Paul Kirk, vice president of information systems at Woman’s Hospital, refers to last August’s flood as the “unnamed event.” By not being a named storm, at least in the beginning, the Great Flood of 2016 managed to catch some Baton Rouge hospitals off guard despite having well-established emergency response plans in place.
Across the Baton Rouge area medical community, an estimated 30% of hospital staff members were displaced by the flood and unable to get to work in the days that followed. At some medical centers, that number was even higher. In effect, those providing care to the flood victims were victims themselves.
At Woman’s Hospital, some 500 employees were impacted.
“Nobody ever named it and nobody ever said there was an event until after there was three feet of water in houses,” says Kirk, who also oversees emergency response at the hospital. “It caught a lot of people flat-footed.”
As a result, some area hospital incident command systems weren’t mobilized as early as they could have been, thereby slowing the reaction time.
“There are things that typically trigger a mobilization, such as a certain number of hours before landfall of a hurricane,” Kirk says. “In this case, we didn’t have anything to trigger the response.”
To assess what went wrong—as well as what went right—hospitals in the Baton Rouge area conducted “after action” evaluations to identify problem areas and create plans for correcting issues. While most hospitals had well-established, precise emergency response plans, areas for improvement were quickly identified.
“Unfortunately, that is the nature of disaster planning,” says Coletta Barrett, vice president of mission and incident commander at Our Lady of the Lake Regional Medical Center. “In Louisiana, we think of hurricanes as the primary threat from a natural disaster. We have 120 hours to put our plans in place, and it becomes a checklist exercise. You get lulled into thinking, ‘We’ve got this,’ then suddenly you have to respond in an hour or two.”
OLOL did a similar post-flood assessment, but found few weak links in its response plan thanks to lessons learned from the ice storms of a couple of years ago.
“I would say that all hospitals around Baton Rouge were very surprised by the ice storms and learned a lot,” Barrett says. “That is not something that we deal with very often. We all learned to start watching The Weather Channel a lot more. That is why we test our plans routinely in hospitals. We collectively test our response. Unfortunately for all of us, we have been tested a lot more this past year.”
By most measures, the emergency response plans for area hospitals worked as intended. All hospital systems fall under the umbrella of the National Incident Management System, overseen by FEMA, and are organized by regions. Communication between the hospitals and the emergency response team are facilitated by designated regional liaisons, and in turn each hospital’s own incident commander ensures that response actions are executed properly.
During the flood, delayed activation of emergency response measures was the biggest problem.
“We’ve got to try to be a little bit more proactive and get ahead of it,” says Kirk, adding Woman’s Hospital is no longer going to wait for the state to make an official emergency declaration. “We’re going to watch the weather more closely and go ahead and activate a simple HICS shell structure. While we won’t have the whole group there, we’ll have the resources to quickly access them if needed and not wait to see what’s going to happen. Obviously, it caught everyone off guard. We thought we had more time when there wasn’t.”
Dr. Robert Kenney, Baton Rouge General Medical Center’s vice president of medical operations, says the flood also highlighted the need for facilities to better serve patients with chronic conditions.
“It’s so vitally important that in situations like this that public accommodations are put in place for those with chronic illnesses,” he says. “During a crisis, hospitals have to remain available to handle the acute needs, so they can’t be choked with an influx of patients who have chronic needs. That is something that we must encourage in our public response, so that the hospitals can remain available to the most urgent needs.”
“During previous events, we learned that no single hospital can handle things by themselves. We have to communicate and we have to collaborate if the community is going to be able to coordinate a disaster response like this.” —Dr. Robert Kenney, vice president of medical operations, Baton Rouge General Medical Center
“It’s so vitally important that in situations like this that public accommodations are put in place for those with chronic illnesses,” he says. “During a crisis, hospitals have to remain available to handle the acute needs, so they can’t be choked with an influx of patients who have chronic needs. That is something that we must encourage in our public response, so that the hospitals can remain available to the most urgent needs.”
Kenney and others plan to propose such a measure to the Louisiana Department of Health.
Disrupted communications and limited transportation were the top concerns for Woman’s Hospital, specifically, communicating with staff and providing transportation for employees and discharged patients. The hospital hopes to get both problems resolved before the beginning of this year’s hurricane season.
“When the cell towers lose service and phone lines lose service because of the flooding, then you have a serious communications problem,” Kirk says. “We couldn’t communicate with our physicians or with our nursing or clinical staff about needs. While everyone learned to lean heavily on texting in the wake of Hurricane Katrina 12 years ago, the Great Flood of 2016 revealed that even texting isn’t always reliable.”
That has left many looking for other options.
“We have it in our budget to begin using the same cloud-based communications system the state uses, called Everbridge,” Kirk says. “It will send out a message in multiple formats, everything from a text to an SMS to an email, then will track who received it and they’ll respond back. We’ll be able to track who’s getting the information, and who’s not.”
To overcome communication challenges, Baton Rouge General created a closed Facebook account for its employees.
“It was a means of accounting for our employees and saying, ‘Hey, do you need help, are you safe, do you need shelter?’” says hospital spokeswoman Rebekah Johnson Maricelli.
Transportation was another issue. Because ambulances were needed for emergency use, in many cases discharged patients with flooded cars and homes were left stranded. That’s when the nursing staff at Woman’s Hospital came up with a very 21st century idea.
“They asked, ‘Why can’t we set up an account with Uber?’” Kirk says. “Subsequently, we set up an account, social services helps schedule it, and we pay for the patient to go home or to other accommodations.”
Despite the hiccups, there were many things that Baton Rouge area hospitals did right following the flood, and Baton Rouge General’s Kenney says collaboration was key.
“During previous events, we learned that no single hospital can handle things by themselves,” he says. “We have to communicate and we have to collaborate if the community is going to be able to coordinate a disaster response like this.”
To that extent, Baton Rouge General did very well—in fact, it had so much food left over after the flood that it donated the surplus to the Salvation Army. OLOL’s Barrett says area hospitals have cultivated a “culture of preparedness” and are reaping the benefits.
“No matter what the disaster, situation or issue, if you are an organization that has a culture of being prepared then you can scale to the situation,” she says.
OLOL recently conducted a successful ramp-up of its incident command system as it transitioned to a new integrated electronic medical records system.
“It was a huge endeavor,” Barrett says. “If you can’t transfer your patient from the emergency room to a bed in the unit because the systems are not talking to one another, it could have a significant impact. We were prepared, and it went very well.”
