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Hurricane Harvey lessons are a roadmap for hospital disaster response

A Texas Hospital Association analysis of the storm, which killed 90 people and closed 20 hospitals, showed what worked and didn't.

Beth Jones Sanborn, Managing Editor

A new report released by the Texas Hospital Association is shining a spotlight on the barriers and inefficiencies that plagued Texas hospitals as they struggled to stay open, let alone effective, while Hurricane Harvey ravaged the area. It is also drawing a roadmap for the improvements that need to be made and issues hospital leadership must address if they are to face the next storm with an improved level of preparation.

Hurricane Harvey made landfall on August 25, 2017 and for more than a week it pounded the region between Rockport, Texas and Cameron Louisiana with more than 60 inches of rain and unimaginable wind. As the first Category 4 Hurricane to hit the U.S in 13 years, it killed 90 people and caused $200 billion in damages.

[Also: Hurricane Harvey devastates critical access hospital, forces closure]

According to the Texas Hospital Association Hurricane Harvey Analysis, during the course of the storm, only 20 hospitals actually closed or evacuated but with the level of preparedness at the time, that was enough to wreak havoc on patients and hospital staff alike as other facilities were pushed to the brink logistically, physically and emotionally. The multi-layered toll the storm took on those affected will be long-lasting, to be sure.

The financial impact of the storm cannot be ignored either. The report called Hurricane Harvey the nation's costliest natural disaster. THA surveyed its members located in the impacted area and the initial response from 92 hospitals showed the estimated disaster-related costs for reporting hospitals totaled $460 million, which included $380 million for capital, operating, emergency work and other costs; $40 million for increased uncompensated care costs; and $40 million in other increased costs.

[Also: CMS waives provider screening requirements in Texas and Louisiana during Hurricane Harvey recovery efforts]

Hospitals also reported impact to revenue and cash flow thanks to billing and claims filing interruptions, business office closures and reduced hours, insurance and patient payment delays, decreased patient volume and canceled services.

The analysis focused in on nine areas where notable deficiencies or lack of preparedness adversely affected hospitals' ability to respond to demands. First, usually communities have five to seven days to prepare for a hurricane. With Harvey, that time was cut to 50 hours, a little more than two days. As such, those in harm's way were not prepared. There were not enough emergency shelters open and ready to take in evacuees, and shelters were not equipped to care for residents with medical needs, especially those with quadriplegia, those requiring dialysis and those who were ventilator-dependent or otherwise medically fragile. 

Despite federal law requiring general population shelters to be equipped to meet the needs of people with medical conditions like those mentioned, the report said hospitals' experience during Harvey was that people with medical needs were turned away from shelters or that shelters that took them in could not handle their medical needs. 

This lack of medical preparedness at shelters snowballed into the second focus area of the report: inappropriate reliance on hospitals as impromptu shelters and evacuation sites. Those storm victims turned to hospital emergency departments and the barrage of people taxed hospitals' resources, including food, linen, hospitals staff, physicians and security personnel.

As good Samaritans, first responders and national guard rescuers plucked people from homes and cars, hospitals became evacuation sites, a burden they were not intended to shoulder.

"Hospitals shared dramatic stories of people arriving in dump trucks in groups of 30 or more or being dropped off by Blackhawk helicopters," the report said.

The flood of people in need combined with the inpatient population stretched hospitals to the limit, taxing facilities that were already short-staffed since some employees were simply not able to get to work. Replenishing their quickly-dwindling supplies was also understandably problematic.

Adequate security staffing also emerged as an issue for many reasons. Some hospitals didn't have enough security, and those that did sequestered them, then struggled to house and feed them along with patients. Hospitals reported increased costs due to this issue.

"Hospitals reported eruptions of domestic violence amongst some of the individuals who had sought shelter. In addition, as more people relied on the hospital for shelter, and resources were stretched thin, stress and anxiety levels rose, creating tensions and the need for security personnel to maintain an orderly and calm environment," the report said.

Displaced residents broke into a Beaumont hospital that had closed seeking shelter, and some hospitals reported break-ins by people looking for drugs. For hospitals that staff off-duty police officers as security, some officers were called to duty in neighborhoods. One hospital that happened to be treating ten prison inmates at the time got help from their accompanying prison guards, who stepped in to help with general security when they were off duty.

Timely delivery of needed supplies became an issue, not just because access to the hospitals had been impeded by flooding, but also because the facilities where the supplies were sitting, like UPS terminals, were also inaccessible. 

Dialysis services were at a particular premium, with many dialysis facilities closing before the storm hit and many shelters ill-equipped to provide it. These patients also flocked to hospitals for treatment, who reported problems accessing these patients' medical records or reaching their regular providers. Logistical challenges also abounded. Shortage of fluids required to perform dialysis occurred as there was a lack of safe water, which is also needed for the procedure. 

Communication with state and federal level officials and decisionmakers was reportedly problematic, as was a dialog with military responders and coordinators, who did not always check if a hospital was open or accepting patients before dropping evacuees there.

Volunteers also met challenges, especially healthcare professionals who tried to pitch in. Many out-of-state health care professionals had trouble getting their credentials cleared because the registry only checked Texas-based licensing boards. Hospitals had to manually check medical volunteers' licenses if they were issued by another state. Getting permission to use foreign health care professionals was also challenging and hospitals said they needed more clarity on the scope of liability protection for volunteer providers.

As the storm raged on, the emotional and mental toll it took on overworked and anxious staff became apparent. Many stayed at the hospital and were separated from their families, and hospitals also reported enlisting the help of chaplains and social workers to help staff cope with mounting stress, anxiety, burnout and separation from family, the report said.

Finally, coordinating the transfer of particularly vulnerable patients like neonatal unit babies to other facilities while minimizing the negative emotional impact on family members was a problem, as was arranging for the return of these patients if they passed away after being transferred. Managing fatalities was also an issue.

"Some hospitals reported quickly reaching maximum capacity to store deceased individuals. Others reported search-and-rescue workers and regular citizens dropping off deceased individuals without identification or any means of knowing who they were."

The THA is looking at numerous meetings with stakeholders in these various areas to pinpoint the gaps in operational efficiency and propose changes. No doubt there is a lot of work to be done, but any C-suite leaders looking at the onerous barriers that emerged during Hurricane Harvey would do well to take a lesson and consider how their own facility would handle such challenges. Ensuring specific and detailed protocols for all areas of operation, contingency plans and secondary sources for resources both human and material, boosting cash stores for disaster preparedness and establishing partnerships with outlying facilities are all things leaders should consider.

Establishing a "disaster committee" to focus specifically on such efforts could be valuable, and clarifying who specifically you will be communicating with at the state and federal levels, and how you'll communicate from the ground, could help thwart misunderstandings, inaccurate information, and delays in aid.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

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