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November-December 2010

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A Plan for All Seasons: Helping Hospitals Prepare for Extreme Weather

 

Chad Ware recalls that when he drove to work at the Mercy Medical Center in Cedar Rapids, Iowa, the morning of June 12, 2008, he and others at the hospital knew something unprecedented could happen that day.

The National Weather Service had predicted that a big flood coming down the Cedar River would crest in Cedar Rapids at 24 to 26 feet that day. Since flooding begins in the city at the 12-foot level, the flood would be major. Nevertheless, Ware says, “The hospital is so far from the river we never expected [before this] it would happen to us.”

At 7:42 that morning, flooding knocked out electrical power to large parts of the city, including to Mercy Medical, forcing the hospital to switch to the emergency generators in the basement. If flood water reached the hospital it would lose all electrical power. With the predicted flood height of 24 to 26 feet, “We would have been OK,” Ware says. “We ended up with 31.8 feet.”

A little after noon, as flood water inched toward the hospital, staff and volunteers from the community began piling sandbags around parts of the buildings. Those who helped included nurses—some had to change and shower three times during their shifts as they switched between sandbagging and caring for patients.

Caption: Volunteers form a human chain to carry sandbags in an attempt to protect Mercy Medical Center from the rising flood waters early Friday, June 13, 2008, in southeast Cedar Rapids.

Later in the afternoon sanitary sewers began backing up in the hospital, and at 5 p.m. the hospital started evacuating the first floor where the emergency room was located.

Sixteen patients were in the emergency room when the evacuation began, including one in critical condition with a stroke. This patient, the nursing team, and the physician treating him were in a room away from the water, where they stayed until they finished administrating tPA clot-busting medication and were able to take the patient to the intensive care unit on a higher floor.

The Mercy Medical Center flood illustrates a danger many hospitals face: Some of the most crucial equipment in a hospital is at high risk for damage from weather-related natural disasters because it is housed on lower floors. In addition to the emergency room, facilities needed to help physicians make their diagnoses and offer treatments, such as the cardiac catheterization lab, ultrasound, MRI, and the CT scanner, are on the ground or basement floor. “We build a hospital for accessibility and look for other ways to protect facilities from disasters,” Ware says. Ware is now the Assistant Clinical Director of Inpatient Services at Mercy Medical. At the time of the flood he was a Program Coordinator in the Emergency Department.

When the first floor of Mercy had to be evacuated, the hospital lost its access to diagnostic equipment, and the Emergency Department began diverting incoming patients to other hospitals. When patients already in the emergency room were taken upstairs, “one of the amazing things was the work of our IT department,” Ware says. “We picked up (the emergency room) equipment, walked it upstairs, plugged it in, and it worked.”

He says the IT department had “built a solid infrastructure throughout the organization. That infrastructure was not only able to support us in our greatest hour of need, it facilitated a faster recovery and made many of our jobs easier.”

At 10 p.m., with the danger that water could get into the basement and flood the generators, Tim Charles, Mercy Medical's CEO, decided to evacuate all of the hospital's 205 patents. “We have nine floors, and no one wanted to have to bring patients down without elevators” if the power failed, Ware says. Some of the patients were ready to be discharged and were sent home. Ambulances, buses, and National Guard Humvees took the remaining 183 patients to other hospitals or nursing homes.

Looking back on the flood, Ware says, “The most amazing thing was the community's response.” The sandbags that staff and volunteers piled around threatened parts of the hospital meant that “very little water came in. We saved the building.”

As it turns out, the generators kept on producing power. After the patients were evacuated, the hospital's maintenance staff and contractors continued to work on the building, keeping water out of key areas. Mercy Medical was able to reopen some services five days after the flood, and all services were open in 15 days. However, services that had been in the basement or on the ground floor had to be moved to alternate locations while the basement and ground floor were rebuilt. Ware says that the drywall and insulation on the entire ground and basement floors had to be removed. In addition, several sections of the ceiling and heating and ventilation system were replaced. “Our pharmacy robot was ruined and we had damage to our radiology machines including CT scanners and MRI,” he says. The catherterization lab equipment was also damaged. Mercy Medical contracted an Independent Industrial hygienist to work with the hospital and contractors to ensure the flooded areas were healthy and safe before they reopened. The overall cost was estimated at $68 million.

Healthcare Can't Escape the Weather

The flood that shut down Mercy Medical is only one example of the many ways that severe weather halts or impedes the work of hospitals and other healthcare facilities.

