In the aftermath of Hurricanes Ike and Gustav one year ago, Louisiana's emergency rooms are gearing up for the 2009 storm season. Lessons learned from these storms, as well as 2005's Hurricanes Katrina and Rita, are leading to upgrades at hospital ERs from New Orleans' levees to Cameron's coast.
Interim LSU Public Hospital in New Orleans
On August 29, 2005, Hurricane Katrina hit the Gulf Coast, leaving a path of destruction in its wake. Subsequently, New Orleans' levees failed, inundating the city with flooding waters. Severe flood damage shut down Charity Hospital and University Hospital, operated by LSU Health System's Health Care Services Division, rendering the indigent and underinsured in the area without medical care.
In September, the U.S.N.S. Comfort, one of the Navy's hospital ships, sailed into New Orleans to provide medical services and disaster relief. Days later, University Hospital reopened its parking lot with a series of military medical tents to treat patients. Simultaneously, faculty and residents worked alongside the military at the Ernest N. Morial Convention Center. About a month later, the parking lot's makeshift medical center closed, and the portable tents relocated to the convention center.
In April, 2006, LSU's hospitals set up shop in the former Lord & Taylor building and Ochsner's Elmwood Hospital to deliver trauma care for the metropolitan area. That November, University Hospital reopened as the Interim LSU Public Hospital, with an eight-bed emergency department and a six-bed fast track. Trauma services returned to the facility in February, 2007. Three months later, the beds increased to 28 – less than a third of the 90 ER beds pre-hurricane.
Last year, the hospital installed a helipad for transporting trauma patients. In July, LSU's interim hospital will launch a new fast-track area, consisting of 17 beds and its own laboratory.
As the interim hospital continues to add services, its census is gradually increasing. Prior to Katrina, the charity system tallied about 180,000 patient visits per year. Over the past year, 60,000 patients were treated at the facility – an increase of 10,000 over the previous year. "We really don't know where this is going, and how fast," reported Dr. Peter DeBlieux, director of emergency medicine services at the Interim LSU Public Hospital.
But, DeBlieux said that what the New Orleans area really needs is a new hospital to service the returning population. Before the storm, about 60 to 65 percent of medical students who trained at LSU's medical school in New Orleans stayed to practice. Now, only 40 to 50 percent of graduates remain in the area. "There is no firm commitment from the state and federal governments for a new facility," he said. "Our currently facility that we are working in was surrounded by 11 feet of water. The likelihood that we will get flooded again is pretty great. It's even tougher to get our medical students to stay without a firm commitment to a healthcare system for the city. There is no permanency in the healthcare industry here. That's unfortunate."
Memorial Hospital in Lake Charles
Immediately after Katrina, evacuees from the New Orleans metro area inundated hospitals in Lake Charles. "What came out of New Orleans after Katrina was a horror show," recalled emergency room physician Steven Hedlesky. "We were treating patients with tremendous leg wounds – diabetics who had walked through the water, people with terrible sunburns who had been infected from being on roofs of buildings." The most poignant event – a tour bus transporting nursing home residents from New Orleans to Houston dumped off a dead and a dying patient at the hospital's doors.
Less than a month later, Rita smashed the southwest border. At that time, Katrina victims were still trickling in. Memorial's seriously ill patients were shuttled to facilities in north Louisiana, while staff hunkered down in Lake Charles. The storm crashed through the hospital, knocking out windows and heavily damaging the main tower. While the self-generating facility did not lose electricity, the hospital was unable to run its air conditioning through the inoperable public water system. After shutting down for about a week, the hospital reopened to provide emergency services.
Memorial fared much better through Hurricane Ike, which engulfed the city with a massive storm surge. "Our emergency room continued to work fine," Hedlesky reported. "We had the staff and equipment that we needed, and we were able to take care of what came through our doors."
This year, Memorial's ER personnel are fired up and ready for hurricane season. On May 21-22, the facility conducted a disaster preparedness session for staff. The first lesson: getting families out of harm's way so that employees can concentrate on doing their jobs. Vendors also taught employees about generator, electricity and candle safety during power outages. Nutritionists advised participants what foods to buy, including canned goods and quick energy non-perishables – candy bars, crackers, energy drinks and liquid high-calorie supplements. Experts recommended allotting one gallon of water per day per person, and using baby wipes and pre-moistened towelettes for bathing and personal hygiene.
