Back to Front PageVOLUME 6, NUMBER 4

Academic Medical Centers Confront Natural Disasters Head-on

By Jennifer Proctor

The University Health Systems of Eastern Carolina had to rethink its entire method of operation following last September's devastating Hurricane Floyd.

Television news teams seem to be reporting, more and more, live from the site of the latest natural disaster. From fires to tornadoes and earthquakes to hurricanes, these disasters are not only capturing headlines and news footage, but also are leaving communities in ruins. Natural disasters can wreak particular havoc on academic medical centers where a loss of power can result in the shutdown of lifesaving machines and impassable roads can mean no medical supply deliveries. Recognizing this, medical centers nationwide are meticulously preparing for disasters and their diligence is paying off, enabling them to keep their doors open in times of crisis and even to assist other hospitals. And while news crews leave as quickly as storms blow in, academic medical centers are helping communities rebuild.

"Teaching hospitals have an obligation to be open during times of natural disaster," says Dave McRae, chief executive officer of University Health Systems of Eastern Carolina, which runs North Carolina's Pitt County Memorial Hospital (PCMH). When Hurricane Floyd tore through the area last September, the residents of eastern North Carolina were ready. After all, they've seen their share of hurricanes-three in the previous two years, to be exact.

But Floyd was not your average hurricane: It dumped 27 inches of rain in 10 days, and the subsequent floods left the community reeling. "It was the kind of flood that only comes along once in 500 years," McRae says. "Everyone here had to chip in and work hard."

Hurricane Floyd victim Michael Casper Jr., 7, cries as he tells Richard Rawl, M.D., about his broken arm.

McRae says the isolation the flood waters imposed proved the toughest obstacle to overcome. PCMH's disaster plan requires it to be prepared for days of seclusion, but the hospital had to fly in supplies for almost three weeks and regular transportation was hampered for even longer. The disaster plan worked and pulled the system through the extraordinarily difficult time, McRae says, even though it was designed to work for only three to five days.

The importance of ice, fresh water, and portable toilets took on new significance. Making matters worse, there were large chunks of time when the hospital didn't have power or water. And generators were designed to provide only absolutely necessary functions, so the hospital went without air conditioning and cooking.

PCMH staff had to think fast and be creative to keep the hospital up and running. The dialysis and cancer centers were assured the water and electricity they needed, but not all services were so fortunate. In the neonatal unit, for example, power lapses left nurses and doctors scrambling to provide life support to five or 10 children at once. To address the water shortage, hospital engineers filled the rehab center swimming pool with fresh water and rigged it to the hospital's plumbing system, which allowed the hospital's toilets to keep flushing. Getting the water into the swimming pool was no small feat: Each of the surrounding towns sent pump trucks from fire stations to help fill the pool.

The flood also presented a major logistical problem. Many employees were stranded either at home or at work. Cots and air mattresses were set up at the medical school for people whose homes were damaged.

The flood brought out the best in PCMH's staff, according to McRae. He says that employees' positive attitudes and willingness to work, even when they faced great personal loss, touched him very deeply. "Once employees made sure their families were OK, they headed to work to help. They said things such as: 'If someone will loan me a uniform, I can work,'" he says.

Health care professionals also were willing to dirty their hands with nonmedical work. "Everyone did what they saw needed to be done. I would walk into a room to find one of our lead doctors mopping the floor or unclogging a toilet," McRae says. He and his wife, who also works at the hospital, slept in sleeping bags in his office during the ordeal.

Doctors and nurses volunteered to go out into the community and reach people who couldn't get to a hospital or help regional hospitals that quickly found themselves understaffed and overwhelmed. The teams, which traveled in helicopters and all-terrain vehicles, included doctors of all specialties who felt a fundamental need to reach out to the community.

McRae emphasizes that keeping morale up among staff is an important step after a disaster. After several days without coffee, McRae arranged for Starbucks to fly in supplies.

Unfortunately, the crisis wasn't over when the roads reopened and power was restored. The hurricane caused billions of dollars of damage, destroying 7,000 homes and leaving another 17,000 uninhabitable. The University Health Systems raised thousands of dollars for those who lost homes and valuable possessions. It also provided counseling services to employees.

While hospital staff hopes not to see a flood like the one that followed Floyd for another 500 years, McRae says employees are approaching the future with planning, preparation, and awareness. The hospital is in the process of adding generators and secondary wells to keep toilets flushing and taps running. It's also arranging for two full-time helicopters and access to additional ones during emergencies. "We're gearing up for the possibility of another once-in-a-lifetime disaster," McRae says.

