Realistic Expectations, Readiness, and Staff Wellness: Crucial Reminders for Potential Red Cross Nurse Volunteers

This is the last post in a series we’ve been running on this blog by nurses who are or were Red Cross volunteers during the disaster response following the May tornadoes in Oklahoma.

Reading these accounts, one feels that these nurses embody the “nursing superlatives” we hear so much about: competence, caring, teamwork, leadership, humility, knowledge, courage, insight. Honest about challenges and struggles and the real stresses involved in disaster response, they are direct if slightly more relaxed heirs of some of the best aspects of Florence Nightingale’s career and her ethos of public service and excellence. This post consists of three excerpted passages from three different nurses, Susan Deneavit, Eleanor Guzik, and Debra Williams.—JM, senior editor

The first post here is by Susan Denavit, Red Cross staff wellness manager in Oklahoma from May 21 through June 14. Writes Denevit: I have been a Red Cross volunteer since 1987, when a plane crashed at the airport in Denver, my home at the time. I am currently affiliated with the Oregon Trail Chapter of the American Red Cross in Portland, Oregon, after moving from Denver in late 2011.”

Staff Wellness and the Importance of Realistic Expectations and Preparedness When Responding to Disasters:

I spent 25 days in Oklahoma as the staff wellness manager. Before I was assigned, I studied the hardship codes placed on this operation to determine the likely impacts. It was expected to be a difficult situation, with water disruption, power outages, extreme heat and humidity, housing shortages (staff likely to be staying in shelters instead of hotels), hardship working conditions expected, extreme emotional stress due to the number of fatalities and injuries, difficult travel conditions, and air quality concerns. I myself had no conditions that restricted me from any of these hardships. I had only one concern, a cough that was improving, so I was approved by an RN reviewer for deployment.

Staff medical needs. Our staff wellness team cares for our staff on disaster assignments so that our health services team can care for our clients. At first, we saw mostly eye and throat irritation and foot injuries. We tried to keep up with the need for eye drops and throat lozenges and bandages to give to staff until they had time to go to a store. We advised staff on how to care for minor injuries and illness and accompanied some to receive medical care. Eventually, we had to send home people who needed more medical care than could be provided while working in a tornado response.

Shortage of beds. As more staff came to Oklahoma City and fewer hotel rooms were available due to flooding, cheerleader competitions, and a softball tournament, we did open a staff shelter, where staff slept on cots. At this point, staff wellness became very busy, with people who said they couldn’t stay in a shelter. Some said they couldn’t sleep on cots due to mobility issues, some needed refrigeration for meds, and some needed CPAPs at night. Despite the information that these were expected hardships, some people expected to be accommodated in a hotel, and there were no rooms available. After two nights of sleeping in a large room, the shelter was able to move to a university dormitory, and the stairs (and lack of elevators) became an issue.

For those considering traveling to help at a disaster, here are a few things to think about:

• Are you current on immunizations? Tetanus vaccine should be current, as well as flu and perhaps pneumonia vaccines. We also ask our volunteers if they have any medical appointments scheduled in the time they are expected to be there, as well as if they have sufficient medications. Medical care may be available or compromised in the disaster area, but seeking care does take time away from your disaster relief responsibilities.

• Do you have mobility issues? You need to be able to climb stairs, carry your own luggage, and possibly sleep on a cot or the floor. You can’t count on a hotel room or an elevator or power being on all the time. Make sure you have shoes to protect your feet, with closed toes and heels (even when it’s hot). The ground may have been rendered hazardous by flooding, debris, or other damage.

• Do you have chronic health conditions? Disaster areas often make them worse. Air quality is frequently an issue, as debris is often burned. Mold, smoke, heat, humidity, cold, high altitude, and other hazards have made many responders sick. Respiratory and gastrointestinal illnesses are common.

• Have you had recent losses or high stress levels? This may not be the right time for responding to a disaster that includes loss of life.

If you decide that traveling to a disaster area isn’t for you, at least at this time in your life, there are other ways to help in your own community. Everyone wants to help, but perhaps locally is best for now. For each health care professional who does deploy, others fill in for them at home. Someone is working their shifts and helping meet their day-to-day responsibilities. Sometimes the best way we can help is to fill in for someone else to travel. Those who fill in for those who can deploy may be the unsung heroes, as we who travel couldn’t do so without them.

The second post here is by Eleanor Guzik, NP, RN, a volunteer disaster health services manager with the Red Cross, who describes herself as a 74-year-old wife serial volunteer and late-in-life RN who worked in critical care for 10 years, was an NP for 10, and retired in 1995. She wrote one previous post in this series.

