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This is not a drill: Nurses put disaster training to use after fertilizer plant explosion

Saturday May 4, 2013
Hillcrest Baptist Medical Center, Waco, Texas
Hillcrest Baptist Medical Center, Waco, Texas
(Photo courtesy of HBMC)
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After an explosion rocked West, Texas, and leveled nearby structures, nurses throughout north-central Texas hit full throttle to prepare for residents injured in the blast, rapidly treating hundreds of patients. The catastrophic event happened just before 8 p.m. April 17 at West Fertilizer Co. and damaged not only the industrial facility but also structures within several blocks of the plant, including a nursing home and multiple residences. Nurses relied on disaster training to care for the patients streaming into the ED.

Clinicians at area hospitals treated 272 patients as of April 21 and at least 15 people died in the blast, including 11 first responders, according to the Texas Department of Public Safety. Hillcrest Baptist Medical Center and Providence Health Center, both in Waco, Texas, received the majority of patients. After the alert went out, "Staff got the disaster kits ready to triage patients and were working to transfer patients upstairs when the first patients began to arrive," said Marcy Weber, RN, MSN, CNO at Hillcrest Baptist, a level 2 trauma center about 20 miles away from West.


Ellen Hansen, RN
People in private cars and ambulances began pouring into Hillcrest before the hospital had even finished clearing its ED of existing patients. "They were coming in every door near the ED; it was a wave of patients," she said.

Hillcrest treated more than 100 patients suffering from blast injuries, fractures, cuts and contusions. "It was unreal," Heather Branch, RN, assistant manager in the Hillcrest ED, said. "My adrenaline was going. We werenít getting accurate reports, so we didnít know what we were going to get."

Branch knew from past drills to assign the most experienced nurses to assess patients as they arrived. The hospital set up three triage areas and a decontamination station. "What was most scary was not knowing if you were going to have to work on someone we work with every day," she said, explaining 60 Hillcrest employees live in West, and the ED team works closely with that cityís emergency medical personnel.

Branch said some nurses just had to go to a corner and cry, and the other members of the team would cover. "It was a life-changing experience," she said. "We will forever know that no matter what disaster rolls through the doors, we will always be there for each other."

"My clinicians amazed me, in that they were so kind to each other during this time of intense decision making and care," Weber said. "I have never seen anything like it, and I was extremely proud."


Marcy Weber, RN
Providence Health Center opened up rooms, called in additional staff and prepared to treat the critically injured, just as they had practiced. Seventy patients came through the doors, according to Eileen Bohannon, RN, BSN, ED director. Providence assigned a nurse and a nonclinical person to stay with each incoming patient, a tactic Bohannon learned during prior drills to keep patients correctly identified. "Iíve never seen such cooperation," she said. "It went above anything I could imagine."

Among the arrivals were more than 30 residents of West Rest Haven nursing home, which was damaged in the blast. Some did not require medical care but many did not know their names or medical history. Providence transferred all of them by the next morning to other area nursing homes.

Scott & White Hospital-Temple (Texas) received three patients, and Parkland Health & Hospital System in Dallas treated two patients with significant trauma. Two pediatric trauma patients were transferred from Hillcrest to Scott & White Healthcareís McLane Childrenís Hospital in Temple, Texas. McLane opened its command center, prepared to send transport teams and called in its trauma team to care for patients.


McLane Children's Hospital, Temple, Texas
(Photo courtesy of MCH)
"People would come in and do anything [asked]," said Ellen Hansen, RN, BSN, MS, chief operating officer and CNO of McLane. "The collaboration between [the hospitals] was phenomenal."

Hospitals in the five-county region were able to practice their response during a "chemical plant explosion" drill last year. "What we learned from previous drills were put into place for this, and I cannot tell you how smoothly it ran," Bohannon said.

Carolyn Jackson, RN, MSN, director, emergency and acute care services at McLane, agreed that preparation made a difference. "The more you prepare, the more everyone knows their roles and how to work together," Jackson said.

Now that the emergency has passed, nurses and other staff at area hospitals have begun bringing in clothing, gift cards and donations for the victims. All of the hospitals Nurse.com spoke with have employees who live in West. Some have lost their homes and loved ones.


Debra Anscombe Wood, RN, is a freelance writer. Post a comment below or email editorSouth@nurse.com.