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North Carolina hospital dealt with surge in storm refugees after hurricane


August 31, 2017

Dealing with the aftermath of Hurricane Matthew last October forced a North Carolina hospital to scramble to deal with a surge of local residents fleeing rising floodwaters.

The lessons learned by emergency planners in North Carolina at Southeastern Regional Medical Center included having a satellite hookup to maintain internet connectivity, keeping an updated list of local emergency shelters, and establishing an alternate water supply with which to flush toilets if potable water is being rationed.

The list of shelters should include travel directions and whether the shelter could recharge mobile phones. 

The sole hospital in Lumberton, North Carolina, survived the hurricane winds with minimal damage but was then deluged when it became a public safe haven during the flooding that followed.

Southeastern Health includes the 292-bed medical center plus another 20 clinics, a long-term care hospital, and a hospice house, says Craig Kuhl, the health system’s manager of safety, security, and emergency management. The medical center has about 2,200 employees serving a regular daily census of about 215 patients.

Supplies consolidated ahead of storm

As with most hurricanes, the health system had a few days’ notice to plan for the impending storm, although initially Matthew was forecast to primarily impact Florida and maybe South Carolina.

Generators were checked and medicines, food, fuel, linens, and other supplies were evaluated and restocked to ensure the hospital could hold its own for at least 96 hours, says Kuhl. With clinics closed ahead of the storm, some of their supplies were moved where they could be better used, Kuhl adds. 

Contractors with prearranged agreements for post-storm supplies were put on standby, and plans were coordinated with local officials. Workers also double-checked the connections to the hospital’s water well, which had been dug some years earlier following the lessons learned in previous storms. 

In addition to the hospital, preparations were made at the hospice and long-term care center, including checking supplies and evaluating patients who might need to be moved. The hospital made arrangements for some maintenance workers to stay at the two centers to deal with problems if they occurred there. 

Patient care shifts were also rearranged to ensure that enough staff were on hand for rotating 12-hour shifts through the storm, and routes were preplanned for those employees who were to provide shift relief afterward. 

Landfall shifts north

As happens with hurricanes, the forecast of a Florida landfall became more uncertain and Matthew took aim a little farther north. While it made its U.S. landfall in South Carolina on October 8 as a category 1 hurricane, the storm’s far-reaching and torrential rains produced flooding in North Carolina that ultimately killed 26 people, forced others out of their homes, and left more than 600,000 without electricity.

Forecasters in Lumberton, which is about 20 minutes from the South Carolina state line, initially called for 4–7 inches of rain. The storm dumped 12.8 inches, says Kuhl.

While the Lumber River crested at a record 24 feet well to the south of the medical center, the flooding there and along Interstate 95, which runs within a mile north and west of the facility, isolated the hospital from many resources and employees. “We pretty much became an island for almost 96 hours,” says Kuhl.

Still, it was the refuge of choice before and during the hurricane, especially after flooding forced state police to close I-95 at exit 20, which is about a half mile from the hospital, adds Kuhl.

Hurricane winds cause little damage

The exit closure funneled traffic off the interstate and into the nearby area, where the hospital stood as a sure location of food, medicine, and electricity.

About three hours into the storm on October 8, the hospital lost power along with others in the area and emergency generators kicked in, Kuhl says. When minor flooding occurred on the roads leading to the emergency room, ambulances were redirected to another entrance.

Facility workers were kept busy dealing with water seepage from the rain that was being driven horizontally into the building, but otherwise the facility suffered little damage in the storm itself. The main impact during the storm was the number of people who came into the hospital searching for shelter. The hospital’s public areas were filled to capacity. Late on the first day of the hurricane, the hospital made the decision to close the cafeteria to the public to ensure it had enough food for patients and staff for the pre-planned 96 hours, Kuhl says.

After the hurricane passed, staff armed with a list from local officials began diverting people to shelters. At that point, the floodwaters were not a major problem near the hospital. Lumberton has a river levee system that works in concert with the interstate construction and is designed to control flooding along the river. The month before, a tropical storm had produced some flooding but did not threaten the medical center, Kuhl says.

