September 14, 2011 — Late in August, Hurricane Irene left more than a million Virginians without power and thousands trapped in their homes or in shelters.
The storm had barely passed through the state when Audrey Snyder, assistant professor in the University of Virginia's School of Nursing, received an alert to be ready to deploy to an area that had been hit hard. A specialist in rural and emergency health care, Snyder was one of seven members of Task Force II of the local Thomas Jefferson Emergency Medical Services Council to deploy.
The team was assigned to New Kent County, where winds caused widespread damage and left both electricity and communications outages for days.
"The goal is to facilitate the local emergency response in an area," Snyder said. "Maybe their emergency responders are injured or hurt or their buildings are destroyed or they've worked to a point that they're exhausted, or it's really time they need to go home and check on their families. Then they pull in one of the disaster teams to come to facilitate care that is customized to that community."
Snyder's role on the team was as a pre-hospital provider, or paramedic. Her team was often forced to cut through fallen trees to reach homebound patients whose portable oxygen supplies had run out and to meet other emergency medical needs.
"Some of the people lacked financial resources to have a generator in their home and had significant medical problems, or don't have transportation to get to a shelter or they don't have the ability to get to a physician's office," Snyder said. "We were finding out what their real needs were at home and facilitating phone calls to pharmacies and oxygen companies and helping them to get what they needed long-term, with a prediction of a power outage of up to two weeks."
Team members also cared for those who came to the fire station where they were based. Some needed to plug into the station's electricity to use their home nebulizer or have their equipment assessed to be sure it was working properly.
Task Force II helped out for 72 hours before a team from Blacksburg took over.
"Your hope is that by the sixth day, the community could normalize as much as possible to get their team and rotations back in to provide care. If not, then a third team comes in," Snyder said.
She is no stranger to helping out in disasters. She's been to India and El Salvador, and deployed to New Orleans after Hurricane Katrina and Haiti after the 2010 earthquake.
Medical needs often linger long after the initial disaster. Though her first visit to Haiti was geared to disaster relief, she has returned three times since. She helped establish a follow-up care clinic and worked with the Community Coalition for Haiti, of which she is now a medical committee member, to set up a permanent clinic along with a rehabilitation clinic to help those who have lost limbs or have permanent stroke-related mobility issues. She also helped develop a plan to visit patients in rural areas and bring U.S. care providers to aid the rehabilitation program.
Snyder has developed a relationship with the nursing school at the University of Notre Dame of Haiti in Port-au-Prince, where she taught last March, bringing donated medical supplies from the MERCI program and textbooks collected by U.Va. nursing students. Over the coming winter break, she plans to continue her work with the school and the coalition.
She involves students in her work whenever possible. Last December, a graduate nursing student accompanied her to Haiti to work with local community agencies, helping to draft a plan to address the cholera outbreak from an education and prevention, as well as treatment, perspective.
"It was an opportunity for the student to collaborate with the United Nations, Ministry of Health, and International Medical Corps and provided a view of the reality of the epidemic and a chance to work on a plan of action with the community," Snyder said.
Planning and attention to detail are also the hallmarks of the Remote Area Medical, or RAM, Clinic, held annually in Wise. Snyder has been involved in that initiative for 12 years, first as a nurse serving alongside four nursing students from U.Va.'s Nursing Students Without Borders organization.
"The next year, U.Va. was involved through the Office of General Medicine and it's grown from there," said Snyder, who also has an appointment in the Medical Center as the nurse coordinator with Community Outreach.
Snyder and colleagues Dawn Niles, a community outreach coordinator, and Dr. Scott Syverud, an emergency medicine physician, spearhead U.Va.'s RAM efforts, coordinating with the Health Wagon, the local community health provider of free medical care that collaborates with the global Remote Area Medical organization.
With extensive experience as an acute care nurse, Snyder knows the value of community involvement and follow-up care. With the help of Rhiannon Frank, a 2009 biomedical engineering graduate, and Katie Bagley, who earned a bachelor or nursing degree in 2010, she is studying the return rate of medical patients treated from 2006 to 2010 in order to evaluate the success of sending them for follow-up care and to identify barriers to accessing care.
The return rate was only 10 percent, and Snyder credits that to collaboration between the Healthy Appalachia Institute – a joint effort between U.Va.'s Medical Center, its schools of Medicine and Nursing, and U.Va.'s College at Wise, – and organizations and residents in Southwest Virginia.
To help improve services at the Health Wagon year-round, grants have funded more nurse practitioner hours, plus a social worker, a health educator who is a nurse, and the implementation of an electronic medical record system.
"Following RAM, U.Va. faculty and nurse practitioners review all the lab work, and tests to identify abnormalities. There is one nurse practitioner who is designated as a 'navigate the system person' who, along with social workers, helps ensure coordination of care for these patients," Snyder said. Patients requiring follow-up care are then referred to either local medical facilities or to a specialist at U.Va.
For Snyder and her RAM Clinic colleagues, the planning is year-around. Through quarterly visits and monthly teleconferencing, they analyze the past year and plan for the coming year.
"We use the principles of community-based medicine and let the local community help identify what its needs are, and then we assess whether or not those needs are something that the University of Virginia can facilitate," Snyder said.
Throughout the year, mobile mammography units, quarterly endocrine clinics for diabetics and 56 telemedicine sites keep Southwest Virginia patients connected to U.Va. medical care.
Snyder said her approach to health care is directly influenced by her work in emergency medicine.
"Many of the patients I see in the emergency room come from the community and have to go back to the community, and if they have good access to follow-up care, they are less likely to return with another potentially preventable emergency. Our goal is to help break down the barriers to accessing quality health care for those living in rural, underserved areas," Snyder said.