What happens in hospitals during catastrophic emergencies?

[paradoxofchoice]

I would like someone with emergency services experiences to share with us a little of their experience.

For example, currently in TX gulf coast, the major hospitals in the area are inaccessible by private vehicles and some have been evacuated due to flooding.

Does any one have any idea what happens to patients and resources? For example, how long do generators continue for things like ventilators and acute care units? Who are essential personnel? Scheduled surgeries are cancelled, I imaging. But what happens to emergency services, obstetrics, cath/stroke labs, etc.

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[Apollyon]

Every hospital has an emergency plan (I mean, theoretically, they might not, and that means no grant money, and administrators lose their jobs when there is an emergency). Generally, the plans are wide ranging, covering the common things, such as infant abduction, active shooter, bomb threat, riot, weather, and power failure. How long generators operate is not regulated. However, if they fail, low man on the totem pole is manning the BVM. The main thing, though, is nearly seamless starting of the generators.

On September 11, 2001, my hospital in Brooklyn put the emergency plan into action, rapidly and cleanly. Patients were moved into double and triple occupancy, and any doctor - staff attendings, fellows, and residents - was mobilized, physically being on or close to the ground floor. As it was the closest hospital in Brooklyn to south Manhattan (just over the Brooklyn Bridge), there was a great fear that there would be MCI (Mass Casualty Incident) levels of trauma, but none actually came. The vast majority of patients had glass or foreign bodies in the eyes, and abrasions and lacerations.

That is typical. "Failing to prepare is preparing to fail."

For weather, it's all local. If the hospital is on high ground, the flood risk is less. If they're low, pumps should be ready to go. Routine surgeries will be cancelled. People that live further away than a policy-set distance or time might be mandated to stay, or people that are already at the hospital have to stay.

This is just a brief overview. If this is your thing, it can be fascinating. If it isn't, it is as dull and dry as the most boring thing you've ever experienced. But, when the emergency plan works, optimally, you won't even notice the edges and corners.

 

[Apollyon]

Nursing home residents wait in water for rescue


Live TV
Nursing home residents rescued after waiting in several feet of water
By Samira Said, Carma Hassan and Dakin Andone, CNN
Updated 7:48 PM EDT, Sun August 27, 2017

• • 
    (CNN)Residents of a nursing home in Dickinson, Texas, have been rescued after they waited patiently for help as floodwaters rose around them.

A dramatic photo circulating on the Internet showed the residents of the La Bella Vita nursing home sitting in several feet of water as they waited for help.

Kim McIntosh lives in Florida, but told CNN that her mother, who owns the nursing home just southeast of Houston, took the photo.


"My mom sent it to me at 9 this morning. She said it was a disaster," McIntosh said Sunday. "They [were] waiting for helicopters or the National Guard."

"Most of these people are in wheelchairs and [on] oxygen," she said.

The Galveston Office of Emergency Management confirmed Sunday afternoon that it had rescued the residents from the facility.

"They were up to their waist" in water, said Ken Clark, a Galveston County commissioner.

McIntosh said that when she spoke to her mother over the last couple days, she told McIntosh that the nursing home was not told to evacuate. Instead, they were instructed to stay in place and have a disaster plan.

Between 20 to 25 people were rescued from the nursing home Sunday afternoon, Clark said.

First-responders working as the Houston area copes with catastrophic flooding are facing big challenges in both the high water levels and a lack of resources, like equipment and personnel, he added.

"We have complete sections of freeways that were closed and intersections that are closed," Clark said. And it's still raining.

He told CNN the county has received more than 1,000 requests for evacuation and rescue.

View on CNN

 

[Crayola227]

Nursing home residents wait in water for rescue


Live TV
Nursing home residents rescued after waiting in several feet of water
By Samira Said, Carma Hassan and Dakin Andone, CNN
Updated 7:48 PM EDT, Sun August 27, 2017

• 
  
  
  • • 
      (CNN)Residents of a nursing home in Dickinson, Texas, have been rescued after they waited patiently for help as floodwaters rose around them.

A dramatic photo circulating on the Internet showed the residents of the La Bella Vita nursing home sitting in several feet of water as they waited for help.

Kim McIntosh lives in Florida, but told CNN that her mother, who owns the nursing home just southeast of Houston, took the photo.


"My mom sent it to me at 9 this morning. She said it was a disaster," McIntosh said Sunday. "They [were] waiting for helicopters or the National Guard."

