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How surviving a disaster changes the disaster plan


December 1, 2016

As the South recovers from Hurricane Matthew, heed lessons from facilities that survived natural disasters

Putting a disaster plan in place is a critical step for a healthcare facility, but it becomes especially important for the facility operations department—without its proactive action, doctors and nurses will have nowhere to practice, and a community safe house could be lost.

In reality, however, it’s difficult to truly prepare for the chaos of a disaster. Each event teaches a lesson, and it’s the facility manager’s job to make sure this lesson isn’t learned at the expense of patient or staff lives.

An evolving plan
Few recent events have had the impact of Hurricane Katrina, not only on affected localities but also on building codes as a whole.

“Hurricane Katrina was an indescribable event that forced the hospital and the community to deal with issues that were not planned for,” recalls Ken McDowell, CHSP, CHEP, safety officer for Memorial Hospital at Gulfport (Mississippi).

Prior to the 2005 arrival of the largest hurricane ever to make landfall in the United States, Memorial had a plan in place to help hospital staff prepare for nearly any disaster.

“Memorial Hospital at Gulfport adopted a National Incident Management System–compliant emergency operations plan (EOP), which is an all-hazards plan. There are incident-specific appendices for hurricanes, tornadoes, loss of essential utilities, security, safety, etc. The engineering department also has procedures in place that support the hospital’s EOP,” McDowell says.

While Memorial was significantly affected by Katrina, it was not at the heart of the storm in the way that Ochsner Baptist Medical Center in New Orleans was. Thankfully, Ochsner Baptist was prepared too.

“We have a disaster plan, and we had one at the time of Hurricane Katrina. It worked out well,” says Wayne Hill, director of the physical plant at Ochsner Baptist Medical Center. “We did make some changes to it after going through such a terrible disaster. We made some changes to improve it in case we ever have to go through that again.”

For Hill and his team, many of those improvements involved fortifying major equipment to better protect it from future flooding. Katrina’s flooding was unprecedented, putting nearly 80% of the city underwater when the levees broke, and the scale of the incident served as a lesson.

“We’d never experienced that type of flooding before, and after incurring that, we realized we needed to do a few things in case it ever happened again,” Hill says.

An initial survey of the damage
There is much to be done to prepare a facility as forecasters announce the potential arrival of a massive storm.

“Pre-landfall, the typical events for hurricane preparation took place: boarding windows, securing missile objects, topping off fuel supplies, testing generators, ordering more food and water supplies, and so forth,” McDowell recalls.

Adequate preparation is crucial, since it’s impossible to predict just how your facility might be affected. Then, as McDowell says, “During landfall you are pretty much in a wait-and-respond mode.”
It was immediately after Katrina that the real work, and learning, began. The first step was to assess the damage and determine what needed to be improved in the event of a future disaster. For Ochsner Baptist, there were several immediate problems that needed to be addressed. First, of course, was the flooding.

“The fuel systems that feed the generators were one of our weaker links,” Hill recalls. “We had our generators up high, but we had one electrical panel that fed the fuel tanks, and that was actually on the ground floor, so we weren’t able to get the fuel up to the generator.”

The second significant challenge was that the air conditioning system wasn’t original to the hospital building, which had been built in 1950. As the hospital grew over the years, air conditioning was added, but a backup power source for it was not.

“They never did put the air conditioning system on emergency power, so when the event happened in the summertime—as it does most of the time in the South—there was a big issue with not having the air conditioner working,” says Hill.

As a result, the facility management team determined flood elevations and raised much of its equipment on platforms, including a new backup power system. “If we do flood again, we will have air conditioning, and we’ve also added some additional generator power to supplement that,” Hill says.

Generators proved to be among Memorial’s biggest challenges as well.

