Guns & generators: Surgery programs handle Hurricane Katrina’s devastation
(Editor’s note: The desolation caused by Hurricane Katrina has been felt throughout the country, and surgery centers are no exception. In this special issue, we tell you about two centers that have dramatic stories to share from the storm and its aftermath. We explain what one center did immediately after the storm to recover. We also obtained suggestions on items that would have made recovery easier. Additionally, we tell you about two surgery centers that responded immediately to help the sick and needy.)
In all of your disaster planning, did you imagine that you might have to climb onto the roof in the middle of a hurricane to ensure water drains away and doesn’t collapse the roof?
This is just one of the perilous moments that managers of surgery facilities found themselves in while addressing Hurricane Katrina and its aftermath. Their experiences and advice are helpful for preparing for other types of disasters, such as flooding.
In Hattiesburg, MS, people were pulling guns on each other and, in two cases, shooting each other over ice and gasoline. There also was looting in the community. The administrator at South Mississippi Surgery Center was concerned about protecting patients and staff; some patients discharged from a local hospital didn’t have houses to return to and were moved to the center.
"We made provisions in terms of self-defense and protection in case anything happened on site," says Jeff Noblin, CHE, administrator.
A physician kept a firearm, Noblin says. "I think it’s wise to have precautions in place," he explains. "Have someone with a least one firearm that’s kept in a safe place where it can be accessed if needed." Check the gun laws in your state, and ensure the person who owns the gun has undergone firearm training. Also keep in mind that a gun, like any weapon, can be used against you, your staff, or your patients.
Much of the violence in Hattiesburg occurred when residents were trying to obtain gas, Noblin explains. "Two employees were really low on gas, so we escorted them to a gas station that we knew would give priority to health care providers," he notes. People in the community began siphoning gasoline out of cars, he adds. "We got creative about how we parked," Noblin says. Cars were parked so the gas tanks faced each other or faced the building.
Additionally, as a safety precaution, the surgery center allowed patients to enter and exit only one door. Staff cared for an average of six to eight patients a night.
When Same-Day Surgery contacted Noblin one week after the hurricane, he said, "We’ve got around-the-clock staffing, mainly by a couple of nurses and myself."
The center had three hospital beds already in place for 23-hour stay procedures, he says. Other patients slept on stretchers, Noblin says. "We converted space with very little effort for patients to spend the night," he says.
The center lost power for about 36 hours, but used its generator. Water was intermittent initially. The center is on the same power distribution grid as the hospital, so they were given priority to have full power and full water restored. Noblin picked up food for staff and patients from the hospital.
The lesson learned from this experience? Be prepared, Noblin says. "Make sure you have your cars gassed up; make sure you’ve got precautions in place. Try to do what you can to help, because a lot of other people are in worse shape than you would be," he advises.
Staying in the facility during the hurricane
South Mississippi wasn’t the only surgery facility where staff persevered in spite of the hurricane. In fact, in Louisiana, surgical hospitals are required to staff their facilities 24 hours a day . . . hurricane or no hurricane.
At Fairway Medical Center, a surgical specialty hospital in Covington, LA, five staff members and 12 family members, including some children, rode out the storm inside the facility, on the north shore of Lake Pontchartrain.
While the hurricane’s eye passed at least 45 miles to the east of the facility, Fairway Medical encountered severe winds of about 80-100 mph with gusts of up to an estimated 115-120 mph, says Kory Krista, director of plant operations.
Fairway Medical suspended all procedures for Monday, Aug. 29 in preparation for the hurricane’s arrival, Krista says.
"Our CEO, David Guzan, made it a point to delay surgical procedures that would require inpatients to be in the facility over the weekend and upon the arrival of the storm," he notes.
When a storm of Katrina’s strength and size is imminent, evacuation of staff and patients is the best way to avoid injury or loss of life, Krista emphasizes.
"The biggest problem with hurricanes is that people do not evacuate or wait until it is too late," he says.
Preparing the facility
Krista ensured both of the critical power generators were filled with diesel fuel.
