Hurricane Katrina: What have hospitals learned 10 years later?

Hospital Safety Insider, December 3, 2015

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It's hard to believe it, but it's been just over 10 years since the Gulf Coast was ravaged by one of the worst hurricanes the U.S. has seen, and emergency management officials got the major wake-up call they needed to prepare for future storms.

Things have changed since the hurricanes of 2005, especially when it comes to emergency planning. Hospitals are now required by regulators to plan for emergencies with an "all-hazards" approach, drilling their emergency plans extensively and having evacuation, triage, and resupply contingencies laid out for scrutiny from The Joint Commission and CMS. Officials who rode out the storms on the Gulf Coast say a lot has changed since then. Here's a primer on some of the lessons learned:

Communications. It's a law of emergency management that if you can't communicate with the outside world, you are on your own, and that's exactly what happened to many hospitals after Katrina struck. When the power went out and phone service was cut, staff members tried to use cell phones, but downed towers from the wind and overcrowded circuits rendered cell phones useless. There were a few satellite phones available, but to use the phones, staff had to go to the roof of the hospital to search for a signal.
How things have changed: Things are much different today: Cell networks are much more reliable and cell phones are a much more dependable technology. Also, regulators now require hospitals to test their communications systems often, and have multiple backup systems available in the event of a crisis. Emergency planning experts recommend that hospital staff train to communicate with each other and outside emergency responders using primitive means if necessary, even if that means using pen and paper or two-way radios in the event of a power outage.

Prior to Hurricane Katrina, hospitals in New Orleans didn't have "memorandums of understanding" with other hospitals that let other hospitals accept their patients should the need arise. In many ways, this could have helped hospitals isolated in the most heavily hit areas of the city.
How things have changed: Hospitals routinely train to not only sustain themselves in an emergency, but with other facilities to be ready to help out with supplies or patient care, should a sister hospital become incapacitated. This type of agreement proved helpful during the 2011 tornado in Joplin, Missouri, when an EF-5 twister wiped out St. John's Hospital. Predetermined agreements went right into effect, allowing patients to be transferred (in many cases, by any means possible) to other hospitals to be treated.

Resupply lines.
Gone are the days when hospitals felt like they could rely completely on government resources to resupply them in the event of an incapacitating event. In 2005, FEMA was unable to get supplies into New Orleans because of a failure to properly position and mobilize resources. As a result, citizens and hospitals largely found themselves on their own without ways to resupply food, water, fuel, and medical supplies until National Guard troops were able to move into the city.
How things have changed: While the government has itself learned some lessons, many emergency planning experts still say the best way to plan is to expect to be isolated without help for several days in the event of a major disaster, hence the reason that CMS and the Joint Commission both require hospitals to prove they can be self-reliant and operational for 96 hours. In addition, fuel and other backup supplies may be hard to find in a crisis, and some hospitals-as was the case during Hurricane Sandy in the New York City area-are going as far as having tanker trucks standing by, or agreements to take over gas stations if needed for emergency fuel supplies.

Evacuation plans. One of the biggest problems experienced during Hurricane Katrina was the decision to evacuate that was made much too late. Whether it was the government, which waited much too long to issue an effective evacuation order for the city, or hospitals that waited too long to decide it was time to evacuate their patients and staff, those crucial decisions made the difference between being able to get ambulances and buses in to help evacuate critical patients and waiting until helicopters were available to assist in evacuations when floodwaters overtook the city.
How things have changed: No longer do hospitals take a "last one standing" approach to the difficult decision to evacuate. All emergency plans are written and practiced with the contingency that at some point, someone may have to decide to evacuate. The idea is to know ahead of time who will stay and who will go, and at what threshold it is time to make that decision. If weather conditions are deteriorating rapidly, or transportation arrangements can't be guaranteed, or resupply lines might be compromised, the decisions need to be made earlier. In addition, staff are being more extensively trained in evacuating patients in many different conditions so that the actual situation does not come as a surprise. Hospitals in the New York City area had ambulance companies on standby long before the hurricane ever hit, just in case they were needed, and in some cases the most critical were moved early to inland hospitals as a precaution.

This is an excerpt from the monthly hospital safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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