Hospitals in the storm-battered Northeast get lessons in recovery, retooling from Louisiana colleagues
Hospitals in the storm-battered Northeast get lessons in recovery, retooling from Louisiana colleagues
After Katrina, Ochsner Health System revamps emergency systems, drilling procedures
In the immediate aftermath of Hurricane Sandy, many hard-hit hospitals along the northeast coast were putting in calls to colleagues in New Orleans for advice on how best to pick up the pieces and, perhaps more importantly, bolster their defenses for future disasters. While hospitals along the Gulf Coast are much more accustomed to preparing for hurricanes than facilities in the Northeast, Hurricane Katrina knocked even the best-prepared facilities on their heels when it devastated the region in August of 2005.
Ochsner Health System’s main hospital, not far from the water in the city’s uptown section, was the only hospital in the region that remained fully operational during Katrina and throughout the immediate aftermath of the storm, explains Grant Walker, the health system’s vice president of supply chain and disaster preparedness. In part, this was possible because the hospital was fully staffed with its own physicians, whereas most of the other hospitals only had make-shift crews, he says. But the facility was also physically equipped to manage much of the storm’s impact.
For example, the hospital is situated on property that is nine feet above sea level, which is high ground for New Orleans. Back in the 1980s, the hospital moved all of its emergency generators from a below-sea-level location to higher ground, and placed them on platforms so that the generators were largely out of harm’s way, at roughly 18 feet above seal level. Developers then built 10- to 12-feet flood walls around the generators and other essential equipment, including the switches that enable the hospital to switch over to emergency power.
Ramp up emergency capabilities
Some hospitals in the Northeast had to evacuate their facilities when their basement-level emergency generators were flooded by the storm surge from Sandy, cutting off power to the facilities. “That is not that uncommon for back when those hospitals were constructed. It is not the fault of the New York hospitals,” observes Norris Yarbrough, assistant vice president of emergency preparedness and response for the Ochsner Health System. “We were probably more concerned with flooding here because of our proximity to land-falling hurricanes. I think that is what helped us think a little more progressively. We were faced with this a lot sooner than [hospitals in New York and New Jersey] were because this is an every-season concern for us.”
During Katrina, just one of the four buildings on the main hospital campus had 100% air conditioning, but facility managers were able to leverage this capability to cool the entire facility. “Fortunately for us, all of our buildings are connected together on each floor, and we have these huge fans that we put by the [connecting] doors, and they sucked the air out of that one building and blew it into all the other buildings,” explains Walker.
While the approach worked remarkably well, facility mangers have since made sure that they have enough generator power to provide full power to the entire hospital in the event of an emergency. “Every plug and every piece of equipment would have power,” adds Walker.
Another advantage Ochsner had during Katrina was access to a well that the hospital had never used, but the facility’s founder made it a point to invest in when the facility was first built decades earlier. “We had never been hit by a storm like this before, but we had full water pressure all the way to up to our fourth level from this old well that was put in during the 1950s,” explains Walker. “If you don’t have water, you can’t produce heat or electricity.”
The well proved so indispensable during Katrina that the health system has since made sure that all eight of the hospitals within the current Ochsner system have similar wells at their disposal, and they are also equipped with enough emergency power to run their facilities at full capacity.
Prioritize communications
While Ochsner was, in some respects, uniquely prepared for a hurricane disaster, many of the difficulties experienced by hospitals in New Jersey and New York during Sandy are very familiar to the Ochsner staff. For example, one of the first things to go down during Katrina was telephone service because the telephone lines were largely underground, and they flooded out very quickly, recalls Yarbrough.
“We went in and made sure that we now have satellite phones linked to our switchboard so that we are able to get a dial tone on some select phones,” says Yarbrough. “We also increased the number of Internet protocol phones, which, again, are not dependent on a dial tone coming to you from AT&T or a similar supplier.”
The hospital contracted with a cell phone supplier to install its transmission equipment on the roof of the hospital, and to hard-wire the facility for all the dead zones so that the hospital now has complete cell phone coverage, explains Walker. “If the entire United States had no cell phone service at all, we would be able to turn on our cell phone tower so that we could use our cell phones within a seven-mile radius of the hospital,” he says.
In addition to these measures, administrators equipped the hospital with old-style UHF and short-wave radios. “The key is that we test these devices once a month. You can put that kind of equipment in and let it lay dormant, and then two years later you need it and it doesn’t work,” adds Yarbrough. “We now build all of our drills to a scenario that forces us to test our redundant systems. Prior to Katrina, we didn’t do that.”
Further, Yarbrough explains that these rigorous testing practices are being carried out at all facilities within the Ochsner system. “We reach out and incorporate all of our hospitals in our drills. We are drilling as a group of hospitals, not just one hospital,” he says. “We even pass this thinking on at the state level, where we participate with all of the hospitals in the state on monthly planning.”
During these get-togethers, emergency planning chiefs make sure that all of the hospitals are communicating with each other. “We now have a radio system that is common between all of the hospitals,” adds Yarbrough.
“We did re-think how we do drills after Katrina, but more importantly, we rebuilt the system that we are testing with those drills,” says Yarbrough. “We have a different look in our emergency operating picture than we had in 2005. It is much more robust, and it is much more coordinated among all the hospitals.”
Take cues from crises
It is hard to miss the importance of communications when preparing for a crisis, but there are many other problems that seem to come to light only when a crisis occurs. For example, after Katrina, there was no garbage pick-up for a month. “You can’t keep it in the hospital. You’ve got to get it out of there, but you have to use common sense and do what you need to do to survive,” explains Walker.
What Walker did was designate a particular parking lot as the trash dump, and he eventually was able to get a provider in from out of state to haul the garbage away. But he stresses that these are issues that need to be considered in the emergency planning process.
Similarly, health care organizations need to have a plan in place for food. During Katrina, the issue was never a problem at Ochsner because the health system had an agreement with a large warehouse full of food that was undamaged during the storm. “We had full access to it the entire time,” notes Walker.
Another issue that needs to be discussed is security. During Katrina there was basically no government in the area for several weeks, explains Walker. “Your disaster plan is based on what you are willing to commit to. If you think the government is going to be there to save you, you aren’t going to prepare as well,” he says. “Our plan has always been to stand alone and to assume that we are not going to get any support from anybody.”
Sources
- Grant Walker, Vice President of Supply Chain and Disaster Preparedness, Ochsner Health System, New Orleans, LA. E-mail: [email protected].
- Norris Yarbrough, Assistant VP of Emergency Preparedness and Response, Ochsner Health System, New Orleans, LA. E-mail: [email protected].
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