KK: What did you do in those cases where you realized you were ready to put the chest tube in and you didn’t have any more chest tubes? What do you do?

SS: We utilized endotracheal tubes to substitute as a chest tube until we could get more chest tubes.

KK: That’s impressive. And two patients on one ventilator?

SS: There’s data out there from case studies. If they’re like-sized, you just double the tidal volume and separate the ventilator by an H-tube or a T-tube. Luckily, we only had to do that one time, and it was only for a matter of minutes until we got another ventilator.

KK: Wow, but what a great solution. Who came up with that idea?

SS: Actually, Dr. Menez did. That was one of his patients. We’ve read about it, and the respiratory therapist knew exactly what equipment to provide.

KK: You mentioned earlier that you are really trying to get your arms around the data of this whole event. Can you tell us a little bit about what you know already from that assessment?

SS: A lot of things, very simple stuff. Registration got completely overwhelmed, and you can’t do anything treatment-wise on the patient or order any medications on the patient without proper identification of the patient. When you see 215 patients in 90 minutes, to get them into the computer in an accurate fashion, that was really difficult. We’re working on ways to have a more rapid intake model when it comes to patient identification.

Communication with incident command is really good, but the footprint of the ER grew from a 45-bed ER and multiplied by roughly four times as we took over the PAC-U space and the pediatric ER space and various other spaces on the ground floor of the hospital. It made my job difficult to communicate with the physicians in each station on what they needed and the status of the patients in those stations.

Another issue was obtaining radiology interpretations. When an X-ray is taken, it’s taken electronically and needs to be verified by the technologist before the radiologist could interpret it. We actually had the radiologist follow the portable X-ray machine around and provide preliminary reads to us verbally, or they would write them on the patient’s gurney or on the patients themselves. We had real-time reads.

KK: Did you get anything documented on these patients in a formal fashion at all?