Health care heroes weather Gulf Storm with guts and emergency planning

Advance planning makes the difference

Health care workers were heroes of Hurricane Katrina as they worked under grueling conditions to keep their patients alive despite lack of electricity, air conditioning and water, and sewer service.

Surviving the hurricane required more than guts and dedication. How hospitals fared depended on the level of emergency planning put in place before the hurricane hit.

Stories emerged after the hurricane of critically ill patients who died while awaiting evacuation and of doctors and nurses suffering from dehydration and fatigue. But there also were tales of ingenuity, courage, and professionalism amid dire circumstances.

At Tulane University Hospital and Clinic in New Orleans, George Jamison, HCSP, CHCM, GC, director of facility services and safety officer, arrived at work at 7:30 a.m. the Saturday before the storm and began calling in staff and making additional emergency preparations. He didn’t leave until the following Friday, on one of the last helicopters to evacuate patients and staff.

Not a single patient at Tulane died during the ordeal, Jamison notes proudly. (Two patients brought to Tulane from nearby Charity Hospital were dead on arrival, he adds.) Visitors, employees, and their family members also fared well.

Before the storm, Jamison and his colleagues had imagined the worst-case scenario — a key component of emergency planning. "You think of every hazard that could happen to you and you prepare for it," says Jamison, who is a surveyor for the Joint Commission on Accreditation of Healthcare Organizations.

Every year, at the beginning of the hurricane season, Jamison stocks a supply of shaving cream, extra clothes, and food. Those are his small steps toward being prepared.

But getting the hospital in shape is a much more daunting task. As Hurricane Katrina approached, it began with a conference call with officials at HCA Corp., the Nashville, TN-based hospital governing body. Jamison conferred with the medical director, the chief nursing officer, the nursing director, the chief of the hospital police, and the head of dietary services.

The hospital called in employees for 1½ times its usual staffing, based on its patient load of about 136. The nurses were staffed for 12-hour shifts; physicians, medical residents, and interns also called in. At orientation, before they began work at Tulane, they were advised to have emergency plans. Now they had 24 hours to evacuate their families before reporting to work. The hospital was stocked with food and water.

Family members — and their pets — who did not evacuate were placed in the hotel across the street.

Meanwhile, on Saturday, Jamison called in his facilities team: three engineers, a maintenance manager, two electricians, one plumber, three general maintenance workers, a refrigeration specialist, the biomedical equipment director, and a technician, and the person who supported the hospital’s medical gas supply. He told them all to bring extra clothes and a supply of food.

HCA began stocking supplies at staging areas around the Gulf Coast, with water, food, and linens that could be brought in.

Jamison already had imagined the potential of flooding that submerged the first floor. That flooding would swamp the generator, so he arranged for an additional, 2-megawatt generator to be placed on the mezzanine level. That generator was able to power two elevators, air conditioning, lighting, and medical equipment.

He brought in extra linens and moved the pharmacy, dietary services, and linens from the first floor. He placed huge bags of a kitty litter-type absorbent material on the floors. They were poured into red hazardous waste bags and placed in toilets when the sewage failed, allowing the hospital to maintain hygienic conditions.

Jamison also had about three portable gas generators. Each one was capable of supporting seven ventilators. Jamison wasn’t counting on much outside help once the storm hit. "We actually stocked our supplies based on the thought that we wouldn’t get that much support from other agencies," he says.

Rescues amid gunfire, chaos

On Monday, after the hurricane passed, but before the levees broke, Tulane received 60 patients and their family members from the Superdome — a total of about 130 people. They were paraplegics, amputees, renal dialysis patients, and elderly people in poor condition. The hospital expected an emergency medical team to accompany them, but they came with no support, and no medical records.

Some family members of hospital employees were able to evacuate Monday afternoon, but by Monday evening, the flood waters had extinguished the hotel’s generator. They were plunged into darkness as the city descended into chaos. Gunfire could be heard in the streets outside.

Some family members waded across the street and into the hospital. But Jamison needed to rescue his 79-year-old mother and two dogs. Tuesday evening, Jamison found a rubber rescue boat and, amid the staccato of gunfire, managed to bring his mother and dogs to safety.

Meanwhile, 13 critically ill patients arrived by boat from Charity Hospital. Everyone with nursing credentials — the chief operating officer, the nursing director, the employee health nurse, associate directors of nursing — pitched in to care for patients. When the generator failed from lack of fuel, they worked by flashlight.

Jamison notes the hospital maintained its policies and had a system to "set up command, take control, and communicate." The nurses calmed the patients.

"If you ever want to know what good nurses were made of, it showed there," he says. "It was truly a dedication of the nursing staff, some seasoned nursing and some junior nursing mixed together."

The day before Tulane ran out of fuel, Jamison asked for evacuation plans to begin. "It was actually around noon when I went in and told the COO and CEO and our [HCA] division president, who stayed with us the whole time, that I no longer could support the hospital," he says. " I thought by tomorrow at this time, we wouldn’t have fuel. ‘I’m telling you that, in my professional opinion, we need to start evacuation procedures immediately.’ They contacted HCA corporate, and we started work."

On Thursday, when the elevators failed due to lack of electricity, most patients were already positioned on the second floor, ready for transfer to the garage. Two patients had to be moved by hand — a 350-pound patient and a critically ill heart patient. Both survived the transfer.

Nurses continued to use the portable gas generators for patients on ventilators, but some still had to be manually "bagged" while they awaited evacuation.

Even the evacuation relied on advance planning. Jamison and his colleagues had considered how to turn the top level of the garage into an emergency helicopter landing pad. Bolts on four large lamp standards would need to be sawed off, and the lamps removed, but the garage was capable of holding the weight of the helicopter.

"If we had not done proper preparation, that would not have been possible," he says.

HCA began arranging privately for helicopters, and flew in body armor for the hospital security force because of the dangerous conditions on the streets. They connected with ham radio operators in Tallahassee, FL, to help guide helicopters in a kind of air traffic control.

"We worked with anybody we could find to get helicopters," says HCA spokesman Ed Fishbough. "We started on it before the storm."

Eventually, HCA found 20 helicopters to use in the evacuation. But with 1,200 people to evacuate, it began slowly. Patients were brought from the swamped Charity hospital to be evacuated from Tulane. The small helicopters could take only one or two patients at a time.

"We found out the airport wasn’t being used, [so] we started using it as a triage center," says Fishbough. "[It was an] eight-minute trip to the airport, two minutes on the ground and you’re back. The government started to use Louis Armstrong [airport] as a triage center, as well."

The government rescue teams refused to take pets, and Jamison actually contemplated shooting his two boxers rather than abandoning them in the flooded hospital. But HCA offered to take pets as well as people.

"You can’t ask people to come in and work and leave their pets behind," says Fishbough. "To them, that’s part of their family."

On Thursday night, hospital police said they could not protect all the entrances to the hospital. Patients, employees, and family members moved to the garage, where they spent the night while security officers teamed up to guard the entrances. Everyone was evacuated by Friday afternoon, five days after the storm hit.

After the storm, Jamison moved to Snyder, TX, to stay with his daughter. He immediately began working toward restoring the hospital facility.

Jamison’s advice to other hospitals? Follow EC410, the Hazards Vulnerability Analysis standard of the Joint Commission.

"Exercise your plan to the nth degree," he suggests. "Actually call the people [on staff] and say, ‘How well prepared are you?’ Get [their emergency] names and phone numbers. When you have one of these drills, [think about] what would happen if you had to stay for four days. Could you? Would you?"

Jamison now knows the answer to that question is yes — for himself and his dedicated staff.