In the Eye of the Storm

Who would you pick if you had the choice of moving someone now - planned, controlled, with very good medical assets - versus going out like Katrina?

Of all the ghosts of Hurricane Katrina three years, perhaps the most haunting was the specter of vulnerable residents suffering and dying at home and in hospitals and nursing homes before help arrived.

Hospitals became furnaces as they lost power in the summer heat, surrounded by water and cut off from communications.

Few times in American civilian history have health workers faced such horrific conditions and wrenching choices over whom to save first when rescue boats and helicopters were slow to arrive.

As Hurricane Gustav approached the southern Louisiana coastline last month, an estimated 10,000 hospital, nursing home and home-based special needs patients were moved by plane, helicopter, bus, car, ambulance and train to areas farther north.

Local, state and federal officials coordinated with each other and with private groups to accomplish the evacuation.

It was the largest pre-storm medical evacuation in American history and it sought to address many of the lessons learnt from the August 2006 Presidential Panel into Hurricane Katrina:
http://www.whitehouse.gov/reports/katrina-lessons-learned.pdf

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Hospital administrators swore their facilities would be better prepared for the next storm. Among them was Robert Lynch, CEO of Tulane University Hospital.

Some of them, including Lynch, had watched three years ago when Lake Ponchartrain flooded the hospital's generator, knocking out all the facility's power.

For days, staff labored in extreme heat until all the 1,600 people who had sheltered at the hospital were flown by helicopter off the top floor of its parking garage. Bed-bound patients were carried down staircases on mattresses.

This time, as the storm threatened, hospital officials discharged patients who were capable of going home and told staff to find other accommodations for their own family members and pets.

That left only about 430 people to be evacuated from the main campus if the levees failed again. The Lakeside campus was down to just a few high-risk pregnant mothers and babies.

Generators at the main campus had been raised high above the ground, and a larger fuel tank installed, along with flood gates and pumps. And there was another difference.

Many of the hospital's critically ill patients and those who rely on electricity-powered technology, such as dialysis machines, were being evacuated to other cities that officials expected would be safer.

Doctors used medical judgment when choosing whom to evacuate.

The bottom line, Lynch said, was this: "Who would you pick if you had the choice of moving someone now—planned, controlled, with very good medical assets like a mobile ICU -- versus going out like Katrina?"

When the air evacuation teams arrived, many weren't prepared to transport the most critically ill.

In the end, many of the sickest patients had to be transported by ground. Although careful plans had been established in recent years to evacuate individual regions of the state, "we never planned to evacuate the whole southern coast of Louisiana."

Hours later, Gustav's eye hit the Louisiana coastline.

Of the 18 deaths attributed to the storm, eight were medical evacuees. Some might have been caused by accidents, and others probably couldn't have been prevented.

Although "many of the eight might have died (regardless of being evacuated) because they were that sick, it makes you think hard," Lynch said.

"The decision to evacuate is extremely, extremely difficult."

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Hurricane Gustav provides an interesting example of a disaster planning being put into effect.

It also challenges the reader to assess how broad their disaster planning efforts should be – for as the narrative notes there was never an expectation in any disaster planning scenarios that the whole southern coast of Louisiana would be evacuated.

Too small a scope and one’s disaster planning / disaster recovery and business continuity plans are useless.

Too broad a scope pushes the imagination of the plan’s designer to consider all elements.

What is your corporate equivalent of evacuating the whole southern coast of Louisiana?

(Based on article In the Eye of the Storm by Sheri Fink – ProPublica – September 4th 2008)