By Gary Evans, Medical Writer

Employee health professionals hunkered down with their hospital colleagues recently as hurricanes Harvey and Irma hit the contiguous United States and Hurricane Maria subsequently devastated Puerto Rico. While relief efforts were still underway in Puerto Rico as this issue went to press, Hospital Employee Health talked to employee health professionals who were on hospital duty in the path of Harvey and Irma.

These storms struck right around the five-year anniversary of Hurricane Sandy in the Northeast, reinforcing the impression that extraordinary weather events may be the new normal in a changing climate. “Hurricane-associated storm intensity and rainfall rates are projected to increase as the climate continues to warm,” NASA warned.1

Thus, it is critical to learn from each hospital response and continue to accumulate information about how to best protect patients and healthcare workers during these major weather events, says Victoria Raveis, PhD, a research professor at New York University in New York City, who recently published an analysis of the hospital response to Hurricane Sandy.2 (For more information, see related story in this issue.)

“What we are seeing, as more and more climate-related disasters are occurring, is that there is a shared knowledge and experience,” she says. “To the extent that we can be prepared, we are seeing those plans do help. But more needs to be done. We need more education and advanced training in areas that have never really anticipated the severity or the magnitude of these types of events.”

The old mindset questioned the wisdom of putting in time and resources preparing for an event that was highly unlikely to occur, she notes.

“In the emergency preparedness field now there is really a worry that these are not just random events that happen occasionally,” Raveis says. “We are seeing that these are going to be occurring with increasing frequency and the appropriate plans and resources need to be put in place.”

Hurricane Harvey slammed into south Texas on Aug. 25, inundating the region with torrential rains for several days thereafter. More than four feet of rain was measured in some areas.

“It was all hands on deck,” says Cathy Floyd, MS, BSN, RN, DPA, COHN-S, regional manager of occupational health at Memorial Hermann Health System in Houston.

That said, corporate officials had reserve staffing at the ready in case those in the immediate area could not get to work.

“Those who were able to make it in, made it in,” Floyd says. “[Others] were dealing with critical family or housing issues at home — flooding, damage, or power outages. Many automobiles were flooded. It was all on a volunteer basis. Those people stayed home and took care of their families and their immediate needs and those that were able to come into the medical centers came in.”

As it became clear that the storm was going to hit the region, preparations included setting up a website for employees to post information for colleagues and loved ones, coordinate ridesharing, and help with childcare. As the storm hit, employees also shared knowledge of “safe routes” to get to and from work.

“We drill often and discuss many ‘what-if’ scenarios in our post-drill debriefings,” Floyd says. “For example, before the storm, occupational health clinics were double-checking that their refrigerators were plugged into ‘red outlets’ to ensure power stayed on. [We wanted] to protect the new flu vaccine we just received, and to make sure other vaccines were stocked up.”

As the storm came in, power was down in many locations but the ED and the hospital were able to function on the back-up electrical system. Floyd’s hospital was able to stay open, but another Memorial Hermann hospital was evacuated due its proximity to the flooding Brazos River, she says.

“We did evacuate Sugarland Hospital because it is at a curve in the Brazos River,” Floyd says. “The river was raging, so when it came through that curve, it overflowed. We relocated patients from Sugarland over to our Southwest Facility, which is a large medical center hub. I believe they were there three or four days. We had to move some patients from some locations and some of our outpatient clinics were closed down. We have over 300 of what we refer to as ‘thresholds’ — different locations. Some of them were able to stay open and some were not because of high water.”

Can You Hear Me Now?

While the hospital system was able to keep its communications website up, cellphone service was predictably erratic.

“In all honesty, it depended where the cell tower was,” she says. “Some people, as you can understand, lost cell access and some of us were still able to communicate. Between the hurricane blowing in the high winds, and numerous tornadoes throughout the southland, that affected our ability to move around and communicate with each other. Most of those passed quickly and we were able to reconnect after a few hours. We experienced everything from soup to nuts.”

Once the immediate danger of high winds and street flooding diminished, occupational health clinics — stocked with tetanus and Tdap vaccines — began offering immunizations to those employees who needed updates and were involved in recovery and cleanup, Floyd says.

Many healthcare workers who were not able to get to the hospital went out into the community to assist with rescue and cleanup.

“Some of our nurses were recruited by the Red Cross to work in shelters during the immediate onslaught of clients coming in to shelters with injuries, medication, and health needs, and [needing] emotional support,” says Floyd, who returned to her own home relieved to see the sandbags she stacked in front of her garage kept the flood waters at bay. “Memorial Hermann employees were rescuing neighbors and family with boats, helping rip out Sheetrock and insulation, and cleaning up.”

Amber Mitchell, DrPH, MPH, CPH, who lives in the Houston area and is the director of the International Safety Center (EPINet), assisted others in the community and helped clean up contaminated structures.

“It’s really challenging, I found personally, to wear a respirator in 90-degree heat,” she says. “While correct and effective PPE [personal protective equipment]use is second nature in healthcare settings, it may not be in community settings where healthcare workers are volunteering.”

It is important to follow occupational infection prevention practices and safety measures, and to use respirators, gloves, and coveralls, she noted.

“With mold and other bacterial and viral pathogens like hepatitis A abundant in flooded areas, preventing exposure to infectious microorganisms is crucial,” she says.

