Disaster missions in their own words

Several Johns Hopkins experts were deployed in response to recent hurricanes through their roles with the health system or outside capacities with the federal government's disaster medical assistance teams, or DMATs. Here, they describe their experiences.

Go Team deployment to St. John

Christina Catlett, MD; DMAT and Johns Hopkins Go Team:

The last four months have been by far the most challenging disaster season that I can recall in more than 20 years of doing disaster response. My first two-week deployment was to Houston in August in response to Hurricane Harvey as part of the CA-4 Disaster Medical Assistance Team, a federal response team. We set up emergency services in tents within the NRG Arena in support of thousands of victims who were displaced from their homes into shelters due to the massive flooding. Over and over, their stories were the same: loss of everything—house, belongings, pets, morale, and, in a few cases, loved ones. We did our best to try to temporarily heal bodies and spirits during the recovery period.

Hurricane Irma struck the U.S. Virgin Islands as a Category 5 hurricane while I was still working in Houston. I went home for a few days, repacked and regrouped, then immediately deployed to St. John, USVI, in collaboration with the Bloomberg Philanthropies efforts—this time, not as a federal employee but as the director of the Johns Hopkins Go Team, our own response team.

The original goal was to do a health needs assessment for Irma, but unfortunately Maria struck us during the process. Weathering a Cat 5 hurricane is not something I'd ever like to do again. As soon as she was over, we went right back to work. Two direct Cat 5 hurricane hits in two weeks is as devastating as it sounds, and the entire health care infrastructure in the USVI was severely damaged or destroyed. Once again, the stories of loss were heartbreaking. Over the next six weeks, we were able to deploy four doctors, two physician assistants, a nurse practitioner, four nurses, and a scientist to support the delivery of medical care on the tiny island of St. John.

I couldn't be more proud of the work done by the members of the Go Team who participated in this mission. Each left their families and lives to give to others. We are forever reminded that our commitment to serve our community goes beyond traditional borders.

Robert Greenberg, MD; Johns Hopkins Go Team:

I went to St. John as one of two physicians in the first group of Go Team members. My expertise is in pediatrics, anesthesia/critical care. My role, as I saw it, was to do whatever was necessary to treat and mitigate the surgical, medical, and psychological impacts of the devastation caused by Irma and Maria. I helped by performing minor procedures, such as incisions/drainage of various infections and wounds, managing medical problems (diabetes, hypertension), even performing school exams on kids so they could go to the only remaining school structure on the island, and recognizing and triaging acute psychological decompensation (suicidal ideation) triggered by the events.

I remember a patient ... who had infected lesions, was depressed, and wouldn't abandon her farm.

I remember a patient … who lost his dogs, his home, was living out of a container, and saw no hope in living.

I remember a patient … who needed an exam so she could go back to school while her mom "dug out" from the storm.

This experience has made me realize I am blessed. Every. Single. Day. To have "things" (electricity, food, water), to have my health, to have skills in helping.

I am thankful for getting the chance to serve and grateful to my colleagues who gave of themselves (covering my responsibilities at work) to enable me to go. It's a "village" effort.

Denisse Mueller, MD; Johns Hopkins Go Team:

The Go Team's work in St. John is emblematic of much of what makes Johns Hopkins a great institution: providing care to people when they are most in need, in their communities and around the world.

I don't think I can overstate the degree of devastation the team confronted in St. John. Amid a landscape that was leveled, finding ways to address injuries and illness was an important step in the overall recovery of the island. Watching individuals, governmental entities, and nongovernmental organizations come together to solve problems on the island left me amazed.

I expected that 14 days in a disaster zone, working long days, would leave me exhausted, but it actually had the opposite effect. My experience in St. John left me energized by the fundamental role health care providers play in rebuilding individual lives.

Sharon Owens, ACNP-BC; Johns Hopkins Go Team:

It was an honor to be able to go to St. John to help. So many people are affected by disasters, and I often feel like I would like to help in some way. This was my opportunity to do so. I did not know what my role would be when I went to St. John. It was great to be with a team with a wide range of skills and backgrounds and to have such an experienced team leader like Christina Catlett, MD.

