Supplies, critical system locations are key concerns when floodwaters rise
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August 1, 2018
Consider prepositioning food and medical items needed for potential resupply in an emergency closer to your hospital and review the physical location of critical equipment and systems to ensure their continued operation in a devastating natural disaster.
Most importantly, “make sure you take care of your staff after the storm,” advised Ericka Brown, MD, chief operating officer at Harris Health System in Houston, which was inundated by floodwaters for more than five days last August after Hurricane Harvey came ashore and sat over southeast Texas before moving offshore.
More than 400 employees from Harris Health had homes significantly damaged or destroyed in the flood. With so many workers impacted by the floodwaters, response and recovery after the storm meant helping their staff members as well.
Harris Health had many sites impacted by the storm, including Ben Taub Hospital, one of more than 20 healthcare facilities, including hospitals, nursing homes and other residential care facilities, that faced the possibility of evacuation as the storm moved through, according to media reports.
The hospital sits in the heart of a collection of healthcare facilities known as the Texas Medical Center, deep in the fourth largest city in the United States. With 440 beds, Ben Taub is the largest hospital in the Harris Health System, serves as a teaching hospital, and is one of only two Level 1 trauma centers in the area.
Houston, barely 50 miles from the Gulf of Mexico, is not unfamiliar with flooding. Each year, storms shut down one or more sections of the interstates that surround and intersect the city, periodically cutting off neighborhood access for hours or even days.
The hospital’s Emergency Operations Plan (EOP) has been influenced and updated numerous times after storms over the last few years, noted Brown, who in the two years prior to Harvey served as Ben Taub’s senior vice president and administrator. Some of those changes came in handy. And “some of those things went out the window, because this was different,” said Brown, noting that until Harvey she had never been through a tropical event.
After Harvey, “I have a new appreciation for water,” she said.
The EOP includes identifying the number of staff members designated to ride out any storm, as well as those who are expected to arrive at the hospital as relief afterward.
The staffers are oriented to the plan upon hire and at least once a year, said Brown. Everyone knew their jobs as the storm approached. Emergency systems were checked and supplies were supplemented.
Those supplies included sand bags. The hospital maintains a supply of sand bags day to day anyway, said Bryan McLeod, a director with Harris Health’s communications department. But extra pallets were brought in ahead of the storm as a precaution.
And they were going to be needed.
Slow-moving storm brings epic rain
Harvey was a category 4 storm hurricane when it made landfall at Port Aransas, Texas, on Friday night, Aug. 25, 2017. The massive storm system took a full day to move 200 miles north and east until it all but stopped on top of the city and surrounding Harris County. In one 24-hour period, more than 26 inches of rain fell, overwhelming the county’s sewer and drainage system. More was to come.
For Ben Taub, the first problem with water was the rain that was hitting the facility sideways and finding its way inside through new and multiplying leaks, sending the facility maintenance and engineering staff scurrying to plug holes and redirect water into buckets throughout the building, according to information released by Harris Health System after the storm.
But the real challenge presented itself when water began backing up though the overwhelmed drainage system into the basement of the hospital’s main building. As pressure built on a 6-inch plumbing pipe, it developed a leak that that became a crack, that became a 30-foot long gash.
The rising water began to threaten food supplies, linens, pharmaceuticals, and kitchen operations.
As the 16-member maintenance and engineering crew raced to place sandbags at entryways, Ben Taub’s engineering director, Benny Stansbury, put in a call to a very busy Houston city command center for help. He had to leave a message.
Fortunately, someone from the city called back within a few minutes but could make no promises. An overwhelming number of calls for help were coming in and conditions outside were still dangerous for any vehicles, floating or wheeled, to navigate.
But the city official said if he could get someone safely out to a pump station to reduce the backflow of water into the hospital, an attempt would be made.
Within 30 minutes, the backflow was halted. The maintenance and engineering team worked to deal with the water at hand, using plastic sheeting to funnel water into bins for disposal, lifting supplies and equipment out of harms’ way and sweeping water out where possible.
Disaster averted — for awhile
Five hours into the cleanup, word came in from the adjacent Ben Taub medical tower. The basement there was home to the main hospital’s medical records and telecommunications equipment.
The same water pressure that had ruptured the pipe in the hospital basement had popped a cap off the main drain in the tower basement. A mechanical room already had filled with floodwater and other parts of the basement had up to six feet in some places, according to a Harris Health System news release about the maintenance crews’ heroics. Water was coming within inches of electric panels.
The earlier flood was a problem. But this flood threatened to shut down electrical systems to the hospital’s laboratory services area, housed on the tower’s sixth floor as well as page communications and medical record access throughout Ben Taub. In other words, the entire hospital could fail, with all its staff and 350-plus patients inside and a tropical storm still sitting outside.
Administrators began plans to evacuate.
Stansbury said his team was tired and wet, and they didn’t know if they were going to be able to save the hospital, according to the news release.
“They were lined up against the wall and looked like they had gotten beat up,” Stansbury told Harris Health. “One guy said, ‘We can’t stop it. What are we going to do?’ I said, ‘You know, there’s a lot of experience in this room. You stop and think for a minute. Someone has to have some ideas.’”
Ideas were presented and work began. Water pumps were put into place and clamps to close off the pipe were rigged. But what really was needed was the missing drain cap. An engineer waded into the water and sometimes on hands and knees searched for the cap and found it.
The cap was replaced and secured, the water stemmed. The team began punching holes through walls, in some cases drilling through concrete blocks, to get the water out of the basement and draining into the building’s water retention pits.
