Hospitals Tune Disaster Plans in Wake of Hurricanes

After seeing how emergency plans failed at New Orleans hospitals during Hurricane Katrina, local hospital officials are taking a second look at their own disaster plans.

“All of us in safety have been fascinated by seeing what’s going on in light of Katrina,” said Sue Grace, director of safety for Parkview Health.

David LeMonte, chief operating officer of St. Joseph Hospital, agrees. “It was very sobering. I kept thinking, ‘What if that were my hospital? What if that was me down there?’ ” he said.

Among the many topics they are discussing:

- At least 45 deaths at Memorial Medical Center in New Orleans, a private 317-bed hospital owned by the nation’s second-largest hospital chain, Tenet Healthcare Corp. Ventilators, dialysis machines and cardiac monitors failed when the hospital’s entire electrical system shut down.

- At Charity Hospital in New Orleans, patients and staff lived on canned fruit cocktail and consumed every last drop of drinkable water. Dehydration became such a problem that staff began giving each other intravenous fluids to keep going.

- Staff at University Hospital in New Orleans took in hundreds of people from the community while continuing to care for 110 very ill patients. Elevators didn’t work. Food and water was rationed. Ventilators had to be hand-operated around the clock to keep patients alive. Doctors used flashlights to check on patients. When evacuation was first attempted, out-of-control members of the public shot at the rescue helicopters.

- Sixty-five patients in Touro Infirmary in New Orleans were taken to the roof for evacuation. When it didn’t occur that day, doctors kept patients on the roof because the situation was better than inside the sweltering building.

“It’s very difficult to evacuate hospitals. We’re built to keep patients safe and secure inside,” Grace said.

But John Braeckel, director of hospital planning for the Indiana State Department of Health, said full evacuation plans should be a part of hospitals’ preparedness, whether it’s for natural or man-made disasters.

“There needs to be an evacuation hospital in each (state Homeland Security) district,” a facility where other hospitals could move their patients.

After Sept. 11, 2001, the state Department of Homeland Security divided Indiana into 10 districts, with 17 hospitals in District III, which encompasses Fort Wayne and surrounding counties.

Every hospital has been asked to look at their “surge capacity,” the greatest number of patients they could accommodate in an emergency. But more than just beds, they must take inventory of respirators, dialysis machines and other life-saving equipment.

None of the local hospitals has done a large evacuation drill. St. Joe evacuated one floor recently after the accidental discharge of a fire extinguisher. “We have not done a mock evacuation drill at St. Joe, but we’re about to,” LeMonte said.

A scenario requiring a full-scale evacuation “is not very real in this community,” said Lutheran CEO Tom Miller. “It would have to be a devastating tornado, and our buildings are all brick.”

Grace said Parkview had completed an evacuation drill of one floor but said more extensive drills might be considered for the future.

Lutheran Hospital has a surge capacity of 100 additional patients and St. Joe about 40. Parkview could accommodate 40 easily and about 100 in a serious emergency.

“We maybe couldn’t have 100 more beds, but we could pull 100 mattresses onto the floor,” Grace said, including mattresses taken from the hospital’s nearby child-care center, from storage, and diagnostic and treatment areas. The hospitals have a “memorandum of understanding” with one another and with hospitals in the region to share space, staff and supplies as needed in an emergency.

Braeckel said through the statewide Hospital Emergency Incident Command System, or HEICS, hospitals are also being asked to identify outside evacuation sites such as universities and arenas.

How long local hospitals could survive on backup generators is another concern. “In the past we’d say two or three days was enough. But that may not be sufficient,” Braeckel said, particularly if fuel for the generators cannot be delivered to hospitals. “To my knowledge, in the past, I’d say we haven’t been asked to look at that.”

Without additional fuel from the outside, Lutheran could go three days if the normal power system failed and generators were used. But after re-evaluations in light of the situation in the Gulf Coast, “we’re going to be putting in an extra storage tank, just for diesel,” Miller said. Parkview has several electrical and diesel-powered generators.

“The whole issue of communications was thought to be a lesson learned out of 9-11, but it didn’t get learned enough,” said Bob Morr, vice president of the Indiana Hospital and Health Association.

Braeckel agrees, saying, it’s a crucial issue hospitals and communities must continue to address in light of what occurred in New Orleans.

“We think everybody has a cell phone so we can be in communication.”

Although the 800-megahertz radios are a boon in emergencies, in the worst-case scenario, when even the electrically powered towers for those are down, “satellite is the only option. Satellite phones are very expensive, and few people have them,” he said.

The Gulf Coast disaster forced Lutheran and its parent company, Triad Hospitals, to look at satellite phones, Miller said. “I don’t think anyone thought of that in the past.”

Local hospitals officials say they are better prepared since Sept. 11, and federal funding has made possible purchase of emergency equipment to develop bioterrorism and other disaster plans. Parkview’s incident command system, for example, lists 50 assigned leadership positions that will immediately take over the operation of the hospital in a disaster.

Braeckel said he is preparing a questionnaire for Indiana hospitals to address issues facilities once thought could never happen here.

“I know there’s going to be a surge of questions more pointed to the situation observed in the New Orleans area. I think what we have to do is look at what we’ve taken for granted for so long. Natural disasters can cause us imminently more problems than terrorist (disasters).”

(c) 2005 Associated Press