Learning from past storms, Memorial is also improving its evacuation procedures. During Hurricane Gustav, the hospital evacuated 84 patients out of the storm's projected path. This June, Mutual Aid, a 150-member organization comprised of industrial, commercial, municipal and hospital volunteers from the five-parish Imperial Calcasieu area, conducted an air evacuation drill at Chennault International Airport Authority. Additionally, the association recently tested all 800 MHz radio systems in the area. Both Bill Wilkie, Memorial's director of plant operations, and Tim Coffey, the hospital's senior vice president of operations, are Mutual Aid members.
Now that hurricane season is here, Memorial has already taken steps to get ready, not only as a hospital, but also as a base of operations for first responders. "We have an agreement with the city to house first-responders – law enforcement, fire fighters and municipality workers," Wilkie explained. "They use us as a base of operation because of our having emergency generators. So, we have power and supplies, not only with food and water, but also with medications."
Emergency generator fuel tanks are tuned up and topped off for hurricane season. Pre-planning for resources, supplies and personnel is done. "No matter what the situation is, we will be open," Wilkie emphasized. "We do our best to reduce the risk to our staff, our patients or others who come in our building. We are a full-service hospital that is serving the community."
West Calcasieu Cameron Hospital in Sulphur
After Hurricane Rita, West Calcasieu Cameron Hospital treated a
slew of evacuees from Louisiana's southeast coast. Luckily, the facility sustained only minor damage and a temporary power outage, with backup generators bringing operations quickly back up to speed. Cal-Cam treated displaced patients primarily for post-hurricane injuries relating to encounters with flailing chainsaws, broken boards, hidden nails and shattered windows.
Following Hurricane Ike in September, 2008, Cal-Cam experienced a temporary decrease in patient numbers. Since that time, the ER has steadily increased its patient population to 1,800 visits a month, or about 20,000 per year.
To keep up with the rising patient census, the hospital is staffed with a full-time physician and nurse practitioner contracted through Lafayette-based Schumacher Group.
Having back-to-back hurricanes spurred the Schumacher Group to form a program called the Disaster Assistance Response Team (DART). DART consists of about 100 physicians in Louisiana, and multiples nationwide, dedicated to disaster response. "It is a group that is going to be dedicated for any disaster, may it be hurricane- or fire-related – any disaster which requires immediate response," explained Cal-Cam's ER medical director, Dr. Syed Amir Shah. "We are going to have some core physicians who can be posted in that area, so you don't have to worry about shifts and finding physicians and crew."
Another new Schumacher Group initiative – Sort, Order and Treat (SORT) – is aimed at getting the patient from the ER door to the doctor as quickly as possible. At Baton Rouge General Medical Center, SORT reduced the number of people walking out without treatment (LWTs) by 75 percent since implementation. Over the last few months, Cal-Cam has experimented with SORT, and will implement it at full speed this summer. "When you walk into the crowded emergency room, you will get first care which will be prompt and proper," Shah said. "It's working great."
University Medical Center in Lafayette
Since Hurricane Lili in 2002, LSUHCSD's University Medical Center has managed to stay out of harm's way. During Hurricane Gustav, UMC evacuated patients and staff to Alexandria, La., and reopened after a few days. But, dodging those bullets has not stopped UMC from preparing for the current storm season.
Last year, LSUHSCD entered into a contract regarding evacuation procedures for its hospitals. Recently, UMC held meetings with the corporation's leaders to discuss lessons learned from prior storms. Now, once a hurricane is in the area, the hospital notifies the contractor, who secures ambulances, aircraft and helicopters for deployment.
In 2008, UMC improved its communications network by adding ham radios, installing satellites and giving BlackBerrys to key personnel. LSU is also acquiring a service to send blast e-mails or text messages to staff when a hurricane is approaching. "Communication with the employees has always been of high concern," said Larry Dorsey, UMC's hospital administrator. "So, we will be using this system this year if we have to evacuate or have to close the hospital."
During the year, the facility held a series of employee drills and management training for hurricane preparation. Additionally, UMC is hiring an architect to evaluate the building for any weaknesses. The hospital is also organizing an emergency management team. "We have already notified all of our employees that it's hurricane season, and sent out information to them to get ready," Dorsey said. "If something should come up, then we'll start enacting our emergency plan. We are taking all precautions possible to get ready for the hurricane season."