Then comes the flood

The storm dumped large amounts of rain over 

North Carolina and points north and west, and soon the river and other waterways began to rise. 

The floodwaters rose until they reached an open point in the levee system, allowing the record high waters to spill into parts of the city previously protected. Lumberton’s water treatment plants were overwhelmed and city water was cut off—luckily, the sewage plant remained in operation. As residents began to flee their neighborhoods, with the interstate still closed, the hospital again became the point of refuge, Kuhl says.

While floodwaters never posed a major threat to the hospital, the lack of city water and subsequent road closures did become a concern. Medical staff and other workers sent home after the hurricane with preplanned routes to return the next day found they were cut off by floodwaters, Kuhl notes. The hospital worked with local officials to find a place for workers to meet in the eastern part of town so they could be ferried in by sheriff’s officers.

Floodwaters block suppliers

As the flooding continued into its second and third day, the 96 hours of supplies began to dwindle. The contractors were ready with the prearranged resupply, including the water tankers, but had no safe way into the area. The well, while a good backup, couldn’t replace the need for the water tankers, notes Kuhl.

A liaison from Southeastern Regional was assigned to the local county emergency command center so that officials could figure out routes to get the suppliers as close as possible on the interstate, where they could meet a state police escort to take them around road closures and to the hospital.

Meanwhile, the patients and staff members at the hospice and long-term care centers were also cut off by floodwaters—as were local funeral homes. Hospital officials began making plans to bring in a refrigerator truck in case it was needed, Kuhl says. (It wasn’t.) 

Hospital remains refuge

It would take almost two weeks for the river to crest and floodwaters to begin to recede. In the ensuing days, people continued to show up at the hospital—not only to find shelter but also because their own supplies of oxygen and medications were running out, Kuhl notes. Even staff members began requesting medications.

Residents and visitors showed up to recharge their smartphones and other mobile devices, too. The hospital readjusted its list of shelters to outline which community centers had recharging stations, as well as those equipped to handle families and pets. The hospital then also provided those shelters with medical staff as available. 

But even those things became moving targets—floodwaters forced some shelters to be evacuated, while some shelters sent word to the hospital to request medications and other supplies. Coping strategies were often communal. As hospital staff helped shelter workers move, in turn the hospital relied on county fuel supplies to bridge gaps in deliveries.

Through it all, hospital staff helped themselves and each other, notes Kuhl. Several of the senior leadership chipped in on the “bucket brigade,” he says, which was the group that was assigned the task of using the well water to keep toilets flushed. More notably, staffers helped out colleagues affected by the flooding. The hospital reported afterward that more than a dozen workers in the hospital’s Food and Nutrition Services department alone had homes severely damaged or lost to floodwaters. Other hospital staff stepped in so that the affected workers could deal with their homes and families.

Events highlight some problems

The only major equipment problem occurred after the third day, when one of the three generators began smoking. It never failed, however, and the hospital was back on public power shortly thereafter, Kuhl says. 

While power was out, paper medical records were used. The hospital never lost telephone landline access, and it was able to hook up computers and printers using the generators and hardwired network connections.

What they didn’t have was television or internet access after their local service went down in the storm. Since much of their emergency operations command center depended on the internet service, adjustments had to be made on the fly, Kuhl says. Having the telephone landlines proved key. Mobile phone service was often available but would become sporadic if towers became overloaded with use.

The hospital continued to provide patient care, but limited it to the minimum necessary. Elective surgeries were postponed to keep operating suites available for emergencies. However, as the flooding dragged on, hospital officials decided out of caution to evacuate the nursery and some intensive care patients to hospitals in Raleigh, North Carolina, to the north, Kuhl says. In addition, with the amount of visitors coming in and out of the hospital and the potential for infection related to flooding, hospital officials decided to enact visitor restrictions. Much like during flu season, the number of family members allowed into patient care areas was limited as an infection control measure, Kuhl notes. Otherwise, the hospital was able to handle all of the patients in its care, both before and after the storm.

While the emergency plans worked well, there were some hiccups identified, and changes are already underway in many areas, he says. 

