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Preparedness


Monica Horn, RN, CCRN-K, CCTC
Mhorn@chla.usc.edu

Donna Guadiz, BSN, RN, CCRN, CCTC
Dguadiz@chla.usc.edu

Debbie Dechant, BSN, RN, CCRN
Ddechant@chla.usc.edu
Children's Hospital Los Angeles
Los Angeles, CA, USA



Although natural disasters have occurred since the beginning of time, they still catch us off guard. Reflecting back on this last year, there were many such catastrophic events including hurricanes, floods and fires. Even if not directly involved in one of these nature events, there may be consequences for those nearby as well.

links imageSome may draw strength and composure from past experience. The positive vibes from the old Girl and Boy Scouts' motto, "Be Prepared," or the seasoned ICU charge nurses' catchphrase, "Always Have Plan-B," may be overshadowed by the hospital unit late-shift recollection of the "night that wouldn't end."

It was a busy Friday for the transplant coordinator. Both of her shared-role colleagues were out due to unavoidable schedule changes. Leaving work an hour late, she noticed a news alert on her phone about a fire in the general direction of her home. A quick call to her husband clarified that although he could see some smoke on the horizon, there was not imminent danger at the moment.

Freeway rush hour should have been ending by now, even by Los Angeles standards. Listening to the local radio news feed in the car, she heard and simultaneously saw that her freeway had been closed due to either fire involvement or need to keep clear for emergency vehicle access.

GPS guided her through side streets which were backed up and barely moving. Arriving home at about 9:30 PM, it had taken 2.5 hours to go the 14 miles from the hospital to her house.

As they prepared dinner she and her husband recalled another fire experience from several years ago that they had been called to evacuate from, so they listened for updates on the latest one.

By 10:30 PM, just sitting down to dinner but on-call, she received a donor offer.

After careful data review and discussion with the surgical and medical teams, the donor heart was accepted and the coordinator began to set plans for the case in motion. As those in the transplant world know, many notifications, ongoing clinical and logistical assessments, transportation arrangements, repeated explanations, updates, problem-solving, and negotiations are just part of the actions that are necessary until the transplant is accomplished.

Thoughts of the family and child who had been waiting for this chance while in-hospital about a year due to his tenuous condition, boosted the determination to ensure success.

Unable to give a firm OR time, the OPO was still placing the other donor organs. Each person on the team to be notified of the case she was booking asked, "What time are we going?" She gave the same, "no set OR time yet/still placing organs," answer and explanation that she would keep them posted.

The fire was getting worse -- she heard reports of increasing acreage burn and that it was rapidly spreading while giving a tiny percentage of containment. At about that time she noticed that her assigned work phone had shut down. She knew it had been nearing the upgrade time due to battery signs of age, but the thought in her head at this moment was, "Do I really need this to happen right now?! Really?!" She began to give her personal mobile number as back-up contact and contacted the hospital IS Department who resolved the issue enough to get through the rest of the weekend.

Well into Saturday now, the OPO had been granting requests for further donor diagnostic testing, managing the donor, and continuing to complete their offer list. The challenges of the donor hospital for weekend staffing and test access within their system, despite their efforts, were recognized. Meanwhile the teams were growing more impatient and demanding that case timing be set. Finally, a procurement OR time was set for later Saturday evening.

The recipient candidate coordinator began the task of notifying the large number of team members, some of which were frustrated with the delays and expressed this to the coordinator in various ways. The coordinator was planning to leave her house for the hospital to work on the case when the view from their front porch stopped her cold. She phoned a trusted neighbor-friend, an experienced firefighter, and asked for his professional assessment and opinion if he thought her family would be among those forced to evacuate. After a few minutes followed by his explanation of some highly technical terms and predictions, he summarized for the layperson, saying, "At most, we are looking at a voluntary evacuation...but I don't think it will happen." Good enough for her. Making sure her family was all set, she took off for work.

The helicopter she had arranged for the procurement surgeon and team to travel to the donor hospital in had just departed. As she sat down to complete some paperwork, check on the recipient candidate and prepare forms for the case, the OPO phoned to inform her that the procurement case was bumped due to an emergency surgery that had to be done in the donor OR. The OPO coordinator was obviously concerned, as evidenced by the sound of her voice, but could do nothing but request the organ teams...just wait.

Re-notifications were begun once again and rather painfully received and completed. Three hours later, it was now early Sunday morning. Everything had been re-arranged...once more. The very busy and experienced procurement surgeon was not pleased with the new timing, resulting in idle time in the procurement OR break room, but made the most of it when an old colleague showed up from out-of-state to procure one of the other organs, allowing them to catch up on their past and current events.

Fast forward: By around 5:30 AM, the recipient case was successfully accomplished. The child was transported from the OR to the CTICU where he recovered rapidly over the next few days and was discharged home in just a little over a week.

The local fire was beginning to be contained, but would take several days for completion.

links imageWhen the coordinator looks at the photos of the fire now, she is reminded not only of the stress experienced on that particular weekend, but also how transplant coordinators routinely just assimilate, making the best of difficult situations in order to move forward for the benefit of their patients/patients' families, while assisting the talented medical teams to accomplish the important end-result of successful transplantation.

In retrospect, the coordinator can't help but wonder if the stars were somehow aligned those nights described in the story above. The recipient's father happened to be a firefighter.

Transplant families seem to always make the most of their life challenges. I guess the least we coordinators can do is help them to accomplish their goals.■

Disclosure Statement: The authors have no conflicts of interest to disclose.




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