The news reports that came from New Orleans, Louisiana, in the aftermath of Hurricane Katrina in 2005 certainly showed the world how disasters can turn hospitals into horror stories, but even before this devastating event, the National Weather Service and the American Meteorological Society (AMS) were working with healthcare institutions to reduce their vulnerabilities to severe weather, says Wendy Marie Thomas, a policy analyst with the AMS Policy Program in Washington, D.C.

According to Thomas, former National Weather Service (NWS) Director David L. Johnson initiated this work in 2004. Since then, AMS has conducted two policy forums in Washington, D.C., with the help of a $300,000 NOAA grant. These forums brought together representatives from healthcare, the legal profession, engineering, hydrometeorology, and insurance—all with different perspectives. One of the main goals, according to a summary of the 2009 forum, is to make everyone aware of the public- and private-sector hydrometeorological products and services that are available to improve hospital safety.

Caption: This image is an example of the graphic warnings that NOAA' National Severe Storms Laboratory is developing for the National Weather Service. The graphic shows the area under immediate threat from severe weather, at the top, the odds of which areas will be affected in the coming half hour and the next hour, and the estimated time the tornado or severe thunderstorm should arrive.

The AMS Policy Program is focusing on hospital protection, because hospitals are not only centers of emergency and ongoing medical care, but also economic engines in their communities. Thomas says that as a community recovers from a natural disaster, its hospitals “are essential anchors that support rebuilding efforts.” The lack of adequate healthcare makes a community less attractive to new businesses and could prompt some existing businesses to relocate rather than rebuild.

Disconnects

“When a natural disaster threatens or hits a hospital, there are disconnects on both sides,” Thomas says. “The hospital side sees a different set of reality than the meteorology side.” As such, it is important for hospitals to understand how the news they hear from meteorologists can affect their planning.

For example, all weather forecasts are, at least to some extent, probabilistic. This can lead to one kind of disconnect, Thomas says: “Hospital administrators and physicians must understand how the forecast relates to them and their work. If we say there is a 20 percent chance [of a particular event occurring], that's confusing. They look at it as ‘only 20 percent’ and not a one-in-five chance.” For example, if officials consider that there is a one in five chance that storm surge from a fierce hurricane will flood a coastal hospital's ground floor, while 100 mph-plus winds threaten windows on the upper floors, they might decide to undertake the dangerous and expensive evacuation of a hospital before the water and wind begin to arrive.

The Role of Forecasting Companies

Some disconnects arise because the NWS can't supply fine details of a forecast to everyone who needs weather information in order to make decisions.

For example, a hospital's leaders might need to know how much threat a particular severe storm or flood will be to their hospital and when the threat should begin and end at the hospital, not in far-away parts of their county. The NWS is the source of official weather warnings and general forecasts for the public, but it can't provide the more detailed forecasts that decision-makers often need. Fortunately, NWS observations and forecasts constitute a database that other U.S. and foreign government agencies and private companies can access and use to produce more detailed forecasts that meet their particular needs.

Mike Steinberg, a senior vice president of AccuWeather, Inc., based in State College, Pennsylvania, says that AccuWeather and other firms provide two kinds of tailored forecasts for hospitals:

  1. Specific warnings regarding weather that could damage the hospital, such as a hurricane, tornado, or flood.

  2. Alerts for weather that could increase hospital emergency admissions without damaging the hospital. For example, a heat wave could cause heat-related sickness in the elderly and the young, an air pollution event could send asthma victims flocking to the hospital, or an ice storm could overwhelm the emergency room with auto-accident victims.

Caption: Americus, GA, March 12, 2007 – An EMT and a doctor push a new patient into the temporary emergency room across the street from the damaged Sumter Regional Hospital. The hospital was badly damaged by a series of tornadoes.

Mike Smith, the Founder and CEO of WeatherData Services, Inc., in Wichita, Kansas, which is now an AccuWeather company, explains how his company provides specific tornado information that hospitals need:

A National Weather Service tornado warning means there is a high probability of a tornado at some location within their warning area. However, hospitals have found that using NWS warnings creates too many false alarms. One of the most important benefits of our warning service for hospitals is to give them a null warning, to let them know that even though a NWS tornado warning is in effect in their area, the hospital itself will not be hit.

One of WeatherData's clients is the University of Kansas Medical Center in Kansas City, Kansas, where Rick Johnson is Director of Public Safety and Chief of Police. “We are in the middle of the Midwest and are familiar with severe weather,” Johnson says. “We're also aware that a hospital can be challenging for emergency management.”

For instance, a basic tornado safety rule is get into a room with no windows on a lower floor when you hear a tornado warning. Flying debris, including debris that crashes through windows sending shattered glass flying into a room, is a big cause of injuries.

Taking shelter away from windows is usually easy enough if you're at home or work. But, if you're in charge of keeping hospital patients and staff safe, you can't order patients to be moved into hallways away from windows.

