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Hospitals live through Ike and Gustav and tell you what they learned about emergency preparations


December 1, 2008

Hospitals live through Ike and Gustav and tell you what they learned about emergency preparations

When Hurricanes Gustav and Ike respectively slammed southwest Louisiana and east Texas in late summer, area hospitals invoked disaster plans sharpened by the difficult experiences of Hurricane Katrina (2005) and Tropical Storm Allison (2001).

Representatives of two facilities hit by Gustav and Ike, Tulane Medical Center in New Orleans and The Methodist Hospital in Houston, spoke with Briefings on Hospital Safety during recovery efforts to share their experiences.

“Our plan worked well because we practice—and practice a lot,” said John Cook, MBA, CPE, CHSP, director of facilities management services at Methodist, a 900-bed hospital comprised of five buildings.

The campus sits on the end of a network of tunnels shared by 16 hospitals under the Texas Medical Center umbrella. Thus, Methodist’s tunnels were the first to flood buildings during Tropical Storm Allison in 2001, which devastated Houston and its medical infrastructure.

Methodist’s subsequent improvement of its defenses included closing the tunnel flood doors between the hospitals along a nearby bayou. During Hurricane Ike, Methodist didn’t take on water from the swollen bayou and a connected network of overflow gullies, although the water levels in the bayou peaked at just 2 inches from overflow.

Prepare the building for local weather

During Hurricane Katrina, Tulane flooded. The storm left the hospital’s patients, staff members, and citizens stranded. Responders airlifted 1,600 people off the hospital’s parking garage roof, and the facility was forced to close for five months.

Alluding to the fact that the brunt of Gustav missed New Orleans, Tulane CEO Bob Lynch, MD, says, “Obviously, we didn’t get tested at the worst. I think we were much better organized; we had a much better handle on the situation.”

Much of Houston lost power during and after Ike, and Methodist ran on generators for a time, but it never closed its ED. (For more about emergency power preparation, see “Generator lessons for all to heed” on p. 6.)

However, the hospital lost its main source of water for two days. Dipping into stored cases of potable water kept services running. Tapping secondary hookups on campus wasn’t ideal, but provided enough water pressure to keep chillers operating, Cook says.

Ike taught Methodist emergency planners they needed to refine their sandbag system.

In the future, crews will store sandbags in tunnels closer to the sites at which they’ll be used, as opposed to storing them in a central location to be distributed by employees in pickup trucks.

Strive for less mouths to feed

Managing fewer people per building makes housing and food stretch further, which becomes important once you’re cut off from the larger community. Living in a hospital for three or more days on stored food is like “living on a submarine,” Lynch says. Feeding staff members and patients “becomes a huge issue,” he says.

Tulane evacuated about 20 high-risk patients in advance of Gustav—11 of them neonatal ICU babies. After evacuating as many people as possible, Tulane had fewer than 80 patients and 450 people total riding out Gustav.

That number was down from 1,600 during Katrina. Planners reduced the number of hospital occupants by evacuating some patients and reduced staffing needs by hosting several staffers in-house—some of whose families stayed at nearby hotels instead of at the hospital, as they did during Katrina.

“Just having fewer people means you have fewer people to feed, to house, to deal with,” says Andre duPlessis, chief operating officer of the hospital. “It’s a lot more manageable.”

During Ike, Methodist reduced its census from about 900 to 686 patients as the hospital, for the first time, put its storm ride-out plan into action, Cook says. The plan involved housing two groups of staff members at the hospital and having them work alternate 12-hour shifts.

Although the plan functioned well for patient care, the facility will refine staff living arrangements for the next time, he says. The plan had called for employees to ride out the storm on their units, but a higher-than-anticipated patient census prevented that.

During Katrina, Tulane admitted patients from the Superdome in New Orleans. However, during Gustav, the city eliminated downtown shelters, preventing a surge of patients from that source. Hospitals preparing for citywide evacuations also need to prepare for the aftermath, Lynch says. Make plans to be fully operational as soon as possible after residents return, because that’s a potential surge period, too.

Add details to evacuation plans

During Katrina, Tulane modified its evacuation plan on the fly, because it wasn’t very detailed beforehand.

For example, one factor to consider is determining ground and air transportation. Lynch says hospitals need to reach out to the community during disaster planning and arrange transportation in the event of an evacuation. “The government does provide for evacuation. I think [authorities] would be a little bit better about getting transportation in here now if we had a catastrophe,” Lynch says. “But you’re better off if you have your own assets lined up and know what you’re going to do.”

Hospitals not only need to plan for the temporary evacuation of patients, they also need to build plans for their return, Lynch says. He adds that disaster plans need to be flexible, because you can’t foresee and plan for all circumstances.

Drill for various contingencies until staff members are accustomed to them.

Generator lessons for all to heed

In the 36 months between Hurricanes Katrina and Gustav, Tulane Medical Center—a 235-bed facility in New Orleans—upgraded its buildings in preparation for future storms.

During Katrina in 2005, flooding cut off fuel to the generators, wiping out communication.

To correct that, Tulane used old analog phones that could be connected to still-working landlines—in case its in-house digital network went down again—and added radio, cell phone, and weatherproof satellite communication equipment, says Tulane’s CEO, Bob Lynch, MD.

Tulane moved generators above flood level, where possible, and sealed rooms containing other generators. It also reinforced its electrical system from possible flooding.

Sealing generator rooms meant Tulane had to dig a new well to provide cooling water to generators, which could no longer be air-cooled, Lynch says. The facility also added fuel capacity.

When Gustav hit, the hospital didn’t flood. And, although the facility ran generators as needed, it never lost power.

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