Armstrong finds Puerto Rico deployment valuable experience

2018-01-03 | The Daily Star-Journal

Jan. 02--WARRENSBURG -- Troy Armstrong says his 10-day deployment with a medical response team to Puerto Rico "was the opportunity of a lifetime" and one that will help improve emergency response operations locally.

Armstrong, who serves as chief deputy of the Johnson County Emergency Management Agency, volunteered to go with a five-person task force from Missouri to relieve another medical assistance team from Louisiana that had been deployed for 14 days, first in Florida and then in Puerto Rico.

He said the state of Louisiana contracts with a private firm, Response Systems Inc., for its health and medical response.

Because their staffing was stressed, Armstrong said, Response Systems Inc. contacted the Missouri Disaster Response System for vetted and credentialed staff who could leave immediately.

EMA Executive Director Gloria Brandenburg said she encouraged Armstrong to go when he approached her about the mission.

"I thought he could bring back what he learned there," she said, for inclusion in the county's emergency operations plan.

29 people were deployed from New York, Louisiana, Kansas, Missouri and Illinois.

The team included doctors, pharmacists, pharmacy techs, registered nurses and emergency medical service providers.

Originally deployed as a paramedic, because of his emergency management and operational skills, Armstrong was assigned as the operations section chief at the federal medical shelter in the Bayamon (P.R.) Regional Hospital, one of two such shelters on the island.

The shelter housed 13 patients who had been displaced from their homes or nursing homes, either because their homes had been destroyed or they did not have electricity needed to operate their medical machines.

"They were sick and had health care needs but didn't meet the criteria for hospital admission," Armstrong said.

Most had chronic health conditions, and some were on ventilators and feeding tubes, he said, but were not considered "acute" patients.

Armstrong said part of his duties included overseeing day-to-day operations of the shelter, managing requests for supplies and acting as a liaison with local officials. He also assisted with patient care as needed.

"We always had to have a doctor, pharmacist or tech, a charge nurse, two patient nurses and three or four emergency service providers on duty," he said. Teams worked 12-hour shifts seven days a week.

The hospital had four floors, he said, but the fourth floor had been closed by the Department of Homeland Security as it was deemed unsafe due to flooding and mold issues.

The third floor, where the shelter was located, did not prove much better.

It leaked heavily every time it rained and had no exterior wall on one side. A fake foam wall had been installed, he said, adding, "We didn't utilize that side."

Fire alarms also were "constantly going off," he said, adding, if a fire had occurred, "We wouldn't have known."

There were intermittent power outages, and the hospital's generator had been damaged, so the Federal Emergency Management Agency "brought in a huge generator" to supply power.

They also lost water service a few times, he said. Volunteers "became creative" at saving water supplies, not flushing toilets and using sterile water to supplement drinking water, which was in short supply.

The nearest place to obtain bottled water was a Walgreen's store, he said.

All the FEMA workers were housed in a hotel that had been heavily damaged in the hurricane and "was not fully operational," Armstrong said.

The only place to eat was a Denny's restaurant, he said, and a mobile "Jesus bus" that provided baked potatoes and burritos for $9 a day.

"I think ($9) was what they knew how to say," he said, explaining the price.

Denny's had a limited menu and the only drinks available were 7-Up and Coca Cola or liquor, with supplies of those also getting low.

The DHHS sent 32 cases of medical supplies such as gloves, trauma care and wound care supplies and IVs, but because supplies also were deployed to Texas and Florida for hurricane victims there, some supplies were limited until they could rebuild the supply.

It's amazing how many supplies we went through," Armstrong said, adding shortages impact local communities.

There is a shortage of saline, he said, because it is made in a plant in Puerto Rico that sustained damage.

"Puerto Rico definitely (operates) on island time," Armstrong said. "Everything is so slow."

That includes the process of restoring electricity, he said.

"There was no electricity to street lights, and power lines were down everywhere," he said. "We started seeing more and more lights every night."

At the end of his deployment, the shelter housed only two patients, including one on hospice that was admitted to the hospital and a second that found placement in a nursing facility.

That shelter then closed down, he said, but the other continued to operate with teams rotating every two weeks.

"They wanted us to deploy from Puerto Rico to the Virgin Islands," Armstrong said, but only one pharmacy tech accepted the assignment.

"It's humbling to see how things happen there versus here," he said. "We have a lot of resources. Although Puerto Rico is a territory of the United States, things are totally different."

The conditions he found "70 days after the initial incident, still blew my mind -- the way they were operating and the resources they had gone through."

Brandenburg said the island has a high poverty level and most people earn money from tourism.

"They're trying to get that up so people can go back to work," she said.

Armstrong said the DHHS is pushing for the island to become self-sufficient again.

He said the goal is "to push it back to the local level so they can sustain themselves with local resources."

He said he found his experience to be "very valuable, not only for the professional side, but personally. I appreciate what we have here."

That includes technology, he said, which was in short supply in Puerto Rico, forcing them to use hand-written forms and communicate "face-to-face."

They did have Internet at the hotel so Armstrong could send pictures back to Brandenburg, he said.

He said he also found a difference in what is considered a critical patient in Puerto Rico.

"You have a person on a ventilator and with a tracheotomy that you're suctioning regularly, but they don't meet the criteria. You're handling them upstairs with a paramedic" instead of in intensive care, Armstrong said.

Brandenburg said, "I'm hoping his experience will give us a broader view for planning and bring up things we have not thought about" in making the local disaster plan.

In addition to serving as a paramedic with the Johnson County Ambulance District, Armstrong is a member of the State of Missouri Emergency Management Agency's Missouri-1 Disaster Medical Assistance Team, Disaster Mortuary Operations Team and the Kansas City Mortuary Operational Response Group.

He also is a firefighter with the Johnson County Fire Protection District and deputy coroner with the Johnson County Coroner's Office.