By Howard Larkin

What every hospital needs to know before trouble strikes

In the wake of Hurricane Wilma, which tore through Florida last October, health care architect Rolando Conesa of MGE Architects in Coral Gables, Fla., fielded an unusual question. Baptist Health South Florida wanted to know how much it would cost to upgrade a hospital already on the drawing board to withstand a Category 5 storm.

Within a few days, Conesa came up with an estimate: hardening the hospital structure, adding Category 5 hurricane impact-resistant windows and installing larger backup generator fuel tanks would raise the cost of building 80-bed West Kendall Hospital, with shell space for a total of 120 beds, by about $3 million. That’s a lot of money, but by no means a budget-buster on a $93 million facility. So Baptist decided to spend it.

“It is our responsibility to provide health care services to the community in quiet times and disaster times,” says Javier Hernandez-Lichtl, executive vice president and chief administrative officer at Baptist Health South Florida. “We can’t do that if we can’t survive a hurricane.”

West Kendall will be the third hospital that five-hospital Baptist has built to withstand a Category 5 storm—even though the state building code only requires resistance up to Category 3. “It’s part of an ongoing review of our emergency and disaster preparedness plans,” Hernandez-Lichtl says.

While the decision to strengthen the new West Kendall facility was under consideration before the 2005 hurricane season began, the unprecedented damage Hurricane Katrina wrought in the Gulf Coast prompted Baptist to upgrade its requirements even further—notably, increasing the size of backup generator diesel fuel tanks.

“Our existing facilities can go two to three days before we have to refill,” notes Ana Lopez-Blazquez, chief strategic officer at Baptist. “If the roads haven’t been affected and traffic can get through, that’s no big deal. But if the roads are closed, you need five to seven days. It wasn’t until after Katrina, Rita and Wilma that we realized how important that factor was.”

That’s quite an awakening from a health system that has lived through several severe hurricanes, including Andrew, which destroyed Homestead, Fla., in 1992. With hurricane season beginning June 1 and tornadoes already wreaking havoc this spring, it should be a wake-up call to executives who have not yet reviewed their disaster plans.

Welcome to the post-New Orleans world of disaster planning, where even the unexpected must be expected. While hospitals on the coasts may be most vulnerable, even those hundreds of miles inland could be caught off guard by unexpected disasters—or by the spillover from major events elsewhere.

Indeed, an October 2005 national survey of 350 hospital executives and managers by VHA Inc., Irving, Texas, found that 48 percent plan to update their disaster recovery plans, while 68 percent of responding emergency department coordinators said they would. “I was chatting with CEOs in our organizations in California, Hawaii and Alaska, and they were relating it to earthquakes and tsunamis,” says Cynthia Hare, vice president for performance improvement at VHA Southeast in Tampa. “They felt they were under the gun to make fairly substantial modifications to their disaster plans.”

Jim Bentley, senior vice president of long-term policy at the American Hospital Association, agrees. “The lesson is we need to think bigger,” he says. In addition to natural disasters and terrorist strikes, hospitals must prepare for things like major failures of the electrical grid or water supply.

Some of the major precautions hospitals are taking include:

1 Communications: Four years after 9/11 exposed major weaknesses in telephone, cell phone and even police and fire department radio networks, many hospitals thought communications problems were a thing of the past. Katrina  proved them wrong. “Cell phone towers were the first thing to come down in the storm,” Bentley says. “OnStar radio in GM cars was about the only thing that worked.”

Hare recommends investing in satellite phones for management and emergency team members for external communications and radio telephones for internal communications.

2 Security: “If your facility isn’t secure, no one will feel safe and your staff will leave,” Hare says. She recommends working with local police and calling in the National Guard early to ensure that all entrances are guarded. Security personnel also need to be clearly briefed on where to direct patients and citizens seeking food and shelter during storms.

3 Generators: Electricity is the first thing that goes out in a major storm, making backup power a top priority, Lopez-Blazquez says. Generators and their fuel supplies must be placed above flood high-water levels and must have adequate capacity to run not only medical equipment but air conditioning for at least part of the facility for an extended period. Bentley notes that many hospitals experience generator failure, suggesting that redundant systems and stocks of repair parts are also needed.