"We are fortunate that our critical power circuits are on one generator and our main elevator and HVAC [heating, ventilation, and air conditioning] system for a large portion of our hospital is on another generator," he says. "This effectively allows us to run minimal critical power while selectively powering the elevator and HVAC system as needed, to conserve fuel."
Krista removed items outside the facility including benches, garbage cans, and small signs. Computer servers were moved to a higher floor. All electronic equipment was unplugged, elevated off the floor, and covered with plastic bags.
"I also began to systematically turn off critical power circuits for lighting in portions of the facility that would not be occupied or accessed to avoid unnecessary use of electrical power," Krista explains.
As they would do in a fire, they closed all doors to isolate all the rooms from egress corridors. "We did this with the intention of keeping wind and weather from causing further damage to the facility if the exterior envelope of the facility was compromised," he says.
Latching fire-rated doors leading to rooms on the exterior of the building provided protection from high winds that could enter and pressurize the roof/ceiling and walls, thus potentially causing them to collapse, Krista adds.
"Remember, most roofs are designed to prevent collapse from downward compression, but the deck structure may not be able to resist selective penetration from the force of a 120-plus mph wind that pressurizes the envelope of the building from the inside, thus leading to further wind and rain damage," he warns.
Managers conducted a visual inventory of food, linen, and medical supplies to know the location and quantity and to ensure they weren’t in an area that could be infiltrated with water, Krista says. "All these supplies were either relocated or thoroughly covered," he says.
Remember that return air ductwork, grills, and exhaust fans can provide free air exchange with the outside, either through the actual exhaust vent or the fresh air intake of an HVAC system, Krista says. "High winds can actually force dirt and debris back into the facility, thus creating unsuitable conditions for sterile corridors, supply rooms, and operating rooms," he notes.
As a security precaution, all exterior doors were locked. Fairway uses proximity readers for card access. The motion sensors on the inside of exterior doors that released the latch mechanisms were deactivated, Krista says. This deactivation avoided the exterior doors being accidentally opened by someone approaching the door from the inside, he points out.
"This would have effectively allowed the wind to blow the door open and create a route for high winds and rain to enter the building," he says. "Also in the aftermath of the storm, we needed to avoid any unauthorized entry."
As the storm approached, the facility began to accept some family members of employees who had difficulty evacuating, Krista says. "Since we had nurses here as required by DHH [Louisiana Department of Health and Hospitals], we were more than glad to shelter their families as well," he notes.
The hurricane hits
When Hurricane Katrina hit, the area experienced a massive loss of trees, Krista says.
"Indirectly, we were affected by the surrounding vegetation because the wind would blow the debris onto our roofs and clog the roof drains at the strainers," he says.
Even with roof scuppers to drain water at the parapet walls, the roof was accumulating large amount of standing water, Krista explains. "In the height of the storm, I actually ventured out onto the affected first-floor roof areas and physically removed all the drain strainers to allow the water to drain off of the roof," he continues.
The wind gusts were incredibly strong, Krista says. "Before venturing onto the roof, I waited at the roof hatch until there might be a break in the wind," he says. "I waited for 15 minutes before I thought it would be reasonably safe." The rain stung when the wind would gust, Krista adds "At times, the wind would throw me off balance," he notes. Krista stayed low to the roof and used rooftop structures as cover.
When he removed the drain strainers, it was as if a 10,000-gallon toilet flushed, he says.
"I cannot imagine what possibly may have happened to our facility if we suffered severe water and structural damage due to the weight of the quantity of standing water on our roof," Krista adds.
Source/Resource
For information on surviving a disaster, contact:
- Kory Krista, Director of Plant Operations, Fairway Medical Center, 67252 Industry Lane, Covington, LA 70431. Phone: (985) 809-9888. E-mail: [email protected].
For information on Hurricane Katrina assistance opportunities being coordinated by members of the Association of periOperative Registered Nurses, go to www.aorn.org/hurricaneoptions.asp.
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