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As Hurricane Harvey heaped more than 50 inches of rain on Houston, the most from a single storm ever recorded in the continental USA, streets turned into rivers, cars floated away and much of the city lost power. The tropical storm, with winds up to 134 miles per hour, rendered tens of thousands homeless, ultimately causing some $200 million in flood and wind damage. It was a disaster of near-epic proportions—and no more so than for Houston’s hospitals.
But by and large, the city’s healthcare leaders were ready. Some 16 years earlier, Tropical Storm Allison belted the region, flooding hospitals, drowning pharmacies, destroying medical records, shorting out medical equipment and snuffing out backup generators. Afterward, leaders representing a coalition of local-area hospitals, emergency medical services and fire departments came up with plans to bolster the city’s medical services in times of crisis. Hospitals installed floodgates and submarine doors that could be closed to wall off critical sections of a hospital. Emergency generators were moved to upper floors and key supplies were stashed throughout buildings. Communications systems such as cellular networks were beefed up.
The results were impressive. Although Harvey still caused extensive damage and took lives, only 20 of Houston’s 110 hospitals were forced to evacuate any patients—a far cry from previous disasters.
This kind of leadership is needed now more than ever. Though politicians can debate the causes, the number of natural disasters worldwide continues to climb—to now more than 400 a year, according to several government sources. Hardest hit by these events—defined as earthquakes, storms, floods and heat waves with death tolls of 10 or more and government emergencies declared—have been the US, China and India. But wherever they happen, they put the medical field on crisis alert, and there is little question that health organizations that had planned ahead respond the best. The first issue, though, is how to get teams focused on what may never happen.
“Weather-related disasters are increasing, but they are still rare events,” says Mahshid Abir, MD, assistant professor of emergency medicine at the University of Michigan and director of the acute care research unit at the university’s Institute for Healthcare Policy and Innovation. “You are asking hospitals to prepare for rare events, and it is difficult to get them to do that.”
Even in times of relative tranquility, many hospitals are functioning near or at maximum capacity. There is little bandwidth for adding the kinds of drills needed for coping with a disaster or improving communication or coordination among rescue workers and hospital staff. Experts say such advance planning can be almost as disruptive to the systems as some of the storms. It all begins, they say, with leadership at the top. “In essence, preparedness is another form of agility, to deal with the unexpected in an organized and successful way,” says Harry Greenspun, MD, chief medical officer and managing director, Korn Ferry Health Solutions.
Some changes can be small, such as ensuring that staffs have the proper tools and resources at their disposal. Healthcare concerns also need managers and CEOs who can motivate people to come to work in tough times.
“One of the issues that has come up in different disasters is people’s willingness and ability to come to work,” says Jennifer A. Horney, associate professor, department of epidemiology and biostatistics, Texas A&M School of Public Health. “Sometimes 50 percent of people don’t report to work out of concern for their families.”
That changes by creating a shared sense of purpose and ensuring that communication networks are robust enough to handle major weather events. Other preparations are more complicated and involve structural changes to the physical hospital—again, requiring a heavy dose of vision-setting from the top.
Fortunately, some hospitals have been adapting. After floods unleashed by Hurricane Katrina destroyed paper medical records, the state made a push for digital patient records. When a tornado destroyed a hospital in Joplin, Missouri, a new medical facility rose in its stead four years later, with an exterior composed of reinforced concrete panels. Windows in the intensive care unit can handle gusts of wind up to 250 miles an hour. Each floor boasts a fortified safe zone with reinforced ceilings, stairwells and walls, while critical life-support systems are equipped with backup batteries. Crucial supplies—crowbars, flashlights and shovels—are stored on every floor, and the new hospital receives signals from four cell-phone carriers as well as a HAM radio operating center.
Was it expensive? Actually, the fortifications only raised construction costs a few percentage points. In the end, consultants say, nothing can control Mother Nature, of course—but a dose of the right leadership moves can weather at least some of the storm.