• compra 
• venta $
• sobre
• My DOTmed 

by Joan Trobetti

This report originally appeared in the October 2008 edition of DOTmed Business News

"When the levees broke, we were able to run on generator power until Tuesday, but when the authorities would not allow our vehicles to carry additional supplies of fuel into the city to keep our generators going - the situation quickly became critical." - Andre Duplessis, Chief Operating Officer, Tulane Medical Center, Member of Command Center Team speaking about the aftermath of Hurricane Katrina hitting Tulane Medical Center in New Orleans.

In North America, there has been an increase in the number and intensity of tropical storms and major hurricanes. Hurricane Gustav recently flooded low lying areas on the Gulf coast, causing major damage to areas of the already beleaguered state of Louisiana, and as of this writing, the damage from Hurricane Ike is still being accessed.

Lessons Learned - Saving City Hospitals

In areas vulnerable to flooding, more attention is paid to disaster plans and evacuation orders, particularly for those hospitals and other institutions that hold custodial responsibility for people. Due to the ramifications of Hurricane Katrina, most major cities hospitals reviewed their emergency response and evacuation plans and have made adjustments to accommodate the special needs that apply following a major natural disaster.




Designated Incident Command Centers are located at Ochsner hospitals in Louisiana to ensure communication remains intact internally and with outside agencies throughout periods of severe weather. They include satellite phones, internal cell phones, exterior cell phones, and HAM radios with operators and 800 MHz radios. The Centers' emergency plans include stockpiling fuel, food and supplies and drawing water from multiple wells according to Joe Guarisco head of emergency services at Ochsner. Two medical teams have been designated for every service in the hospital - one to ride out the storm and another to remain on call at home. "The hospital is taking no chances this season. Our top priority is the safety of our patients and employees, and we are now prepared for what the future might bring," says Warner Thomas, President and COO of Ochsner Health System.




Tulane Medical Center (part of HCA's Delta Division) made major improvements by waterproofing existing generators an additional eight feet higher and increasing their diesel holding capacity from 10,000 to 25,000 gallons. They have cell phones with out-of-state area codes, "brown" phones with direct connections to the phone company and hurricane-proof satellite dishes. "We also installed a water well that is tied to our back-up power supply," notes Stephen Baldwin, Vice President of Operations.

Andre Duplessis explained that the difference between Hurricane Katrina and Gustav from a planning and preparation perspective was like night and day. "Although Gustav was not as bad as it was expected to be, we had three years to prepare for this type of storm and the upgrades that we have made to our physical plant and improved communication capabilities have really paid off," he said.

Meanwhile, New Orleans' Children's Hospital has also made adjustments. The building is designed to handle up to 14 feet of water on the first floor and evacuation plans call for patients and essential equipment to be pre-positioned or moved on or above the hospital's second floor, which sits more than 28 feet above sea level - higher than both the river floodwall (23 feet) and lake levee (17 feet). "We've learned much from Katrina," says Doug Mittelstaedt, Vice President of Human Resources. "We know our building is a safe place to be during a powerful storm because it withstood the hurricane with only minor damage. We also learned that we needed to make some improvements before the next hurricane and we've done that." Those improvements include positioning generators on the third floor of the hospital or above, digging its own water well, constructing a helicopter-landing pad and building a pump capable of supporting the roof-based air conditioning system, sewerage and showers on campus even if the city water system fails.

LSU Health System is composed of 10 public hospitals, five of which are below the Interstate 10 Corridor in South Louisiana and are at risk for hurricane damage and flooding. Michael K. Butler, MD, CEO of LSU's Health Care Services Division, strongly believes that hospitals must rely on their own personnel and resources in times of crisis because depending on outside resources is "too risky" when immediate action is necessary. "You can't wait on the cavalry to get things done," says Butler. "If you do, you might end up waiting for assistance that will never show up."

Following Hurricane Katrina, LSU improved communications, adding satellite phones, Ham radios and 800 MHz radios to their inventory. This communications system helped keep all of the LSU hospitals in contact with each other during Hurricane Gustav. There is also a direct link to vendors in place in the event that fuel, food, water or pharmaceuticals are required. Additionally, there is an advanced electronic medical records system on-board at all LSU hospitals, which is designed to track patient information during the many transfers that may be made during a major catastrophe. Butler says the real heroes during Hurricane Gustav were the system's 6000 employees. "Our planning and preparation for a storm like this led to taking orderly and timely steps to guarantee the safety of our hospitals, and more importantly, our patients."