Since the island's only clinic was damaged during the hurricanes, we moved supplies and set up a clinic space in a building in Coral Bay. We needed to think about what supplies might be needed and what types of patients we might see. This clinic eventually became the care center for the island. Once the clinic was set up, we started to see and treat patients. My background is cardiac surgery, so I was not sure I had the skills I would need in this setting. I felt like using my basic nursing skills, talking to patients and trying to get them what they needed, such as medications, were the most important tasks we could do for people. Everyone on the team had different skills and backgrounds, and I think this helped us to take care of the variety of situations that arose.

The most memorable part of the trip for me was hearing how everyone was helping their community in a variety of ways. People whose homes were intact took in several families for shelter. People worked together to ensure the children went back to school. I could tell people take pride in their homes. Several people said to me, "Please come visit us when our island is beautiful again."

Jessica Peirce, PhD; Johns Hopkins Go Team:

As a psychologist responder, I typically have two groups of people to support: the residents directly affected by the disaster and the providers on the ground, including the Go Team members. With providers, I'm often the one bugging them to sit down and eat or take a break. We all need to take care of ourselves to be able to take care of others.

For residents, I mostly listen and support their own coping. I talked to one person who was having trouble sleeping because she was afraid there would be an uncontrolled fire and she wouldn't be able to get away. Since the island was stripped bare of vegetation, the risk of fire spreading quickly was considerably higher than usual. So we talked about ways she could prepare for that event and a more realistic estimate of the risk.

Sometimes the need is greater. One person reported feeling hopeless because of his losses and had some suicidal thoughts. After determining he wasn't at imminent risk of acting on those thoughts, we checked in with him daily and encouraged healthy problem-solving and taking small steps. Once he had the opportunity to talk through some ideas, he figured out how he could take better care of himself and contacted friends on the mainland, who encouraged him to travel there to make another start.

What I love is getting to see how resilient people really are, even in the face of inestimable loss. And, in St. John in particular, I was deeply impressed by the sense of community and social connection I saw. Everyone I spoke with wanted to help support others.

Maddie Whalen, RN, MSN/MPH, CEN; Johns Hopkins Go Team:
While deployed with the Go Team, I provided nursing care on the island of St. John. We staffed a clinic that was responsible for most medical care on the island, as well as an EMS outpost. In addition to administering medications and other nursing tasks, I helped to inventory donations, prioritize requests for medical supplies, and assess the prior clinic building, which was uninhabitable. We also made visits to the local Red Cross shelter and worked with the Vermont National Guard and the local pharmacist to ensure patients were receiving their medications.

I had an amazing experience and was able to witness a community truly coming together to rebuild. I was able to see the types of diseases and injuries commonly associated with a disaster as well as the problems that arise when attempting to provide medical care in a disrupted setting.

The public and private partnerships that came together on St. John were truly remarkable. Many people were helped due to the swift work and community spirit of people. I am extremely grateful for the Bloomberg Philanthropies group. It was a great experience. They were amazing to work with. This experience will stick with me for a very long time.

DMAT deployment in response to hurricanes

Michael Millin, MD, MPH; DMAT:

I was deployed for both hurricanes Irma and Maria. In Puerto Rico, I was stationed in Comerio. The patient volume and acuity level were lower than in Haiti, but the impact on the community and on me was greater. I served as the chief medical officer for the team, which was also made up of three nurses, three paramedics, one nurse practitioner, and support staff. We saw patients in a makeshift clinic in the offices of the local mayor, which was open from 8 a.m. to 5 p.m. We averaged about 40 patients per day in our clinic. We saw a lot of patients with diabetes mellitus who were out of insulin as it went bad in the heat with no refrigeration. Interestingly, we also saw almost an epidemic of viral conjunctivitis.

The greatest public health problem was clean drinking water. The people here needed this more than power or food. People were drinking right out of streams. We also saw an uptick of diarrhea.

One of the most unique aspects of our deployment was our team's community outreach. At one point, I went into the mountains in a jeep with a DMAT nurse, an army medic, and our security detail to see bedridden patients. Every day, we had a team that traveled into the mountains for such visits.

Our team really connected with the community. I connected with local physicians and local pharmacists and had developed a partnership.

At night, we stayed in the hallway of a government building that is the local emergency operations center.

