Four several hours each day, residents from the small Louisiana State University-Health Science Center Family Practice Residency program came in for a “sick call” to see more complicated cases, notably those requiring prescription medications. On the 685 patients seen in first aid, only 157 patients were referred on for evaluation at the OPH clinic area by the OPH Regional Medical Director, two OPH APRNs or a family practice resident. Since there were no x-ray or lab facilities, the care provided was that of alternate standards of care or “field medicine.” Nonetheless, only 30 patients were referred on to local ERs and, of those, only 15 were admitted to local hospitals. Thus, of 685 patients seen in the first aid station, only 15 were hospitalized, representing only 2.5% of those treated medically in the shelter and a very manageable burden on our two local hospitals (CHRISTUS St. Frances Cabrini and Rapides Regional Medical Center).
This highly efficient use of resources was duplicated during the Hurricane Harvey (2017) evacuations. On August 31, 2017, after passage of Hurricane Harvey, large swaths of Southeastern Texas received monumental amounts of rain (up to 50 inches total over several days). This resulted in extensive flooding not only in Houston, but also in the towns of Beaumont, Vidor and Orange, Texas, all close to the Louisiana border. Evacuees were first transported to Lake Charles, Louisiana, but were subsequently bused to the Megashelter in Alexandria, Louisiana. Around 2000 evacuees arrived between August 31 and September 1, 2017. Of these 1,840 went to the CTNS and 113 were admitted to the MSNS. Once again, many MSNS eligible evacuees chose to remain with their families in the CTNS sections.
Again, a first aid station, manned 24 hours a day with EMS personnel, was established in the CTNS section of the Megashelter providing over-the-counter medications, blood pressure and serum glucose checks, breathing treatments, simple wound care and other minor services. Residents from the LSU-HSC Family Practice Residency in Alexandria provided more complex care as well as writing prescriptions at the “sick call” several hours each day. Of the 858 evacuees seen at the first aid station, only 214 were referred for an evaluation in the OPH run clinical area adjacent to the MSNS. Of those clients, only 42 were transferred to local ERs. Twenty-two (22) patients were admitted for further care (or 4.5%of those evaluated in the first aid station.)
In addition, the medical residents collaborated with local pharmacies, who sent personnel to the shelter, to provide or renew prescriptions, which were filled and returned to the Megashelter by the pharmacies. This greatly reduced the need for convenience runs (organized by the Department of Transportation) to local pharmacies as had occurred during Hurricane Isaac. Over 900 prescriptions were filled during the Harvey event.
Of particular interest was the problem of narcotic prescriptions. Those were filled only by the OPH Medical Director on a short-term basis and only after consultation with Louisiana’s Prescription Monitoring Program, which has reciprocity with Texas (as well as Arkansas and Mississippi). Around 40 narcotic prescriptions were filled, including hydrocodone (10), clonazepam (6), tramadol (6), alprazolam (5), dihydromorphone (3) and diazepam (2). The reciprocity arrangement between the Louisiana PMP and that of Texas proved an invaluable asset.
The adjacent Ag Center operated by the Department of Agriculture in collaboration with the Department of Wildlife and Fisheries, housed 208 dogs, 38 cates and 1 bird during the event. All pets were accounted for and returned with their owners who either left the shelter with friends and relatives or were repatriated to Texas after a week in the Megashelter.
While there can always be room for improvement, the organization of medical care with a 24-hour EMS-operated first aid station, supplemented with daily “sick calls,” and prescription writing by medical residents, and the use of an OPH clinical area for triage and treatment of more complex cases, proved a highly efficient use of shelter and community resources. Although the OPH clinical area had minimal diagnostic possibilities (an EKG, glucose finger sticks, an oximeter and urine dip sticks) providers (including the residents, OPH Medical Director and OPH APRNs) were nonetheless able to provide care, albeit using altered standards of care consistent with field medicine during a disaster.Sheltering, to be effective, must be a collaborative effort from all of the ESF components. Our experience during Hurricanes Isaac and Harvey demonstrated that cost-effective, high quality services can be deliver with even with significant personnel constraints. While all communities do not have the luxury of a fixed shelter facility such as the Megashelter, the model for medical care delivery could be duplicated with limited resources, accompanied by excellent collaboration among all the providers. While we did have some volunteer physician assistance, it would not have been adequate in itself to satisfy the medical needs of the evacuees.
David J. Holcombe, M.D., M.S.A.
LOUISIANA PUBLIC HEALTH ASSOCIATION