There have been reports of infections caused by the flood water, including a fatal case of necrotizing fasciitis in a Houston woman who fell in flood water and contaminated a wound. Another person died of sepsis after exposure to flood water, which included a mix of bacteria and various chemical toxins.3

Shelter From the Storm

On Saturday, Sept. 10, JoAnn Shea, RN, director of employee health and wellness at Tampa (FL) General Hospital, arrived at work at 7 a.m., ready to shelter in place for three days. Though Shea and her “Team A” colleagues ultimately dodged the full fury of Irma as it swept northward, there was no way of knowing that in the first stressful days of preparations.

“At 2 o’clock on Sunday, they thought it was coming right into Tampa Bay,” she says. “We were supposed to get either a Category 3 or a 4, so we were really hunkered down. Everybody worked as a team. I think employee health played a good part. We were not sure if we needed to be there initially, but I had agreed to help HR with childcare and then decided I would have a nurse come in for [needlestick] exposures. We had a couple of exposures and we were running a little acute care clinic, to our surprise. I would definitely bring our wellness staff in again because that was really impactful.”

Indeed, that decision paid dividends as the storm approached and the stress level increased among hospital employees.

“When we came in, everybody was kind of heightened and anxious, so I sent out my wellness manager, a yoga instructor, massage therapist, and a fitness instructor,” Shea says.

Many patients were discharged prior to the storm, but there was still a large census in addition to some 3,000 employees on site who relieved each other in shifts. Irma hit Tampa Sunday night, but nobody on Team A could leave until 7 p.m. Monday or 7 a.m. Tuesday, depending on the scheduled shift.

“We tried to discharge as many patients as possible, but we still had over 700,” she says. “We were busy. We worked 12 hours on and 12 off. We had people sleeping on air mattresses — it was very stressful. We didn’t have enough sleeping space. We had people sleeping in our waiting room. The lift team was sleeping in their offices. People just put air mattresses or sleeping bags anywhere they could. That was probably our biggest challenge — finding space to sleep quietly.”

Under such conditions, the stress reduction efforts were welcome and encouraged.

“We did aromatherapy with inhalers with oils and massage therapy,” Shea says. “The CEO would go around the hospital and call my wellness manager, saying, ‘I think they need massages on this unit.’ We would send the massage therapist up, and we also did yoga at the end of each shift. So, at different times of the day, they did yoga and they did exercise. After three days, you are all cramped up together.”

While the stress reduction was a home run, Shea picked up on a surprising trend: More workers than usual were reporting with complaints of pain and illness. She realized many workers had not brought the medicines they use at home, such as pain relievers and allergy and cold symptom relief. She set up a clinic and called the pharmacy to stock up on these over-the-counter meds.

“I think when people get anxious, they start feeling bad,” she says. “We ended up being there to handle a lot of acute illness. We were surprised because we didn’t think that would be an issue, but it was. Saturday we started setting up the clinic, and Sunday we saw 30 people, and Monday, 25. People were sick with colds and flu. We sent a couple [of staff] to the emergency room [who] needed a little more extensive care, but we did triage them for the ED.”

Reality Bites

One worker woke up from sleeping on the floor with an outbreak of hives.

“We had to assess her for bug bites, and we also had a dog bite I had to treat,” Shea says. “She was bitten at home but came in to be treated. Then there was a lot of respiratory problems, and on the last day [after a hospital cafeteria diet for days] we gave them something for constipation.”

Lessons learned include the need for better planning for sleep arrangements, as workers were cramped for space as family members and others from the community came in for shelter, she says. “We had 80 kids of staff [in house],” Shea notes.

This situation was exacerbated as the storm approached and more family members of staff or members of the community sought refuge within the hospital.

“People got a little panicked when it started heading toward us and started bringing in more family members,” she says. “They didn’t want them to go to a shelter. It wasn’t that many, but it did impact the ability to find people places to sleep. We didn’t close the doors. We understood it, but that is something we are going to work on in planning. The hospital is a safe place, but we are not a shelter.”

In the aftermath of the storms, the planning for the next one begins.

“People get very stressed about their homes and their families,” Shea says. “If it had really hit us hard, it would have been very stressful to continue working. They want to be with their families in a crisis. We had our chaplains there if people wanted to talk to someone, but stress relief was a big part of it.”

As the waters of Harvey receded in Houston, Floyd and colleagues began breaking down their response and reviewing preparations and possible weaknesses in their plans.

“It’s all a matter of ‘knowing what you don’t know,’” she says. “In our briefings, we always play the what-if scenarios. We try to anticipate every possible scenario. We’ll look at a situation that occurred and then we’ll say, ‘What if this had happened or that had happened? What would we have done and how would we have reacted?’ Being in that mindset helps us prepare the best we can. We expect the best and prepare for the worst.”

REFERENCES

1. NASA. The consequences of climate change. Available at: https://go.nasa.gov/2nIipFo. Accessed Oct. 2, 2017:

2. Raveis VH, VanDevanter N, Kovner CT, et al. Enabling a Disaster-Resilient Workforce: Attending to Individual Stress and Collective Trauma. J Nurs Scholarsh Aug 25, 2017: doi: 10.1111/jnu.12340. [Epub ahead of print]

3. Astor, M. ‘Flesh-Eating Bacteria’ From Harvey’s Floodwaters Kill a Woman. New York Times, Sept. 28, 2017. Available at: http://nyti.ms/2yD8AKZ. Accessed Oct. 2, 2017.