I can say the impact on the community and me is, well, words don't do [it] justice. We made a huge impact on the people of the area, and this will definitely be a defining moment in my life.

Gai Cole, DrPH, MBA, MHA; DMAT:

Just before Hurricane Irma, I deployed as the administrative and finance officer for a combined team from the Michigan DMAT and the U.S. Public Health Service. We staged in Orlando as the Category 2 hurricane struck. I had never heard trees snapping like that before—it was very eerie. The devastation and flooding I witnessed the following day were staggering. After the storm passed, we bused to Gulf Coast Medical Center in Fort Myers in support of their emergency department.

When that mission ended, we deployed to Puerto Rico, where we ended up stationed at Hospital de la Concepción in San Germán, Puerto Rico.

One big problem we encountered there was that people were home without access to water or electricity or food. Schools were closed, and many roads were impassable. So you had people with chronic health conditions, without access to medications, or refrigeration, and unable to maintain basic health habits. Well-managed chronic conditions became exacerbated as people, many elderly, sat at home for days without eating or drinking. They would then be brought to the ED by family as they deteriorated.

The ED we supported saw about 30 percent more daily volume than usual and much higher acuity. Other hospitals in the region had shut down, so many of those patients came to our hospital. Soon we started to run out of necessities like IV bags, IV lines, and medications. Supplies became a critical shortfall. The focuses on the island at that point were security, distribution of food and clean water, and transporting fuel to hospitals for their generators.

In terms of the island's immediate priorities, medical supplies were not up there because of the demand for much more basic needs. Security was a chief concern across the island. I observed a huge law enforcement presence partly because organized crime was targeting fuel and medical supplies at hospitals and clinics.

Over the past five years, Hospital de la Concepción had invested heavily on structural resiliency and preparedness, and wow, did it pay off big-time. After Maria, it became the medical center of gravity for that whole province. The people of the entire region were the ones who benefited from the hospital's investment.

Edward Johnston, RN, BSN; DMAT:

I was deployed Sept. 8 through Oct. 3 with the Michigan-1 DMAT in response to hurricanes Irma and Maria. My missions took me to Fort Myers, Florida, and St. John in the U.S. Virgin Islands. In Fort Myers, we operated an urgent care parallel to the emergency department at Lee Memorial Hospital. We were the designated receiving unit for all emergency medical services responses that were categorized as nonemergent. From there, the team was split into strike teams consisting of two physicians, a nurse practitioner and a physician assistant, two registered nurses, and two to four paramedics. We were staged in San Juan, Puerto Rico, shortly after Hurricane Maria for a few days before moving to St. John to relieve the Johns Hopkins Go Team, which had established a clinic and a satellite medical station on the island after it was determined the original clinic was uninhabitable as a result of the back-to-back Category 5 hurricanes. We were essentially the health care providers for the people of the island.

I absolutely love being a member of a disaster team. Providing the best care in the worst circumstances is a fulfilling experience that has become my passion as a nurse. This was the longest disaster deployment I had been on, and the unquestionable support I received [from everyone], from my wife and triplet children to my extended family and co-workers at the Johns Hopkins Hospital, made a tough job much easier. I hope to focus on disaster/emergency preparedness in my professional career.

Brandon Parkyn, RN; DMAT:

I deployed with the PA-4 DMAT from Aug. 29 to Sept. 6. We were staged at the Dallas–Fort Worth, Texas, staging site with other DMATs. During this time, we trained in anticipation of an actual deployment to a disaster area. We were about to be deployed, but then our call was canceled, and we ended up not seeing any live situations.

Despite not actually being deployed to a live situation, I still learned quite a bit about the process for these types of teams and environments. We did a lot as a team, got to know each other well, and were on scene, ready at the helm, for the 20-minute departure time that we, unfortunately, never received.

Despite not actually seeing the "combat" zone, we were called upon to do a service for other humans in a desperate crisis. We were called up and responded to Texas in 24 hours and were ready 24 hours a day for the call to be sent to a disaster area to perform our duties to help. Fortunately, our particular team was not needed as the response from many other DMAT teams, public health service agencies, and other entities, both affiliated and not affiliated with the government, had the situation under control and were working diligently to help. I can't stress enough that we were called upon, we responded, and we were ready for anything.

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