“We had four emergency generators and three standby generators prior to Katrina, so the power was not as big of a concern until fuel started getting low,” McDowell says. The hospital housed two 12,500-gallon diesel tanks, but this turned out not to be enough. The facility managers had a plan in place to deal with low fuel levels, but then the unexpected happened. “Mutual aid agreements for fuel replenishment were in place, and the suppliers attempted to provide our fuel as scheduled, but some of the trucks were diverted to other facilities by the Mississippi Department of Transportation,” McDowell says.

That is why, he notes, it is extremely important to have a working relationship with your county emergency management agency. “We were able to get our diverted trucks back to us because of our working relationships,” he says.

A gathering place for the community
During Katrina, Memorial Hospital at Gulfport, with 278 operated beds, sustained damage to its roof and windows as a result of the hurricane’s high winds. Damages totaled roughly $8 million to $10 million, according to a news release issued shortly after the storm. Fortunately, the main facility was never without power and had no problems with its water supply. Memorial did, however, face a unique challenge: It was one of the only area hospitals to remain fully operational. All but 40 beds were filled, and those 40 were empty only because they had been taken out of service due to water damage.

“Plan for mass amounts of victims with a wide array of injuries from mental injuries to broken bones, cuts, and more severe injuries,” McDowell says, looking back at that overflow.

He also notes that it’s important to plan not just for the living, but also for the dead. “Plan for fatality management: where will you store the deceased until the coroner can pick them up,” he advises.
According to the Memorial news release, management pre-purchased many supplies and pharmaceuticals before the hurricane struck, and normal deliveries of supplies quickly resumed. This helped the hospital become a gathering place for a community in need.

“Katrina changed our outlook on the community as a whole,” McDowell says. “The community turned to the hospital for assistance of all kinds. We provided additional medications or medications that were destroyed in their homes. We were one of the few facilities on the Gulf Coast that had power and water after the storm. We deployed watering stations on the hospital grounds for the community to fill water coolers, and we sheltered upward of 250 people at a time after discharge who were waiting for community shelters to open.”

Learning curve
In some cases, a disaster can provide an opportunity for an organization to grow stronger. Mercy Hospital (formerly St. John’s Regional Medical Center) in Joplin, Missouri, is a facility that has taken a disaster and turned it into an opportunity for learning and growth.

Since the May 2011 tornado that destroyed the facility, John Farnen, executive director of strategic projects for Mercy Hospital, has overseen the installation of a number of innovative new products to better protect residents and staff in the event of future disasters.

“That was a historic storm that taught us many lessons,” Farnen says.

In its new facility, opened last year, Mercy features a “tornado-proof” design with a concrete roof, fortified safe zones on each floor, and generators that are being half buried away from the main building. The hospital also employs a window system designed to withstand the 250-mile-per-hour winds of an EF-5 tornado.

Hill of Ochsner Baptist saw firsthand that today’s tough new windows, built to withstand high wind speeds and the impact of flying debris, work far better than older products. Following Katrina, he notes, “Some of the newer buildings fared a lot better than the older buildings, especially the windows. The newer buildings that were only about 10 years old, rather than 30 or 40 years old, had some windows that did stand up to [the storm].”

Following the historic hurricane, Ochsner Baptist installed new windows, and it continues to upgrade that critical part of the building shell. “In some of the buildings that we’re renovating, we’re putting in those big 200-mph-rated windows,” Hill says.

Neighboring problems
One of the problems faced by all windows is not just the pressure of strong winds, but the impact of small debris—often from neighboring rooftops.

“We had a lot of what they call ‘build up’ roofs, which they use in this area a lot,” Hill says. “They would put a tar roof on, and then they’d put rocks or gravel on top of it. We had a lot of problems with that gravel flying around in the high winds.”

Memorial Hospital at Gulfport faced similar problems.

“Overall, the building fared well during Katrina,” says McDowell. “The damage was from the gravel ballast roof blowing off and knocking the windows out. Once the gravel ballast was gone, the leaking started from the wind-driven rain.”