“You have to make sure that it's absolutely necessary,” Johnson says. “You can actually cause more harm by moving patients only a short distance.”

Until 2008, the Medical Center relied on NWS tornado warnings. “The problem isn't that they weren't accurate, but that we might get a warning for a tornado that stays 15 miles away,” Johnson says. WeatherData Services, Inc.'s ability to fine tune warnings for the area around the Medical Center “makes us comfortable.”

While a Great Plains blizzard won't threaten the Medical Center's buildings, it can disrupt operations by keeping staff from being able to travel to or from work. “We use the service in winter to pick up the phone and talk directly with a meteorologist about preparedness,” Johnson says.

Knowing whether a snowstorm is likely to be a six-hour or a 36-hour event enables the Medical Center to make sure its staff is prepared and that enough people will be available, not only to care for patients, but also for snow removal, Johnson says.

He sums it up: “The whole thing that drove us to contract for the service was the need for more information unique to our little sector of the world here.”

Caption: Sumter Regional Hospital in Americus, Georgia, was damaged extensively by tornadoes in early March 2008.

A Guidebook for Handling Weather Disasters

While each kind of severe weather offers unique challenges to those running hospitals in different parts of the United States, there are common elements to preparing for and managing all natural disasters.

No matter what kind of disaster a hospital or other healthcare institution faces, being prepared requires “preplanning and having an ‘all hazards approach’” says Bryan McNally, an Associate Professor of Emergency Medicine at the Emory University School of Medicine in Atlanta and author of the Extreme Weather Events Preparedness Guidebook for Health Care Facilities. McNally expects the book to be published by 2012.

One of his goals for the book is to repair the “disconnects” between the healthcare and hydrometeorology communities that Thomas refers to above. “Rather than trying to have a unique plan for every imaginable disaster, having a universal approach that can be tailored to the disaster event may be a more effective approach,” says McNally, who in addition to his medical degree and work in medical education and care and in public health, earned his undergraduate degree in meteorology.

“Although disasters may differ in many ways, the pre- and post-event issues are often the same—like communication with public or hospital staffing if nearby roads are impassable or a facility needs to be evacuated,” McNally says.

Caption: After Hurricane Ike struck Galveston Island, Texas, in September 2008, patients at hospitals damaged by the storm had to be moved to medical facilities outside the impacted area. Here, members of the Iowa-1 Disaster Medical Assistance Team move a patient with the help of flight nurses and medics.

Chapter 9 of the Guidebook will cover understanding the basics of overall disaster planning, which includes knowing how an Incident Command System (ICS) works. This system provides a common way to immediately set up management and procedures for incidents of any size. It's been widely used in the United States for more than 30 years, and the U.S. Department of Homeland Security requires that emergency services organizations use it in order to obtain federal preparedness funding

The Guidebook will use case studies of disasters, including the Mercy Medical flood story in the chapter on floods. This Cedar Rapids, Iowa, case study will include the NWS precipitation and flood forecasts, flood outlooks, and watch and warning products from the flood that were used by hospital administration to make decisions regarding that flood, and to illustrate how hospitals and other institutions can use such products.

McNally says that healthcare, disaster-planning, and meteorology communities were all equally represented as he was preparing the book. The book will be published online to help get it to the target audience.

In 2008, Chad Ware, in addition to his other duties in the Emergency Department, was on a preparedness committee that worked on disaster planning. Even though the group focused on tornadoes or a release of radioactivity at the nuclear power plant in the county—not flooding—his disaster planning experience “really paid off” during the flood because he understood things such as how the incident command system works.

The Guidebook and further meetings that bring together the healthcare and hydrometeorological communities, such as the AMS Policy Program, should ensure that in the future, more hospitals and other healthcare facilities have men and women on staff who have expertise in disaster planning and response.

Caption: Two years after Hurricane Rita destroyed South Cameron Memorial Hospital in Louisiana in 2005, the medical center reopened its doors. While it was closed, the hospital made improvements designed to reduce potential loss of property and medical equipment in future disasters. The mitigation measures of building safer, smarter, stronger proved to be invaluable in 2008 when Hurricane Ike struck, as the hospital received only minor damages.

JACK WILLIAMS was the founding editor of the USA TODAY Weather Page in 1982. After retiring from USA TODAY in 2005 he was coordinator of public outreach for the American Meteorological Society from 2005 until 2009. While with the Society he wrote “The AMS Weather Book: The Ultimate Guide to America's Weather,” which the Society and the University of Chicago Press published in 2009. This was the sixth book he either wrote or co-authored. He is now a freelance science writer.

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