While Hurricane Harvey was submerging much of southeast Texas with flood waters, another monster storm was aiming for Florida, and hospitals there were preparing for what forecasters said would be a historic hurricane in terms of size and the potential for damage.

As in Texas, hospitals in Florida routinely plan and drill for hurricanes, and this preparation paid off for the University of Miami Hospital (UMH) as the storm reached the mainland on Saturday, Sept. 9. “We have a disaster preparedness management center, and we go through [practice] exercises for the first six months of the year,” explains Tanira Ferreira, MD, the chief medical officer at UMH and an assistant professor of medicine. “Our whole management team meets, and we have a very well-described plan in the event we go into disaster mode.”

For Hurricane Irma, part of that plan involved emptying the hospital as much as possible before the storm made landfall, Ferreira notes.

“We tried to plan for safe discharges where appropriate, and we tried to get as many patients as possible home,” she says.

In addition, the hospital organized two teams of nurses to staff the hospital during the storm emergency, with both teams stationed at the hospital. Team A was in place and on duty before and during the storm.

“It was a very robust team, and [these nurses] could only leave once team B was in place to relieve them,” notes Ferreira, explaining that the teams worked and slept in alternating cycles. The physicians also worked in two teams, and some physicians, including Ferreira, remained on site for three days.

“We also had to flex in additional staff in the ED, and we planned for that because we knew we were going to have a surge in volume [once the storm passed through],” Ferreira notes.

The hurricane shifted to the west before making landfall so that Miami managed to miss the strongest hurricane-force winds. However, the region still was blanketed by sheets of rain and violent wind gusts.

Fortunately, the hospital did not lose power or water during the storm, although the hospital’s primary bank of elevators proved problematic. The elevators stopped working three times during the storm, including once with people inside. The fix required an operations supervisor to reach the roof of the 14-story facility, and then climb an open staircase to enter a small motor room where the elevators could be restarted.

It was a treacherous mission in the midst of a hurricane, but the issue did not affect operations, Ferreira notes.

“We were able to manage the situation,” she says. “We made a conscious decision to put our air conditioning on generators so that we didn’t overflow the capacity for normal power ... but the elevator problem did not interfere with the patient floors or patient safety.”

Volume to the ED was extremely low during the weekend storm, but then surged on Monday, Sept. 11, Ferreira recalls. In fact, in the immediate aftermath of the storm, volume to the ED at UMH increased by more than one-third, she says. The ED saw patients who had run out of critical medicine for high blood pressure, diabetes, and other chronic diseases, and there were patients who had delayed needed care until after the storm, Ferreira observes. Also, similar to what happened in Houston following Hurricane Harvey, the ED at UMH saw a big increase in the number of dialysis patients who had missed dialysis sessions during the storm.

“The dialysis centers, which are usually outpatient clinics, were not open until a couple of days after the storm,” Ferreira notes. Consequently, these patients traveled to the ED. Although the spike in volume was anticipated, it did create difficulties. “We started seeing a lot of patients, but we didn’t have the ability to safely discharge them because a lot of the rehabilitation places, nursing homes, and home healthcare agencies were not accepting discharges — not until Wednesday [following the weekend storm],” Ferreira says. “It took us until several days after the storm to get back to normal.”

What made this storm particularly difficult was its sheer size and scope.

“It affected a very large area — many, many counties, so there were massive evacuations,” Ferreira observes. “What we did really well was to have teams A and B accessible to our building to assure that staff would report to work before, during, and after the storm,” she says.

Although there is no way to be sure when or where a disaster the size of Hurricane Harvey or Irma will occur next, Ferreira’s advice to colleagues is to prepare.

“Have a well-developed disaster plan in place,” she says. “You don’t put that plan in place a day before the storm. It takes months of preparation, and I think that is why we did so well here.”

SOURCE

  • Tanira Ferreira, MD, Chief Medical Officer, Assistant Professor of Medicine, University of Miami Hospital, Miami. Email: tferreira@med.miami.edu.