member. We decided to take a deep breath and a step back to organize ourselves.”

The senior medical officers on the ground set about creating that organization. It began with daily huddles in the morning before patients began arriving.

“That second morning, and for the eight mornings that followed, we started our day with a quick devotional, a public health minute, and shared examples from the day before to get us back in the Trusted Care mindset,” said Anderson-Doze. “We planned out our day, reviewed the patients we were expecting, and went over as many details as we could. It was a great opportunity to help the whole team remember the principles of Trusted Care that should drive us – duty to speak up, respect for patients and safety.”

This process sparked a turnaround for the ERPSS team. That second morning after the Trusted Care huddle, they set up triage stations, established processes to clear patients for evacuation, and reoriented to the way they deliver care back home in Air Force hospitals and clinics. It made a huge difference in handling the challenges that evacuating patients from the storm-ravaged island would continue to present.

“We had patients come in with all kinds of illnesses and injuries, and often without correct information on their diagnosis or what medication they were taking,” said Anderson-Doze. “Because we took the time at the beginning to reset our thinking into a Trusted Care mindset, we were able to overcome these obstacles and maintain a safe and respectful environment for patients, even in the midst of chaos.

“The hospital was trying to send people over in good order, but it just wasn’t possible. We learned to double check everything they gave us – names, diagnoses, medications, blood levels and more. We had to send patients back to the hospital if they weren’t ready to fly. We even had to treat a number of patients who were part of the relief efforts, who were injured or got ill.”

As the ERPSS team developed a flow for clearing patients and loading them onto aircraft for evacuation, they maintained a patient-centered focus. Many patients had lost their homes in the storm, leaving them incredibly vulnerable and calling for an extra level of sensitivity.

“As we continued our huddles, we had to keep reminding ourselves that even though we were still in the U.S., there were major cultural issues that we needed to be aware of,” said Anderson-Doze. “Some of the patients had never been off the island before, and most had never flown in the back of a military aircraft. We were sharing our rations with patients, because they didn’t know there wouldn’t be food. One of my nurses gave a patient the jacket off her back.”

Throughout the deployment, Anderson-Doze’s ERPSS team maintained their Trusted Care huddles and mindset. Out of the chaotic circumstance, they were able to bring a bit of order. By trusting each other and putting the patient first, they created a respectful environment and made a difficult situation a little easier for people undergoing a massive disruption in their lives.

Anderson-Doze had some advice for other medical Airmen who may find themselves in a similar situation.

“No matter how crazy it gets, it’s better to be organized and plan every day carefully. Use the principles of Trusted Care as a guide. Think about what’s best for the patient, what’s best for your staff, and how you can minimize harm to both. Be methodical in your approach to everything, or it can overwhelm you. Develop a process. Do A before B, do B before C, and don’t get distracted by all the stuff happening around you.”