Like Mercy Hospital, Memorial learned firsthand the important role that a strong building envelope system plays.

“A third of the wall surrounding our main communications room was window wall,” McDowell says. “Once the windows were blown out, the wind from the storm removed most of the remaining wall, which exposed our communications equipment.”

Ultimately, Memorial Hospital had several rooms taken out of service due to the window damage inflicted by the gravel ballast roof. “We placed patients into the center core away from windows and extended utilities such as power and oxygen into the corridors to better protect the patients,” McDowell says. “Post-storm required specialty companies to come in and dry out a couple of the upper wings of the hospital due to the rain damage after the gravel ballast blew off.”

Since then, needless to say, Memorial has removed all of the gravel ballast from its roofs. McDowell advises other facility managers to review their roofing construction, no matter the makeup. “Is it the best option for the climate you are located in? Gravel ballast proved not to be a viable option in hurricane-prone areas,” he says.

What else is needed?
Once Ochsner Baptist’s immediate needs had been met following Hurricane Katrina, the hospital’s facility management team began to look further.

“We did put in an additional generator, not only to take care of the air conditioning system. It is a generator large enough to supply normal power throughout the facility. Basically, we’ll be like a cruise ship on the ocean, where we can run normally without electricity,” Hill says. He adds that these projects are ongoing.

McDowell agrees that the generator and boiler rooms, main communications room, data/IT center, kitchen, and command center are among the elements most in need of protection. For hospitals that have limited budgets, though, he suggests the one system to reinforce now should be the hospital generator and its fuel capacity. His second choice: “Install a well if you don’t have one, and tie it in to your emergency power.”

For Memorial, recovering from the disaster meant changing some aspects of the layout and adopting newer products. “The communications room was reconstructed and no longer contains a window wall. The gravel ballast roof was removed and replaced without gravel. We are currently under construction, adding two floors and replacing the building brick skin with window wall. The window walls are hurricane-rated,” McDowell says.

Today’s plan
Having come through one of the country’s worst natural disasters, the Ochsner Baptist team takes its disaster planning very seriously. Hill explains that the facility has a thorough plan in place when a dangerous weather event is forecast.

“We’ll start out by cleaning off any loose materials on the roofs, and tie down anything that we can,” Hill says. “Then we go into the neighborhood streets and actually clean the drains and make sure they’re all free of debris. Then we come back into the facility and we check our sump pumps to make sure they’re operational. We do preventive maintenance on them all the time, but we double-check that.
“We actually go through and clean the light wells to make sure there’s no debris and the drains are all free and clear. We also have little portable pumps and generators, and we make sure they are fueled up, and then we run them to make sure we don’t have any mechanical problems with those. Then we go out and stockpile extra gasoline and diesel fuel and whatever is required for those pumps. Finally, we check our fuel levels in our generator and make sure we top those off, if there is the threat of a storm coming soon, and we make sure we have the maximum supply of fuel in the generators,” Hill adds.

Preparing for the worst
It is nearly impossible to be prepared for every eventuality that may result from the chaotic destruction brought by hurricanes, tornadoes, and other natural disasters. And as Hill knows firsthand, no disaster is without its challenges.

“The flooding [from Katrina] was really a big challenge, and the fact that we did lose city water and natural gas,” he says. “It was difficult to overcome. You make provisions for the things that you feel like are going to go down, but every day it was just a little bit worse and a little bit worse.”

McDowell advises putting in place today the relationships that will ensure no hospital has to go through a disaster alone. “Build strong working relationships with your community agencies: city, county, and fellow hospitals,” McDowell says. He adds, “Always consider the worst-case scenario during your planning stages of projects.”

Having come out on the other side of such a devastating event, these facility managers are able to emphasize the importance of having a disaster plan in place and regularly assessing the operation of vital equipment.

Editor’s note: Portions of this story originally appeared in Facility Care, a publication of Thompson Information Services.

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