New York City Vulnerable




Nicholas V. Cagliuso, Sr., MPH, Corporate Director of Emergency Management of Continuum Health Partners, Inc. in New York City says that Continuum institutions apply a comprehensive, scalable, all-hands approach to their emergency management efforts to ensure that patients, workforce and facilities are safe regardless of the incidents that affect them. "Given our all-hazards approach to emergency management, we initially manage hurricanes, or any severe weather event, as we do any incident," says Cagliuso. He explained that this means that using the best available information; Continuum employs their emergency management plans' hazard-specific events, such as flooding or utilities disruptions due to a hurricane. These appendices outline very clear actions to ensure that the ability to maintain and provide essential services to patients, workforce and communities before, during and after a storm. "In hurricanes for example, this may include the need to shelter-in-place, or to evacuate the facility in whole or part," says Cagliuso.

Continuum Health Partners is parent company to Beth Israel Medical, St. Luke's and Roosevelt Hospitals, Long Island College Hospital and New York Eye and Ear Infirmary in New York City. As the Assistant Vice President of Public Affairs/Corporate Communications for Continuum Health Partners, Jim Mandler says that his job in the event of an emergency is to deal with the related issues for the entire system. "I think my role and those in my department is to be sure that we are communicating with the media as to what the impact of the event is on our hospital, ensure that our patients and staff know what the impact is on the hospital and serve as a source of continuity in both of these efforts if, in fact, the event is a prolonged one (lasting more than a few hours)."

Lesson from Hurricane Rita - University of Texas Medical Branch
Hospital's Team Effort

"It looks like the emergency preparedness plans worked. Thank God we evacuated patients and weren't in the position of trying to care for really sick people with no power. Our leadership had a plan and stuck to it." Marsha Canright, Director, Media Relations, University of Texas Medical Branch, Galveston, TX, comment following Hurricane Ike.

What the University of Texas Medical Branch at Galveston (UTBM) learned from Hurricane Rita in 2005 proved to be valuable lessons as emergency plans were put into place to face Hurricane Ike.

Karen Sexton, R.N., Ph.D. FACHE, Interim Executive Vice President and Chief Executive Officer for the UTMB Health System led the team's efforts to plan for resumption of full services following Ike. She believes that specific factors are crucial for success, including identifying an incident commander with sole authority to make decisions, developing and communicating a set of guiding principles, setting patient safety as a top priority, establishing an incident command center that consolidates vital institution functions, avoiding delays in deciding to evacuate, identifying strategic partners, selecting essential personnel who are not distracted by personal concerns during the emergency and conducting periodic trial runs of emergency preparedness.




"Our clinical activities will be minimal for the next two weeks," Sexton says. "Many of our emergency generators are running smoothly and our communication systems are coming online one be one." Sexton also went on to say that UTMB is bringing outside crews and an environmental health team to help with the clean up and recovery.

The Disaster Medical Assistance Team (DMAT) is onsite and patient care responsibilities have been turned over them.

Deploying to Help Save Lives

DMAT operates under the auspices of the U.S. Public Health Service's Office of Emergency Preparedness as an integral part of the federal disaster plan. The National Disaster Medical System is composed of state-based Disaster Medical Assistance Team (DMATs) with volunteers representing different medical disciplines. These teams provide an organized approach to medical disaster management that ranges from primary care to surgical emergencies and from pediatric through geriatric care. They are deployed when a disaster overwhelms local response efforts and resources.

University of California, San Diego campus has a DMAT, sponsored by UC San Diego Medical Center. "DMAT San Diego, CA-4 is now staged in Atlanta preparing for its assignment in response to Hurricane Ike," says Therese E. Rymer, RN, Deputy Commander, DMAT San Diego, CA-4. Team members are refreshing their skills on the use of electronic medical record equipment specifically designed for use in disaster environments. Additionally, a new patient tracking system will be used to follow the location and movement of evacuated patients. The 35-person team of local medical volunteers is led by Irving "Jake" Jacoby, M.D., Emergency Medicine physician and Medical Director of Emergency Preparedness and Response at UC San Diego Medical Center. "Our team will support medical needs related to disasters including acute medical issues after the storm passes, and for whatever is necessary, when and where a storm hits," says Jacoby.

By learning from the problems faced in the past, it is hoped that lives will be saved when hospitals are threatened by natural disasters in the future.