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Harvey left lessons in challenges of hurricane risk management

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As Hurricane Michael starts to batter the Florida coast, one Texas-based hospital system revisited the lessons learned from the devastation caused by Hurricane Harvey last year, which showed that even the best risk management plans cannot account for every contingency.

Memorial Hermann Health System has 15 acute care hospitals, more than 26,000 employees and annual emergency visits of more than 564,000 in South Texas, Charlotte Spence Koenig, system director of enterprise risk management in Houston, noted at the American Society for Health Care Risk Management’s annual conference in Nashville on Tuesday.

“We had no idea what we were facing because we live in Houston and we have hurricanes and we drill for hurricanes and we’re ready for hurricanes so it was natural procedure,” she said. But Harvey “was not the normal hurricane for us. We had water coming from every which direction and that we aren’t used to.”

Harvey stalled and dropped significant rainfall in the area over a five-day period, with the highest rainfall amount totaling 48.20 inches – the highest rainfall amount in a single storm for any place in the continental United States, according to NOAA.

The hospital system took precautions such as stocking supplies and started sending patients home that did not need urgent care, but “we weren’t really expecting anything catastrophic,” said Amber Johnson, the system emergency management planner. “I will never forget waking up (the) Sunday morning and it had rained feet overnight. Suddenly, we had hospitals that were about to take on water, we had people whose homes were flooded out and the staff that were in the hospital could not move around. You were stuck at that point and it just changed dramatically the way we responded.”

The flooding damage inflicted by Harvey caused some unusual issues for the Houston-based health system such as military personnel transporting patients to different hospitals in the Houston area, “which is something we had never experienced before,” she said. “They weren’t familiar with the infrastructure of the hospital system so they were sending Level 1 trauma patients to Level 4 hospitals and it was definitely a huge learning experience for us.”

One of the facilities in the system called Ms. Koenig during the storm to tell her that they had no place to transfer their dead bodies to, she said.

“We had to think about alternative ways to store the bodies until we could get our bodies to the morgue,” she said, adding that the hospital system ended up contracting with a refrigerated food truck company to park one of their vehicles in the facility to store the bodies. “That was a new one for me.”

But one of the biggest risk management challenges occurred a few days into the storm when the hospital system needed to transfer 69 patients from its Sugar Land hospital to another hospital 14.8 miles away because rising floodwaters threatened a nearby highway bridge.

“Being in the coastal area, we have two hospitals further south than ours scheduled to be evacuated depending on the category of the hurricane,” Ms. Johnson said. “This hospital that we evacuated is not one of the two so that was the really interesting thing about Hurricane Harvey.”

“The risk of evacuating a hospital is catastrophic,” she continued. “It was one of the hardest decisions we’ve ever had to make, but we felt that if we get cut off from that highway and things were to get worse, we could not move around. We couldn’t get any supplies in. We couldn’t get any high acuity patients out so we decided to move them. Our top priority, of course, was to maintain a safe environment. We wanted to shelter in place and we were not in a mandatory evacuation zone but given the risk we felt it was the best thing to do for our patients and our staff. Floodwaters were on main concern.”

Health care facilities, especially nursing homes, were criticized for not evacuating patients ahead of Hurricane Katrina, she noted. “It’s not that simple because when you have that type of patient population, that high acuity, moving them could be deadly,” she said, referring to patients that may be suffering from life-threatening or serious health conditions.

The Sugar Land evacuation took about seven hours, with the last vehicle moving across the bridge with water under its wheels, Ms. Johnson said.

“We were cutting it pretty close,” she said. “It was as calm and organized as something like that could be.”

Risk managers of hospital systems need to be aware of critical issues such as having enough food and water for patients and staff, having enough beds for their staff to sleep –  a neighbor showed up at one hospital with air mattresses – and having medications, not just for patients, but for their staffers dealing with conditions such as diabetes and depression, they said.

“Your staff burnout – you need to be keenly aware of that because no matter how hard you try, that’s going to happen and it was pretty monumental,” Ms. Koenig said.

Harvey also taught the importance of ensuring that pictures are taken to submit with potential insurance and U.S. Federal Emergency Management Agency claims, she said.

“We lost hundreds of thousands of dollars in a storm because it wasn’t documented well,” Ms. Koenig said. “You can recoup a lot of that money, but you have to be able to show what you had and what you lost.”

Such lessons are particularly relevant with the 2018 hurricanes, she said, noting the devastation caused by Hurricane Florence in the Carolinas.

“I feel horrible – they’re going through the same thing right now,” she said. “This will continue to happen. You can plan and plan and plan. You can do every table top in the world and guess what: you’re going to get hit with something” unexpected.