When a major storm is coming, hospitals try hard to stay open, have their staff shelter in place, and not evacuate their patients. That is why preplanning, extensive training, and review of past practices are keys to success.
On September 13 Hurricane Florence churned with the strength of a Category 4 storm toward the coast of North Carolina. With this forecast counties and local municipalities focused on established plans for emergency responses before, during, and after landfall.
Although it was downgraded to a Category 1 as it struck the coast, Hurricane Florence brought more than 36 inches of rain and tremendous flooding to the region. The U.S. death toll exceeded 50 across four states. But Kevin Collopy, BA, FP-C, NR-P, CMTE, clinical outcomes manager for New Hanover Regional Medical Center’s AirLink/VitaLink programs in North Carolina, says he was confident about the help New Hanover County’s emergency operations center (EOC) would be giving the region.
“I take off my hat for the entire system—they are always looking out for the greater good,” Collopy says.
Still, in spite of annual drills and lots of planning, there is great uncertainty in any major-hurricane situation.
“You have to be ready for anything, because nothing is going to go as planned,” he says.
Decompressing the Hospital
Leaders stood up the New Hanover County EOC at the public safety communications center on September 11 and included numerous participants: public safety, mass transit, public information, shelters, road maintenance, finance, logistics, sanitation, and the county manager.
Collopy’s focus was the hospital. New Hanover Regional Medical Center (NHRMC) needed to decompress the facility to be prepared to help the expected influx of patients after the storm and focus resources during the storm on the patients least able to be discharged or moved.
Many patients who needed continued hospitalization but could safely travel were moved out of the hospital to other locations as far away as Asheville. One of Collopy’s responsibilities in the EOC was to work with the state’s emergency managers to secure airplanes for critical patients.
While this may seem an ineffective way to decompress the hospital, Collopy found it was extremely efficient, as NHRMC was just one of many hospitals making storm preparations.
“Coordinating patient transfers from within the county EOC and in conjunction with the state allows state officials to know who has been approved to operate all these transports,” he says. “For reimbursement purposes the state can keep track of assigned mission numbers for the flights, and it also gives all of us a way to know who’s flying in the state and how to make it safe.”
Because of the anticipated strength of the storm, it wasn’t safe for the medical helicopters to stay in their hangars, which might not have withstood Category 4 winds. They were all flown to a safe location to await return as soon as the weather permitted. NHRMC also knew there was a possibility they’d be isolated and the city would be without power or access to any help for days or even weeks. They staged generators, food, medical supplies, and more in safe spots to be used later.
The Safety Net
Working in a position called “Emergency Support Function 8” within the public health and medical services, Collopy was part of many of the EOC’s sections. Each section works in somewhat of a silo to do its own job but also with each other to communicate important information. Other staff includes health and human services, mass transit, public utilities, and the public information group.
Collopy was scheduled for 12-hour shifts, which often stretched to 18 or 20 hours. Cohabiting a building with the 9-1-1 communications center meant bringing a sleeping bag and sharing living quarters, bunk room, kitchen, and showers.
“I was the safety net watching the weather for healthcare providers across the whole county,” Collopy says. “I had to share this information with everyone without having any idea what the medical needs were. Wind speed, sustained wind speeds, gusts, tornadoes—this is essential for everyone to know so the EMS providers, police officers, and firefighters are safe.”
During storms NHRMC EMS operations are shut down for safety reasons in a phased manner: At 35 mph sustained wind speed, EMS is not allowed to use high-rise bridges; with sustained 50 mph winds, all of EMS shuts down. At that point Collopy helped coordinate the transfer of critical patients who still needed the expert care at NHRMC but for whom normal transport resources weren’t available. As the storm approached, a patient was moved in a Coast Guard helicopter in high winds too dangerous for a medical helicopter. Later staff coordinated with the military to use a military ambulance and high-wheel-clearance Humvee to pick up a patient in need of immediate care.
Collopy stayed focused on the job at hand: “What’s important [in that situation] is that I remain ignorant of all the nuances of the other patients who need help, because I’m working on that one patient who needs help to be moved,” he says.
And while he was focused on his tasks as a coordinator, Collopy was grateful for his experience as a paramedic. He says there are many roles EMS providers can fill in disaster and response.
“We are essentially helping do that essential task of ‘sick/not sick’ in an EOC,” he says. “We are helping with triage in a totally different context. Being able to apply triage there is pretty profound.”
The Real Test
Florence did not leave quickly. For 36 hours hurricane-force winds pounded the region and the EOC continued to plan for the aftereffects of the storm. Some 200,000 people in the area would need potable water and food for seven days, as the area was essentially cut off from all services. Roads were flooded or impassable. But when they opened and emergency vehicles were returning to service, there would be needs for diesel fuel.
Numerous staff were unable to get home, remaining stationed at the hospital for days without relief. NHRMC paid building-service personnel, food-service workers, EMS, and nurses for 24 hours a day until they were able to go home. When more than 50 NHRMC employees’ homes sustained damage, the hospital set up a fund to assist them.
During the storm Collopy tried to get replacements back to the hospital to relieve their coworkers, but all the helicopters were being used for critical rescues. Thankfully a local congressman, David Rouzer, who was at the airport awaiting a scheduled aerial survey flight, offered the use of the military transport so employees could get back to NHRMC.
Through it all Collopy was reminded often that he could be proud to work for NHRMC, because they knew how to handle a difficult stretch of patient care and operations challenges.
“Day-to-day operations should be easy for an organization,” he says. “But the real test is how they perform in a crisis.”
Collopy says while it was difficult to not be out in the field, he has utmost respect for the teams responding every single day.
“I trust the job they’re doing, even though I was isolated and did not see any of them for nine days,” he says. “I will affect patients positively by coordinating resources effectively. While it’s extremely stressful because everyone who reaches out to me feels they have the most important need on the planet right now, that’s not wrong—it’s just human nature.”