"Most of these people are in wheelchairs and [on] oxygen," she said.

The Galveston Office of Emergency Management confirmed Sunday afternoon that it had rescued the residents from the facility.

"They were up to their waist" in water, said Ken Clark, a Galveston County commissioner.

McIntosh said that when she spoke to her mother over the last couple days, she told McIntosh that the nursing home was not told to evacuate. Instead, they were instructed to stay in place and have a disaster plan.

Between 20 to 25 people were rescued from the nursing home Sunday afternoon, Clark said.

First-responders working as the Houston area copes with catastrophic flooding are facing big challenges in both the high water levels and a lack of resources, like equipment and personnel, he added.

"We have complete sections of freeways that were closed and intersections that are closed," Clark said. And it's still raining.

He told CNN the county has received more than 1,000 requests for evacuation and rescue.

View on CNN

I'm cracking up because it seriously looks like that one lady is chilling on the couch working on her sewing

I could make a joke about wrinkling in water but I won't

 

[Apollyon]

I'm cracking up because it seriously looks like that one lady is chilling on the couch working on her sewing

I could make a joke about wrinkling in water but I won't

And here I am, thinking you're all smoove!

 

[Hakuna Matata]

Listen to the podcast "Playing God" by RadioLab. Super interesting. It's about what hospitals do in emergencies. It talked about 1 specific hospital during Hurricane Katrina and basically how the doctors decided who lived and died while they waited for the hospital to be evacuated (no water, no O2, no power, etc).


Sent from my iPhone using SDN mobile

 

[Bobblehead]

There are emergencies of all sorts. Every hospital has an emergency operations plan and usually during predicted weather events there will be an emergency command center of senior hospital staff to ensure that various personnel and resources remain available. The classic example is a hard hitting winter storm in the parts of the country that get them. During those types of weather events most hospitals will remain fully operational although elective outpatient surgeries may be rescheduled. Outpatient clinics tend to be "open" although that usually translates to checking with the patients whether they really are coming and virtually all patients rescheduling. Inpatient units tend to remain undisturbed and most of the staff (nurses, housekeeping, lab services, etc.) make arrangements for staff to stay late in or around the hospital.

Then there are unplanned emergencies like the Boston marathon bombings where staff will simply come in because they know they'll be needed (critical care/surgical nurses, surgeons, EM physicians, etc.). Usually even with Just In Time inventories, since these are local events the supply chain won't be particularly significantly disrupted and new equipment can come in. Plus there are always national back-ups such as the Strategic National Stockpile. Strategic National Stockpile | PHPR

And then there are bad events like at Memorial Medical Center during Katrina where you can't quite fathom how something like that can happen in the US. That was a failure of not just local but regional and national resources.

 

[AdmiralChz]

I would like someone with emergency services experiences to share with us a little of their experience.

For example, currently in TX gulf coast, the major hospitals in the area are inaccessible by private vehicles and some have been evacuated due to flooding.

Does any one have any idea what happens to patients and resources? For example, how long do generators continue for things like ventilators and acute care units? Who are essential personnel? Scheduled surgeries are cancelled, I imaging. But what happens to emergency services, obstetrics, cath/stroke labs, etc.

So, the first thing that happens is elective surgeries/appointments/procedures are cancelled which helps decrease hospital admissions and staffing needs. In major events the hospital may go on diversion, not taking any transfers from other, surrounding community hospitals for patients who need a higher level of care.

Depending on capabilities (especially for existing inpatients) there likely will remain some emergency level of staffing for most units in an academic center like OB, cath and IR suites mostly to address existing inpatients. The emergency room may stay open, but likely will become some sort of a treatment center for those affected by the storm - in Houston, traditional ambulances may not reach some of the ERs so only military craft can get patients in.

In the event of a power outage, most state laws require hospitals to have a pretty robust generator system to keep emergency power on - these things power things like monitors/ventilators in the ICUs and ORs and the lights and A/C in the ORs. At my medical school there was a mini-power plant adjacent which could power the emergency power to the hospital for weeks to months, if needed.

As for staffing, many units have backup call systems they develop well ahead of situations as you can usually see them coming as in Houston. If a hospital is likely to become inaccessible, you might have attendings/residents/fellows taking 12 hour shifts or so in house with sleeping quarters provided. All of this is typically worked out in advance.

Does this ask your questions? They were pretty far reaching, but happy to elaborate if you'd like as I have a background in emergency management.