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Follow these tips for before, during, after next big storm


August 25, 2019

By John Palmer (johnpalmer@palmereditorial.com)

Well, as the quick formation of tropical storm Barry in July showed, you can't relax. Hurricanes, especially the monster storms, have taught American hospitals some big lessons, and if you haven’t put those lessons into your resiliency plan, then you’re behind the game. For an example, just look to New Orleans.

It’s been 14 years since Hurricane Katrina hit the New Orleans area on August 29, 2005 as a Category 3 storm, which may not have been a big problem for the city’s medical facilities in normal circumstances. But when 53 of the city’s protective levees failed, almost 80% of New Orleans was left underwater—sending citizens scrambling to rooftops to escape the ?oodwaters.

Several hospitals were left stranded, with no evacuation plans, a lack of doctors, staff unable to get to and from work, and failed utilities that ultimately led to the deaths of many patients on life support systems. The storm’s aftermath prompted emergency preparation overhauls and changed the way healthcare organizations plan and drill for disasters.

Then there was Hurricane Sandy, a Category 1 storm that hit the New York City area on October 29, 2012. The area isn’t generally considered at risk of a direct strike from a major hurricane, but emergency officials had warned for years that the low-lying areas and tunnels of lower Manhattan could be flooded if a storm came in from the ocean in just the right way—which Sandy did.

Hurricanes that come up the East Coast generally weaken and take a right turn out to sea, but Sandy made a sudden and unexpected turn inland, coming ashore in coastal New Jersey. It sent storm surges as high as 16 feet into New York Harbor, flooding tunnels and basements and cutting power to many parts of lower Manhattan.

During the apex of the storm, 12 hospitals that had originally planned to shelter in place were forced to evacuate some or all of their patients, according to the New York Times. This was mostly due to flooded generators losing power or backed-up sewer systems spewing water into the lower levels of buildings. About 65 hospitals had to take in patients from evacuated facilities.

According to a 2014 report from the U.S. Department of Health and Human Services Office of Inspector General, up to 89% of hospitals surveyed faced “substantial challenges” in their response to the storm. The challenges cited were mostly related to infrastructure breakdowns, such as electrical and communication failures, and community collaboration issues over resources such as fuel, transportation, hospital beds, and public shelters.

Hurricane Matthew in October 2016 was more of a wild card. Though Matthew first hit Florida and South Carolina, it then stalled over North Carolina, dumping more than 12 inches of rain, flooding basements and generators, cutting off access routes, and testing hospitals’ emergency plans. And in September 2017, Hurricane Harvey stalled over Houston, delivering four feet of rain, causing hospitals to close for up to a month, and forcing the evacuation of 1,500 patients.

Resiliency preparations

If the National Hurricane Center’s projections are right, this season may not be too bad. The season ends officially November 30, but weather experts say we’re in for 14 named storms, with half of them slated to become at least Category 3 strength. Are you ready?

How vulnerable are you?

The only way to clearly anticipate the hazards that could strike your hospital (and more importantly, to understand whether you’re ready to deal with them) is to do a Hazard Vulnerability Assessment (HVA). If you haven’t done one, you’re already out of compliance with CMS and The Joint Commission (it’s a requirement). The HVA is the document that measures the disasters likely to hit your community.

From here, you can tailor your response possibilities and drills to practice those responses. Specifically, the HVA lets you know where your weaknesses are. For example, if your facility is prone to flooding and in an area prone to hurricanes, now is the time to mitigate that problem with a system of dikes, or to stock up on sandbags, or to practice your evacuation procedures. New York City hospitals learned this the hard way when Hurricane Sandy flooded the basements of older buildings.

What are your contingency plans?

One of the biggest issues that hospitals dealt with during Sandy was closed roads. Trucks weren’t able to get through to resupply hospital generators with fuel and oil, and facilities didn’t have backup plans for this occurrence.

Since then, some New York City hospitals have begun constructing extensive contingency plans, such as parking tanker trucks on-site during weather disasters or signing agreements with fuel stations to take ownership of the station’s reserves in an emergency.

Similarly, hospitals in North Carolina faced stubborn flooding after Hurricane Matthew. While they had contingency plans in place for deliveries of fresh water and fuel, closed roads forced hospitals to make backup plans on the spot. Hospitals coordinated with state police to reroute supply trucks around roadblocks—and brought in refrigerated trucks for corpses in case power to morgues and funeral homes couldn’t be restored.

Is your utility infrastructure protected?

Without power, lights, and other important utilities, you will literally be in the dark. If there’s one thing storm-hit hospitals have learned, it’s that wind and floodwaters will find an infrastructure’s weaknesses and creep into its utilities—or simply blow them away.

In what has been called an example of “upside-down” construction, many hospitals are being built or retrofitted with their main primary electrical services on the rooftop, powered by a fuel pump that is secured in a flood-proof vault with reserve fuel stored on-site. Many emergency fuel tanks are stored in hospital basements or bottom floors.

During Hurricane Sandy, many generators were rendered worthless because floodwaters either contaminated emergency fuel stores or destroyed the tanks. As a result, some hospitals are now using ballasted fuel tanks that can float in floodwaters.

Some facilities are being built so that even if the first floor completely floods, critical care can still take place as usual on upper floors. Underground parking garages are being designed above current flood levels, with special uphill “lips” that will cause water to pool rather than rush down into the garage. An addition to Massachusetts General Hospital is being designed with a parking garage that can be used as an emergency shelter for 96 hours in the event of a disaster.

How will you keep your lights on?

The Federal Emergency Management Agency (FEMA) has published guidelines to help hospitals establish a contingency plan to prevent electrical outages. What happens if your on-site generator gets flooded? You’ll need to truck one in.

If you haven’t already, choose a location for the generator, preferably close to where it will be electrically connected to the facility. Concrete slabs can be placed to support generators, or designated parking areas can be assigned to house the trailers. To get a generator to your hospital, there must be an open road that can handle a truck with a huge load (at least 10,000 pounds). Assuming your generator is delivered after the disaster, at least one access route must be clear of fallen trees, debris, and other obstructions.

Next, ensure you have a pre-installed connection. Consider the types of cables you’ll need when connecting your generator. Flexible cables are normally used to connect a temporary generator to a facility. Smaller installations (approximately 15 kW single-phase or 25 kW three-phase) often use a multi-conductor cable that terminates in a twist-lock receptacle. The receptacle can connect to a mating plug mounted on the building. Larger generators typically use single conductor cables that terminate in slip-fit plugs and matching receptacles.

Is your communications technology updated?

It’s a rule of emergency management that if you can't communicate with the outside world, you’re on your own. That’s exactly what happened to many hospitals after Katrina struck. When the power went out, staff members tried to use their cell phones, but downed towers and overcrowded circuits made them useless. There were a few satellite phones available, but to use them staff had to go to the roof to get a signal.

Today, cellular networks and phones are much more reliable. Still, cell towers can be destroyed in high winds, and when coordinating a mass evacuation, staff may need to rely on shouted commands or codes, handwritten notes, or a system of walkie-talkies. Have those contingencies ready and test them often.
For more information and forms from FEMA to help you update your emergency plans, check out the National Incident Management System website at https://training.fema.gov/icsresource/icsforms.aspx.


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