Recovery begins

In the aftermath, the hospital reached out to provide counseling to staff and offer assistance to those financially or physically impacted by the floods, he says. Initially, supervisors were asked to fill out a one-sheet survey identifying employees who were living in shelters or otherwise affected to determine the needs of the staff. The hospital also increased the availability of its employee assistance program, including extending hours for counseling.

In general, Kuhl has high praise for the hospital staff’s response during the storm. Now the focus is on making improvements so the staff can face the next storm, whenever it comes. 

Editor’s note: This story originally ran in Environment of Care Leader.


Consider these lessons learned in North Carolina as you plan for the next storm

When Hurricane Matthew roared into the United States last October, hospitals from Florida to Virginia prepared for the storm that had already killed dozens as it barreled through the Caribbean. While the storm itself did only minor damage to the sole hospital in Lumberton, North Carolina, the rains and flooding it left behind were devastating to the surrounding area.

Residents and visitors alike turned to Southeastern Regional Medical Center for not only healthcare but also refuge and comfort as floodwaters rose.

While most of the hospital’s preparations proved valuable in getting the facility and its patients and staff through the ordeal, there were lessons learned, says Craig Kuhl, manager of safety, security, and emergency management for Southeastern Health, which includes the 292-bed medical center plus another 20 clinics, a long-term care hospital, and a hospice house.

Use these observations to assess your own plans for a hurricane or other event that requires your facility to be self-sufficient for several days.

Plan for a backup if internet access fails. Service from the hospital’s internet provider failed during the October storm, meaning there was no television for gathering information and no computer service other than Southeastern’s internal, hardwired network, Kuhl says. The hospital used its intranet system for medical records and printing. However, without internet connectivity, the web-based emergency operations command center functionality had to be scrapped and other adjustments made. 

It helped that the hospital’s land telephone lines continued to function throughout the storm and the flooding aftermath. The hospital is arranging to have backup internet service via satellite for future events, Kuhl says.

Explore software that can be preprogrammed to plot paths to and from the hospital campus. In anticipation of needing to get employees to and from work, both to allow them access to their homes and families to deal with the storm and to allow shift changes for tired hospital staff, planners had pre-plotted where employees’ homes were in the area and provided them routes to get back into work. But that plan was based, in part, on flooding patterns from previous weather events, particularly a tropical storm that had moved through the month before, notes Kuhl. After Matthew’s arrival, record floodwaters breached the city’s levee system and cut off areas in unexpected ways. 

Before the floodwaters began to recede, staff spent hours plotting new routes by hand, sometimes daily, and then communicating them to each employee. To minimize this burden in the future, Kuhl says the hospital is looking into software that can be preprogrammed with employee locations and use GPS coordinates to plot new routes in minutes instead of hours. Ideally, the hospital will be able to outline an area and send a single text to employees living in that area with information about routes into the hospital, rather than communicating with employees individually, he says.

Work closely with local officials to coordinate access to emergency shelters. Hospital staff also spent a lot of time dealing with visitors and residents who sought shelter at the hospital. Kuhl says that staff worked to develop a list of community shelters; this list noted the amenities at each shelter, such as charging stations for mobile devices or the ability to house pets, as well as directions. 

Assess and reassess what systems are on generator power. While it was not an issue during the October storm and aftermath, facility officials realized at some point that parts of the facility’s heating, ventilation, and air conditioning system were not on generator power. Engineers began evaluating how to get those areas onto generator power. 

While Kuhl says he was pleased with the hospital’s overall planning, response, and recovery related to Matthew, he emphasizes the value of learning lessons through regularly scheduled exercises.

In addition, he wants to bolster emergency planning within the community. While local emergency response leaders relied on the hospital for help in resupplying medications and other supplies at the shelters, the hospital itself had to rely on county fuel reserves as the flooding dragged on. In addition, state police and local sheriff’s officers provided aid for workers and suppliers who needed help getting to the hospital.

The events surrounding Matthew pointed to a need to improve community collaboration, including something as simple as getting on the same page with terms and references. Everyone has their own shorthand when talking about particular supplies or processes, and Kuhl says he wants to work on bridging that communication gap now, ahead of the next emergency.

“It helps to know who your partners are,” Kuhl says—and to know what they’re saying.

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