The work was a team effort. As was facing the risk of danger. All that water and all the electricity posed a very real threat. At one point, the team formed a line to hold the cord of an electric hammer drill overhead to keep it out of the water.
Stansbury eventually told administration that the water had been tamed. Immediate evacuation wasn’t mandatory.
But within a couple of days, evacuation would become the focus anew.
Lingering storm stresses supplies
The first big flood in the main basement had damaged some food and other supplies, and some kitchen operations were compromised. With the entire Houston coastal plain inundated with rain, floodwaters had cut off whole sections of the city, including parts of the 2.1-square-mile Texas Medical Center district.
By monitoring weather reports, road conditions, and local emergency communications, incident command workers were able to get some of the relief staff in to the hospital and to send some ride-out staffers home -- if they could get in and out safely, said Brown.
The ride-out staff that reported to the hospital before the hurricane made landfall had been working 12-hour shifts to allow each other to sleep and decompress. But the pressure was on. With stress high and supplies depleting, Brown and other administrators made the call to begin some evacuations, starting with the six most critical patients.
Transfers were arranged through a local emergency health coalition and ambulances were called Monday night. But only three patients made it to their intended destinations.
Two others couldn’t make it through the floodwaters and had to return to Ben Taub. Another ambulance was canceled before the transfer was made. Evacuations planned for Tuesday were put on hold.
Meanwhile, supplies for the hospital also could not get through. Other Harris Health facilities nearby faced similar concerns, as did hospitals throughout the area.
Eventually Monday evening, a vendor was able to make it through to Ben Taub with some food, while another supplier was able to provide fresh linens. Other supplies were consolidated and conserved.
By Tuesday, the storm began to move off and by Wednesday traffic was able to move freely in and out of the medical center area.
The worst of the storm was over. But flood waters would take several more days to recede. And recovery would be long, painful for many, and expensive.
Staff ‘gave more than they had to’
While staff is trained and prepared for dealing with storms, especially considering the hazards of living in Houston, Harvey was different, said Brown. Ride-out staff particularly “gave us their time and really gave more than they had to -- during the storm their homes were affected, too,” she said.
Of 8,200 full-time Harris Health employees, more than 400 faced significant flood damage to their homes and many lost everything to the storm. Yet whether it was being trapped at a hospital for five days as part of the ride-out crew, or dealing with personal losses elsewhere, the impact of Harvey was everywhere and with everyone.
“The mental exhaustion of the entire health system was clear,” Brown said.
As soon as possible, Harris Health began to assess the well-being of its staff, including offering mental health services and bringing community services onto campus to help employees as they sorted out insurance and other flood- and storm-related issues.
That included finding a place for Federal Emergency Management Agency officials to work at the hospital, so that staff would not have to travel as far or take time off from work to deal with a problem. That served to help the hospital fill continuing staff needs and help the staff handle personal business with less stress.
The hospital also worked to identify staffers who need financial assistance in the aftermath of the storm. By tapping philanthropic sources at the hospital and harnessing the donations that came in from across the country, those most in need were offered stipends to help get them through, Brown said. When possible, staff was also given paid time off to deal with issues.
Waters recede, recovery begins
As happened after storms in the past and as required by accrediting organizations, part of the recovery effort following Harvey included pinpointing what went right as well as what went wrong, and what to do better the next time.
Nine months after Harvey, hurricane season opened again June 1 and Harris Health System has been preparing for months, said Brown.
The hospital traditionally reviews its hurricane plan starting in January, she said. And one of her first pieces of advice to others in leadership positions is to listen to staff, identify and prioritize trouble areas, and start mitigating the physical plant problems as soon as possible.
“Once you are in the storm, there is not much you can do if there are major issues,” she said.
Whether you oversee a facility within a large health system or a small hospital with fewer resources, taking care of the physical plant has to be a priority for leadership, said Brown. Facility infrastructure isn’t “‘sexy’,” she noted, and it’s easy sometimes for it to be taken for granted because it’s not direct patient care.
But neglecting infrastructure “puts patient and staff lives in jeopardy as much as [neglecting] direct care does.”
Another of the chief lessons learned in Harvey was the impact such a catastrophic flood can have on the ability to get new supplies into the hospital. Working with other Harris Health System facilities and the local community, administrators have identified where extra food, medical supplies, and other items can be stored closer to both Ben Taub and the system’s other acute-care facility, Lyndon B. Johnson Hospital in northeast Houston, so that resupply “doesn’t have to be shipped in by 18-wheelers that can’t get in,” said Brown.
In addition to supplies and logistics, the hospital and Harris Health as a whole is reviewing where critical systems are located on healthcare campuses and in buildings themselves, she said. While repairs were made to get the hospital’s communications and medical record systems back fully functioning, the facility is looking at where it can move those services in the future, away from such a direct flooding threat.
Overall, Brown was proud of her staff and how they handled the storm before, during, and after Harvey. And she had high praise for the engineering staff.
“They did such an amazing job -- they were very proactive before the storm in weatherizing us as much as possible,” as well as during the storm, of course. She noted that it didn’t hurt that some of the team had military maintenance and engineering experience. “They were very innovative in how to plug some things.”
The hospital has honored the engineering staff for their work, she added.
And not a moment too late. While hurricane season officially began June 1, the first named Atlantic storm of 2018 made landfall in Florida on Memorial Day Ñ the first cyclone to enter the Gulf of Mexico in May in more than 40 years.