Be willing to go where you are most needed. I am at Red Cross Headquarters in Oklahoma City, awaiting my assignment. Due to my experience as a disaster health services manager, the likelihood of a headquarters assignment is high. I accept this fact with mixed feelings, knowing that I can handle most assignments. Most Red Cross volunteers prefer working in the field, touching the clients. But if assigned to headquarters to handle administrative necessities, I accept the fact that I can best help the clients indirectly by providing a productive working atmosphere for the field staff.

Condolence duty. And it does turn out that that I’m assigned to headquarters to lead the integrated care team (ICT) or condolence team. This group, led by disaster health services, includes representatives from disaster mental health, spiritual care response and client casework. The initial May 19 and May 20 tornadoes left 26 fatalities in its stead, some of them children. Oh the children, which included six third-graders who died at Plaza Towers Elementary School in Moore, Oklahoma.

My initial ICT peers and I follow the procedure by contacting the medical examiner and verifying the deaths as disaster related. Initially, clarifying team roles is a bit of a chess game. Spreading duties across the team results in duplication of tasks due to most team members being overachievers. . . .

Information lockdown. Next we get contact information for the families of the deceased so that we can offer Red Cross health, emotional, financial and referral assistance. All of these services are possible due to the generous donations of the American public. Getting this contact information becomes a daunting task during my tenure. The Oklahoma community is very protective of the families and the usual information channels are locked down tight.

So, Plan B: Get the information out so that the families can contact us. We distribute “Red Cross Condolence Services” business cards with our exclusive ICT phone number. We relay the word to the field staff to be on the lookout for family and friends of the deceased and share our contact information. We send letters explaining our role to appropriate funeral homes, churches and government officials.

One week after the tornadoes, the calls for ICT assistance begin.

As I work on the condolence team, the remainder of the disaster health services response swirls around me. At times, it seems to produce its own tornadoes. Many varied high achiever personalities with various levels of stress tolerance make for some interesting exchanges. With it all, the realization that the need for help is great—the level of chaos is high at times, but the level of service to clients, offered in a timely manner, is unprecedented. . . .

The last post in this series is by Debra E. Williams, MSN, RN, American Red Cross full-time volunteer nurse leader in national and state positions. Her previous post in this series is here.

Morning after first round of tornadoes:

Woke up after three hours of sleep, heard that my family’s ok (six people and five dogs in our shelter, whew!  It’s supposed to hold six people). Found out that several tornadoes hit around OKC, Edmond, Luther, Blanchard, Norman, Bethel Acres, near Shawnee, near Prague. A state of emergency for 16 Oklahoma counties was declared.First short meeting held to see that:

• Health services response (disaster nursing) Just-In-Time Training is completed for local, spontaneous volunteers and Medical Response Corps.
• Emergency Aid Stations (EAS) are placed and have equipment. Triage and/or provide first aid to individuals; then, if needed, send them on to Urgent Cares or the hospitals; or provide case management to replace medications, durable/consumable medical supples lost in the tornado.
• Shelters are covered with nurses.

Wife in the hospital, home destroyed. One of the local hospital social workers called and requested a hospital visit for one of her patients who is being discharged in a few hours and needs some case management. Everyone in health services is out doing other jobs so I will go.

Thankfully, there is a RC caseworker, Terresa, at the EOC who can do the case management piece for Class 2 food, clothing, and all the other items that RC providesm so I tell my job director we’ll be right back. However, we have to run to the ‘RC safe spot – a bathroom’ for about 10 minutes since a tornado is coming our way. When that’s over we leave for the hospital. Terresa and I are met by the social worker who explains Bill’s (not his real name), the patient’s, needs as she sees them:

• A hotel room to stay close to his wife who will have another surgery in the morning and who has no anticipated discharge date.
• Money for clothing since all his clothing is gone.
• An assistive device was taken care of by the hospital. The couple’s home was completely destroyed.

The caseworker and I ask for permission from the client to enter his ER room. We introduce and discuss with him his needs, all the choices he had, and what we could provide. What Bill really wants is to stay at the hospital with his wife. I ask the social worker if that can be worked out for him since he’s so banged up and she says yes.

We provide financial assistance for clothing and food while he stays in the same hospital room as his wife on a fold-out chair. We tell him to contact Red Cross and FEMA when his wife has been discharged and I leave a business card just in case he forgets, as well as the paperwork we usually leave behind. He says his church has visited and will help him buy what he needs.

As we prepare to leave, Bill says how grateful he is and I tell him it’s an honor to assist him and his family through the generous donations of the American public. We all need help at some point in our lives and it is a great privilege to give and to receive. He blesses us as we leave.

Editor’s note: AJN would like to express gratefulness to the generous Red Cross nurse volunteers who have been willing to share their stories here and open a window on their experiences and particular areas of expertise.