Lessons learned: Prepare for the unpredictable

After Katrina, hospitals were ready for Gustav

Surviving Hurricane Katrina was a life-changing experience. It also was a transformational experience for hospitals, which revamped emergency plans and even changed building design.

They learned some important lessons about communicating with staff and preparing for the worst. Those lessons paid off as two major storms struck the Gulf Coast this year.

In fact, even the emergence of two storms (Gustav and Ike) just three years after Katrina reminded those involved in emergency management just how sudden and unpredictable disasters can be.

"I really did not think we were going to have another storm in which we were going to have to do evacuations [so soon after Katrina]," admits Cynthia Davidson, RN, JD, regional coordinator for hospital emergency management of the Metropolitan Hospital Council of New Orleans in Metairie. "I just wasn't expecting it. It was a good reorientation to the realities of life."

Hospitals in New Orleans had made significant changes. For example, East Jefferson General Hospital in Metairie installed shutters on windows on the upper floors and a protective grid on lower windows to prevent them from shattering. The pebble roof was replaced and the pumping mechanism for the hospital's well was raised above flood level. The hospital now has satellite phones, and the land lines connect to three different central telecommunications offices in the region to reduce the chance of a total loss of phone service.

But more importantly, the hospital honed its ability to communicate with employees. For any type of [disaster] scenario, communication is key," says Linda Daigle, MT, ASCP, emergency manager and pathology laboratory administrative director at East Jefferson.

"Because you are very open with what's going on, it eliminates any apprehension that people might have and it makes them want to work more as a team," she explains. "If you take care of your team members, that helps, too. We tell them to bring bedding and food, but we find places for them to sleep if they can't be housed in their units."

Town hall meetings spread info

As Gustav approached, the hospital held town hall meetings, which gave employees an opportunity to ask questions. Emergency planners reviewed the "code gray" plan for severe weather.

More information was posted on "Team Talk," the hospital's intranet. Health care workers received targeted e-mails, detailing their responsibilities. As the hurricane approached, the hospital's CEO even made announcements on the public address system so everyone in the facility would have the updated information, says Daigle.

Employees who evacuated also had several avenues of communication. The hospital used an external web site with a password-protected site and provided a toll-free number to call for information.

The emergency plans and the open communication were reassuring to employees, says Daigle. "Pretty much everybody who was on our "A list" to report to work came," she recalls.

In fact, many employees also brought family members. The hospital actually discouraged bringing their dependents, including children and elderly relatives, but made provisions for child care and elder care.

"For the staff, as well as any other dependents, we tell them you have to come prepared to sustain yourself for seven days. That includes food," she says. "A lot of people will bring canned goods or snacks. It's just difficult when you have that many people to keep track of them. We need to know who's in the building. It puts a drain on the facility as well."

Part 2: The aftermath

The most challenging period may come after the incident. As part of emergency management, hospitals should tell employees to expect to work without backup or outside help for several days, says Davidson.

"There is no way after an event that you can get resources in any quicker. They have to be prepared to stay in place for this period of time," she says.

"Obviously, this was not [explained] to the staff members [before Katrina], because you saw a lot of panic going on because they were there for more than one or two days. The [emergency] plan says you've got to stay in place for three to five days. It still says that. That has not changed," Davidson said.

Education about the emergency plan is critical, she says. "The real issue is that you only have a certain number of people at the hospital who know the plan. The plans for emergency management really need to be made part of the yearly orientation."

Katrina was an example of a prolonged disaster. Employees were due to return to relieve those who had been on duty for days — but they couldn't return to their damaged homes.

"As people would come back to the area, they couldn't live in their house but they wanted to work. People who were here were tired. We allowed people to stay here at the hospital," says Daigle.

The hospital arranged for housing at an apartment complex that wasn't affected by the storm and flooding, and even set up a couple of trailer parks. A few people even lived at the hospital for a while.

As bad as Katrina was, Daigle imagines scenarios of other types of disasters. She takes an all-hazards approach to planning. "If we had a pandemic, it would even be worse than a hurricane situation," she says.

As a huge hurricane approaches, people in the community view the hospital as a safe haven and may even drop off loved ones for "safekeeping," says Daigle. That's much like the "worried well" that hospitals expect to see if there is a pandemic or bioterrorism event.

That is why some hospitals have made arrangements for alternative sites to handle triage and fewer needy patients.

Helping employees cope emotionally also is an important aspect of emergency planning. After Gustav (and Katrina), chaplains visited all the departments at East Jefferson General Hospital. The Team Member Counseling Department (similar to an employee assistance program) put together special programs and met individually with employees.

Post-disaster counseling helps employees cope with tragedies they may have witnessed, but also offers support for personal losses. "In Katrina, we had many, many employees who lost everything," says Daigle.