4 Fuel & Other Supplies: It’s safest to assume that your facility may not be rescued for as long as a week after a major event. Therefore, when a major storm is expected, lay in a seven- to 10-day supply of diesel fuel, fresh water, food and essential medical supplies. For instance:

  • Hire tanker trucks of fuel and water if necessary.
  • Arrange with suppliers to deliver extras before an expected event, and take back what you don’t use afterward.
  • When negotiating supply contracts, make sure your suppliers can distribute to you from more than one point. “We review all of our vendor’s emergency plans every year,” Lopez-Blazquez says.

Remember that when disaster strikes, the hospital will become a magnet for community residents seeking food and shelter. Make room for unexpected visitors when calculating how much food and water you will need.

5 Back Up Patient & Employee Records: Off-site backup of patient and employee records will help maintain care for patients evacuated from your hospital or community, and will help displaced employees get credentialed so they can keep working if your facility is closed. Electronic backup in a location removed from local threats—often out of state—is best, Hare notes.

6 Employee Living Quarters: Keeping employees in place in a disaster often requires providing living quarters for staff and their families. This should also include a kennel or space for pets, Hare says. And be aware that people’s not-so-pleasant habits—such as smoking—will need to be accommodated.

7 Cash & Supplies for Employees: Hare recalls that after Hurricane Charley, a Category 4 storm that hit Florida’s Gulf Coast in 1994, banks were closed and ATMs didn’t work for about a week. “You need to have enough cash on hand so you can advance money to your staff so they can support their families and come to work,” she says. Also, an in-house general store will help employees obtain daily necessities, including dry goods and cleaning supplies.

8 Disaster Team: A disaster team and backup teams should be designated. They should include employees who commit to reporting to the hospital for as long as necessary during a disaster, and teams to relieve them once recovery begins. Making membership on these teams an explicit job requirement will help ensure that the teams are in place. You may want to add questions about disaster team response to your candidate interview and selection process, Hare says.

9 Evacuation: Conventional wisdom has it that the most severely ill hospital patients are safest if they are not moved, and hospitals generally plan to keep them in-house during hurricanes and other disasters, Bentley says. In the light of what happened in New Orleans, he believes hospitals should reevaluate such policies. Hare thinks that evacuation must begin earlier—perhaps three days ahead of an expected storm rather than 24 hours.

Eileen Skinner, who was CEO at New Orleans’ Ochsner Clinic before taking over as president and CEO of Mercy Hospital in Portland, Maine, three years ago, believes that recent changes in evacuation policies in New Orleans kept the disaster from being much worse. “It used to be the evacuation plans were vertical—you moved people to taller buildings on higher ground,” she says. “If that had happened, tens of thousands more people would have been stranded, and there would have been many more deaths.”

10 Community Planning: Serving neighbors who are well but who turn to the hospital as the only source of electricity and food in an emergency can put a major strain on hospital resources that need to go first to patients and staff, Hare notes. She suggests establishing criteria for allowing people to take shelter on hospital grounds and enforcing them with security if necessary.

Bentley notes that such demands can be mitigated by anticipating them and working with schools and other community organizations to set up shelters that have emergency power and food. Lopez-Blazquez says that Baptist leases truck-mounted generators to provide power at its neighborhood community clinics so they can open as soon as possible after a hurricane, which lessens the impact on the system’s hospital emergency departments.

11 Prepare for Overflow: Hospitals hundreds of miles from the Gulf Coast experienced major surges in demand as millions of residents evacuated from areas devastated by Katrina.

“Before this, a hurricane was pretty low on our list of events to prepare for, but now we know it can affect us directly,” says Sharon Ward, director of emergency, trauma and EMS services at Illinois Masonic Medical Center, Chicago. Her hospital saw about 200 additional patients in the week following Katrina.

The same could happen in the event of a major terrorist attack or other major public health crisis, says Lawrence Haspel, senior vice president for the Metropolitan Chicago Healthcare Council. MCHC recently won a $1.5 million federal grant to extend bioterror and other emergency response training already in place in the Chicago area to the rest of Illinois to help prepare outlying hospitals for such events.

12 Leadership: VHA found that the most important factor in successfully responding to hurricanes is to create leadership teams that are empowered to make decisions to meet unanticipated demands.

 “As well as you plan for any catastrophe, the unexpected will happen, and you have to be nimble,” Hare says. “An empowered leadership team is much more flexible than an autocratic approach. An incident command center with empowered leaders allows you the flexibility you need to respond.”