After Hurricane Harvey struck Texas, leaving Houston underwater, case management leaders at area healthcare organizations found it challenging to locate all of their employees to ensure their safety.

• Harvey flooded 200,000 homes and forced the evacuation of 39,000 people.

• Floodgates protected some hospitals, but the roads and surrounding areas were flooded and inaccessible.

• Emergency preparedness plans proved crucial for keeping case management operations going.

Few case managers and healthcare organizations have experienced natural disasters as devastating as 2017’s hurricanes Harvey, Irma, and Maria.

In August, Hurricane Harvey flooded 200,000 homes, forcing 39,000 people to evacuate in Houston. Weeks later, Hurricane Irma caused catastrophic damage in the Virgin Islands, destroying the island’s roads and power grid and leaving 80% of its population homeless. In September, Hurricane Maria devastated Puerto Rico, causing more than 1,000 related deaths. It also knocked out power for several million people and destroyed hundreds of thousands of homes.

One of the more challenging moments during Hurricane Harvey in Houston came when one case management employee, who was in the hospital on duty, learned that her family and pets needed to evacuate due to flooding.

“When your family is calling to tell you they have to evacuate, you are completely overwhelmed,” says Gay Matthews, MSN, RN, CCRN-K, assistant director of care management at Texas Children’s Hospital in Houston.

“I told her, ‘As soon as we get someone else here, I’ll let you leave to go join your family,’” Matthews says. “She was struggling, needing to leave, but it was too unsafe.”

That employee’s family was safe and her home was spared, but case managers in Houston lost their homes and vehicles.

For instance, one case management employee was stranded without access to transportation or communication devices for days. No one knew if she was safe until she was able to call in to the hospital, says Donna Ukanowicz, RN, MS, ACM-RN, director of case management at MD Anderson Cancer Center in Houston. Ukanowicz and Matthews are scheduled to speak about their Harvey disaster experiences at the American Case Management Association’s 25th Annual Case Management and Transitions of Care Conference, April 24-27 in Houston.

Both Texas Children’s Hospital and MD Anderson took precautions after previous flooding and storms to ensure safety of their employees and patients. They installed floodgates around the properties, and these held well during Harvey’s floods, Matthews and Ukanowicz say.

“We had 79 floodgates in place,” Ukanowicz says. “There was no flooding on the main campus, but there was flooding around the main road in front of our buildings. We have a photo of the front of our building and main road, showing it was impassable.”

When a disaster strikes, it’s important to maintain operations, including communicating with staff, patients, and community entities, including home health, durable medical equipment, nursing homes, and other organizations and providers.

“When we pulled together a command center, we focused on three goals: safe coordinated care, patient-centered services, and being supportive of our staff,” Ukanowicz says.

The first step was an emergency communication plan. The hospital sent staff alert messages, saying the incident command center was open. Although Ukanowicz was unable to leave her home due to flooded roads near her neighborhood, she could work and keep in touch with her department through her computer and cellphone.

“We had a call-down tree, and I contacted our associate director, first, to see if she was safe and available,” she says. “I did that with a text message and followed up with phone calls.”

Ukanowicz called each supervisor, who then called each employee on their teams. If they couldn’t reach someone or didn’t have access to a phone, then Ukanowicz made the calls for them.

As Ukanowicz and other staff tried to reach everyone in the department of 71 full-time equivalents, they found that some people could not be reached. “We contacted the next person on the list, but kept trying to reach back to make sure all staff were safe,” she says.

More than one-third of MD Anderson’s 20,000 employees had to evacuate or experienced storm damage. The hospital set up the Caring Fund to accept donations to help staff in need. (See story about ways to deal with natural disasters in this issue.)

Texas Children’s Hospital had a system in place for emergencies. Each department would have a prep team, a ride-out team, and a relief team. The prep team’s job was to work in the few days prior to Harvey’s expected landfall, while the ride-out and relief teams prepared their homes and families for the storm so they could come into work during and after the disaster.

For case managers, disasters that damage roads and power grids make it very difficult to transition patients to the community.

One patient at MD Anderson was ready for discharge when the hurricane struck Houston, but the patient’s home in an outlying area had been lost in the storm, Ukanowicz recalls.

“The patient needed to be discharged, but had nowhere to go,” she says. “So we tried to find a hotel in that area and reached out to the patient’s extended family.”

Eventually, the family found a mobile home that would serve as a temporary dwelling for the patient. “They had lost everything, so they had to pool their resources to find another safe place,” Ukanowicz says.

“We also had to make sure they could meet the follow-up appointments,” she adds.