Attitudes have changed as well. Fifty-one people died as a result of Hurricane Floyd, and McRae says the ordeal created "more respect for the fragility of life."

… And the Earth Moved

In California, earthquakes can become a part of day-to-day existence, and hospitals can't be knocked down in the confusion. The UCLA Medical Center, for one, has extensive disaster plans and structural precautions. "Even the bulletin boards are bolted to the wall," says Victor Kennedy, director of building and safety for UCLA Medical Center. "We use disaster plans to ensure that during crisis times the hospital will maintain its essential function-providing medical care."

Kennedy says every department has a specific disaster plan for assessing damage and maintaining duties. In addition, the hospital works with entities serving the hospital and campus resources, such as traffic control and police, to ensure their disaster plans mesh with the hospital's.

As far as preparation goes, Kennedy underscores the importance of "drills, drills, drills." The hospital conducts more than the two drills required by law each year and requires full participation from the CEO down through every department. Kennedy says the drills simulate realistic scenarios and include outpatient clinics, finance, and medical center computing. "The drills enable us to respond to real events effectively," he stresses.

In January 1994, the medical center faced the real thing with the Northridge earthquake, which measured 6.6 on the Richter scale and killed more than 50 people. Drill practice enabled the staff to move into action. For example, because many of the injuries were minor, such as cuts from broken glass, the hospital enacted its minor mass casualty treatment plan, moving minor injuries to the outpatient clinic and freeing up the emergency room for serious trauma.

Kennedy says the hospital reached out to the community immediately after the quake, sending doctors out to serve harder-hit areas. UCLA also accepted and helped transport patients from other hospitals that were damaged or overrun, including Northridge Hospital, a 414-bed facility near the epicenter of the quake.

If UCLA doctors faced transportation issues coming to work, they reported to a local hospital they could get to. "An earthquake doesn't just happen in the hospital, it happens in the entire community. If we are going to respond effectively, all the different entities must have a role and function," Kennedy says.

Kennedy acknowledges that while community needs are important, staff needs are equally weighty. "Employees can't be here and be effective if they have issues at home," he stresses. After the Northridge quake, medical center administration set up a day care center in the cafeteria, allowing employees to bring children to work because schools were closed. Also, immediately after the quake, the hospital provided staff meals and lodging if they needed it. Long-distance phone calls to check on family members were encouraged, and the hospital provided psychological and pastoral counseling.

While no one was harmed at the UCLA Medical Center during the 1994 earthquake, the hospital did sustain damage. The quake affected load-bearing walls, weakening the building's ability to withstand a subsequent quake. California law requires the hospital administration to fix the damages or build a new one, and the medical center has opted for a new facility.

In the final analysis, Kennedy says UCLA's most significant lesson for other academic medical centers is the importance of drills. "Hospitals have a moral and ethical obligation to be prepared for natural disasters," he stresses. "Afterward, they have an obligation to be able to respond and provide physical and emotional care."

Natural Disaster 101

Two schools in the hurricane belt are spearheading an effort to coordinate disaster relief throughout the Western Hemisphere. The Center for Disaster Management and Humanitarian Assistance, a joint endeavor by the University of South Florida and Tulane University, aims to facilitate collaborative education, training, research, and information and communication services between disaster response and humanitarian assistance agencies.

The center helps Central and South American countries as well as Caribbean nations before storms hit, says Thomas J. Mason, Ph.D., professor of Epidemiology at the University of South Florida and co-director of the center. The center builds infrastructures by helping train community physicians, nurses, sanitary engineers, and specialists to act in times of emergency. The center also sends to disaster sites fly-away teams, who serve as trainers, not just relief workers.

One of the center's missions is to support natural disaster research. To that end, it is developing portable, modular structures that can be dropped in to disaster areas and withstand gale-force winds. These buildings could serve as hospitals, clinics, or safe housing. The center is also studying post-traumatic stress among survivors and relief workers.

The Center for Disaster Management and Humanitarian Assistance, a joint effort by the University of South Florida and Tulane University, aims to coordinate disaster relief throughout the Western Hemisphere.

Now in its second year, the center is looking for ways to expand its reach, Dr. Mason says. For example, he is meeting with other experts to consider a disaster management certificate program, which would include Web-based courses for those with field experience in disaster management. Also under consideration are graduate training, continuing medical education, and short-term rotations in "emergency medicine," concentrated in disaster medicine and relief.

Dr. Mason, UCLA's Kennedy, and Eastern Carolina's McRae all stress the importance of planning. "You can't prevent the storms, but you can better anticipate their movement, predict flood plains, and stop building in susceptible areas," Dr. Mason says. "This takes awareness, involvement, and networking on the part of the entire community-not just health care providers."

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