Patient Safety Quarterly-Hurricane prep focuses on evacuation, staffing needs
Floyd's threat recalls preparation done for Fran
The recent evacuations from Southeastern coastal cities as Hurricane Floyd roared offshore repeated on a larger scale the evacuations called for when Hurricane Fran triggered the implementation of disaster plans.
At Memorial Health University Medical Center, formerly Memorial Medical Center, in Savannah, GA, the 320 patients evacuated this past Septem ber almost tripled the 114 patients the hospital evacuated in 1996.
According to Gary Milewski, the hospital's corporate safety officer, the patients were moved inland to hospitals in Macon and Augusta, GA. More than 100 patients who didn't require ventilation or other mechanical equipment remained at Memorial Health, which did not sustain any damage, he notes.
Milewski's experience in the previous storm caused him to change the disaster plan he had written a year before Fran struck. "Procedures for communicating with the receiving hospitals and now Memorial Health's A and B teams were dispatched and updated," he says, "and the A and B teams are established earlier on."
Members of team A can go home to see to their families' safety then return the hospital 12 hours before the storm's landfall. At that point, members of team B are allowed to go home and see to their families, he says. The result? "Everything went smoother. We moved patients in 26 hours vs. the 30 to 35 hours it took us with Fran, with fewer patients."
Potentially as lethal as hurricanes Andrew or Hugo, the storm raised the specter of massive structural damage, power outages, and worse — danger to the coastal hospital's more than 350 patients.
In a matter of hours, the hospital evacuated 114 patients, discharged 100 more, and moved about 140 to the interior of the hospital, Milewski says. "We started tracking the hurricane the previous week. We have a computer program that is tied into the national weather system."
Because the storm's early path appeared to be on a direct collision course for Savannah, on the Tuesday before it was to arrive, hospital officials made the decision to evacuate, he says.
"I call them [the receiving hospitals] and tell them what kinds of beds I need and they call back and tell me what they have," he says. It took the staff just 16 hours from the time physicians began evaluating patients to the time all of the those eligible for transport were moved.
"We would have liked to evacuate all of the patients, but many were not able to be transferred," Milewski says.
A command center was established in the administrative conference room. Complete with a bank of phone lines, computers linked to the Chatham County Emergency Management Agency, and HAM radio operators, the center was designed to maintain communication with the outside world even if power and phone service were lost, Milewski says.
Critical care patients on life-support equipment were transferred to power provided by the hospital's six backup generators.
The staff cancelled all elective surgery beginning Wednesday and began seeing only emergent patients, Milewski says. "We went through our plan right up until the storm turned and headed up the coast."
All but one of the patients were transferred back on Friday after the threat of Fran had passed. "We had one woman deliver [while she was at another hospital], but the others are all back," he said after the storm.
Milewski credits the successful evacuation to the extensive inservice training Memorial's staff undergoes throughout the year.
The safety plan is divided into separate training modules and presented to employees at regular inservice days throughout the year, says Suzanne Ingram, the hospital's director of business and admitting. The modules detail procedures to be implemented in the case of flood, fire, and other disasters, as well as hurricanes, and all staff are tested on the information once each year, she says.
In addition to the modules, the emergency procedures for each department are spelled out in easily accessible reference sheets, allowing people to work in several different departments, depending on where they are needed most, Milewski says. "We can utilize other personnel. It doesn't have to be admitting [staff]; others can help out."
Weather emergencies present unique problems in terms of disaster planning, says Milewski, who worked with the Federal Emergency Management Agency for 12 years before coming to Savannah.
"It's a twofold operation," Milewski says. The entire hospital must be evaluated for safety, as well as its ability to treat patients.
At the Medical University of South Carolina in Charleston, the staff remain on alert almost constantly throughout the hurricane season, explains Cindy Williams, manager of admitting and financial counseling. Each time a hurricane threatens, Williams immediately begins setting up A and B teams of employees and separate "call trees" to keep the rest of her staff informed of changes in the hospital's status. Williams calls designated people on her list, and each person in turn is responsible for getting in touch with the next employee and delivering the information.
The current plan calls for personnel on the A team to be prepared to work at the hospital through the impending storm and stay there up to three days, Williams says. The B team is sent home and called in after the storm passes to relieve team A.
The importance of having enough personnel at the hospital prior to a hurricane is one of the lessons the staff at Medical University learned from their experience with Hurricane Hugo several years ago, says Maureen McDaniel, the hospital's coordinator for bed management.
"I don't think we really knew what to expect," she says. "We weren't ready to spend lots of time here before the other teams could get in."
Williams says she makes sure she has enough staff to operate for 24 hours straight, just in case the B team is unable to come in on schedule.
For example, Williams says, two admitting personnel are needed for each eight- to 10-hour shift to staff the emergency department. She calls in five people on the A team and sets up a smaller rotation of workers inside the A-B arrangement.
For each A and B team, two people are on duty for the first eight hours, while the other three are at the hospital, but are either off duty resting or helping prepare for the storm by covering computers with plastic and placing important records in high places, out of the reach of possible flood waters.
Discharge planning begins immediately when the hospital administration declares a weather emergency, says McDaniel. Each nursing station provides the bed management staff with a list of patients who are eligible for discharge, she says.
Though many patients are discharged ahead of a storm, many patients recovering at home are brought into the hospital because of anticipated power outages and water problems in the area.
In addition to scheduling enough personnel, the hospital also tries to tend to the needs of its employees, such as keeping the cafeteria open around the clock and setting up an on-site nursery for employees' children.
Another lesson learned from Hugo is the necessity of keeping staff up to date on the hospital's plans in an emergency, Williams says.
"You can't just spring on someone that they have to be here for the next 24 to 48 hours," she says. "You don't need [people working with] the anxiety of 'I wasn't prepared at home.'"
Both Milewski and Williams say their plans for Fran worked well, giving them added confidence for facing future hurricanes. "It's about everyone working as a team and knowing what to do," Milewski says.
He noted that this was the first time in the hospital's 41-year history that it evacuated patients.
Flexibility is also important to remember when dealing with a disaster situation, says Williams. "You have to stay on top of it. You can't say, 'This is the plan, and this is what will happen,' because those things can change."
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