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By Rose Hoban
As Hurricane Florence bore down on eastern North Carolina, Louise Bledson and her neighbors from Trenton, the tiny county seat in Jones County upstream from New Bern, got the word that buses would come to Jones Senior High School to take people out of the path of the rising Trent River.
When they arrived at the school late Wednesday to evacuate, there were eight buses, but only enough willing evacuees to fill two of them. One was the bus she was on, the other peeled off in a different direction to Goldsboro.
“My girlfriend, her mother, she was in the wheelchair,” Bledson said. “She has the Alzheimer’s, they say they have the facilities to take care of the Alzheimer’s, so that’s where they went.”
Bledson’s friend and her mother were triaged, along with other people who need more than just a safe place to lay their heads, to a special medical shelter set up at the old Cherry Hospital. It’s one of three established by the state Department of Health and Human Services to care for people who might need nursing care during Florence.
DHHS opened up a fourth State Medical Services Shelter over the weekend, and according to HHS officials, the department has the capacity to open a fifth as needed.
Showing up for shelter
In many smaller towns, and even bigger ones, people often migrate toward the local hospital, said Steve Lawler, head of the North Carolina Healthcare Association.
“We are the trusted destination for people who need care or who just need compassion,” Lawler said. “What we’re seeing, the hospitals are taking people in, they’re assessing, they’re treating, they’re comforting.”
He noted that during hurricanes, even when people know that their community or their home is at risk of damage, they prefer to stay close. So, they might not take an opportunity to evacuate, the way the women from Trenton did.
While Lawler said that the hospitals were ready, willing and able to accommodate members of their community, it can also be a strain on systems that are stressed during disasters.
“We are taxed,” said David Sumner, from Southeastern Health.
When Sumner was interviewed on Sunday afternoon, he said the system’s flagship hospital, Southeastern Regional Medical Center in Lumberton, was on diversion, meaning they were not taking any new patients and diverting emergency patients to other facilities.
He said that some folks who need assistance with their home oxygen had shown up at the hospital for help during the storm. But he noted that the number of people was far fewer than had shown up during Hurricane Matthew in 2016. During that event, the hospital’s lobby was full of people who were plugged into the hospital’s power, running their oxygen concentrator machines.
He said that was one of the lessons learned from Matthew; local authorities had set up multiple shelters around the area to accommodate even people who need a little extra help. Staff from Southeastern Health delivered oxygen equipment to support those people in the shelters.
That’s something Vidant Health staff did too, said Vidant Medical Center president Brian Floyd.
“We can get people who are essentially in need of sheltering and oxygen… we want them to go to the shelters and not overwhelm the hospitals.”
It seems the state learned other lessons during Matthew, too. During that event, DHHS set up two medical shelters, one in Goldsboro and one in Benson. This time state officials doubled that number.
Patients can’t just show up at those medical shelters, said HHS Sec. Mandy Cohen. They have to be triaged to go there, like Bledson’s friend’s mother.
“It’s mostly like nursing home level care, that’s why you have to get triaged here, you can’t just show up and say ‘I need a medical shelter,’” Cohen said. “If you need 24-hour nursing care. They have some doctors on site, circulating in a large capacity area, and there’s mostly nursing care in giving out meds, doing activities of daily living, things like that.”[sponsor]
Cohen said on Sunday afternoon that there were between 80 and 100 beds available out of more than 300 among facilities in Clayton, High Point, Goldsboro and Charlotte.
One of the points behind opening the medical shelters was an attempt to keep people from showing up at local emergency departments for help with oxygen or dialysis, even as those departments are coping with maintaining their function in the face of a natural disaster.
Time can be of the essence for people who need dialysis, they can’t go more than three or four days without the treatment. Cohen said the state had established a hotline that would allow dialysis patients to find a place to be treated, no matter where they’ve fled to.
“We’re trying to get folks to not to show up at the emergency room for (kidney dialysis) because not every hospital is capable of doing dialysis on a generator,” Cohen said.
She noted that about a hundred dialysis centers in eastern North Carolina had shuttered because of the storm.
“Folks who need dialysis are going to need to move but going to the ER is not going to be the best option,” she said.
Emerging medical needs
Even if vulnerable people end up at special medical shelters, some folks at regular shelters will become sick too.
Within 24 hours of the first hundred people arriving to a 500-bed “megashelter” being opened at the UNC Chapel Hill’s Friday Center, a handful of people were sent from there to the emergency department up the hill at UNC Hospital.
That prompted a visit from emergency physician and faculty member Tim Platts-Mills on Sunday evening.
“There was a patient who was sent from this shelter to the ED this morning, and so someone said, ‘Ah ha, there’s a shelter,’” Platts-Mills said. “I came down here to talk to the nurses and understand how many people are going to be staying here, what the number is, what the health needs might be.”
He found that many people had fled the rising waters without their medications, or they only had a few days’ supply and would need refills.
Platts-Mills said that the Red Cross and other nurses assigned to manage health needs at the shelter would likely manage the bumps and scrapes of life pretty well, as well as triaging people who might need more intensive care. He said though that some patients might need to see a physician, and it might be feasible to have a UNC physician visit to smooth the rough edges.
“We want to make sure that we’re doing what we can in terms of preventative medicine, making sure that people have the medications that they need so they don’t show up in the ED having run out of an important medication, like a blood pressure or seizure medication,” he said.