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Rushing Flood Waters Close Houston EDs

2002; Lippincott Williams & Wilkins; Volume: 24; Issue: 2 Linguagem: Inglês

10.1097/00132981-200202000-00005

1552-3624

Bryant Boutwell,

Disaster Response and Management

The world's largest medical center, the Texas Medical Center, in Houston, never saw it coming. With more than 40 institutions, 54,000 employees, and an international reputation for emergency medicine expertise capable of handling crisis on moment's notice, Tropical Storm Allison was the test of a lifetime. The storm had slipped into town mostly unannounced earlier in the week from the Gulf of Mexico, saturated the ground, and moved north only to turn around and hover over the Texas Medical Center Friday night, June 8. The flood of water unleashed was monumental, even by the standards of this bayou city where street flooding is a common sight during heavy rains. An estimated 12 to 15 inches fell over downtown Houston and the Texas Medical Center complex in less than nine hours. Across the city, homes and neighborhoods went under, and murky lakes emerged above the rooftops of vehicles stranded on Houston's once busy freeways. Without warning, an estimated 10 million gallons poured from surrounding streets into the basement and ground floor of the University of Texas Medical School at Houston shortly after midnight on June 9. At the same time, a river of water swept into the adjacent doors of Memorial Hermann Hospital, which is the primary teaching hospital of the UT Medical School. Baylor College of Medicine, across the street, and many of the major hospitals and research facilities in the Texas Medical Center have similar stories to tell of laboratory animals, research facilities and data, medical records, offices, and files lost in a matter of minutes. At the UT Medical School, a catastrophe was under way as 5,000 research animals along with gross anatomy labs with cadavers in place met the rising waters. Basement walls were crushed and heavy doors bent backwards against their frames in what one construction worker with Vietnam experience could only describe days later as a war scene involving mortar attack. $2 Billion in Damage All told, $2 billion of damage is estimated by TMC institutions. For the first time in Memorial Hermann Hospital's 76-year history, the hospital closed its doors, necessitating heroic efforts to calm, treat, and transfer 540 patients to other hospitals up to 200 miles away. Fortunately, no patient deaths at Memorial Hermann Hospital were attributed to the event. Across the city, the death toll from storm-related events was placed at 22. While the damage was great by all measures, the heroics of physicians, nurses, students, and support staff were the real story. Faculty and staff from the UT-Houston Medical School's Department of Emergency Medicine who provide clinical care at Memorial Hermann Hospital are trained to think on their feet and react swiftly.Figure: In front of Memorial Hermann Hospital, EPs triaged patients for transport to other hospitals.Two emergency medicine faculty members were on duty that night, Sally Awad, MD, and Lisa Freeman, MD. “It was surreal when we finally had time to look outside and see a lake where streets once existed…. We were focused on our work and had not realized what was going on outside until we heard reports that a river of water was filling the basement and a piano could be seen submerged. The hospital's emergency sirens and strobes were going on and off to add to the scenario. Flashlights materialized out of nowhere, and the order to evacuate the emergency room meant that we had to start discharging to the waiting area all patients we could and admitting others,” Dr. Awad said.Figure: Department chairmen, senior administrators, students, faculty, staff, and volunteers worked together to evacuate patients.Looking back on the events of the night, Dr. Awad recalled that while the ED was fairly full, the patients were surprisingly calm. Local media featured the hospital's plight the following morning in photos, including the submerged piano, destined to become part of the city's collective memory.Figure: Downtown Houston under the flood left by Tropical Storm Allison.“It was a mess. By 4 a.m. Memorial Hermann Hospital had lost emergency power and gone dark. Administration declared an internal disaster, and the decision to close the hospital and transfer all 540 patients was made. I knew this was not going to be a typical Saturday morning on the job,” recalled David Robinson, MD, who arrived at 8 a.m. Non-Stop for 48 Hours Dr. Robinson, like many other physicians, staff, and volunteers who made it through high water to the hospital, worked the next 48 hours or more without a break. A number of ICU patients required hand ventilation throughout the early morning hours and into the first day under the watch of Dr. Christine Cocanour and colleagues, who took charge under difficult circumstances. Brent King, MD, the chairman of emergency medicine at UT, was stranded at a medical meeting in Florida and led his group by phone until he could return to the city. “I received the call in the middle of the night, and began immediately working by phone with my faculty to understand the scope of the situation and discuss action steps for evacuating the emergency room,” he said. “If we learned anything, it would be that the best laid disaster plan is only as good as the resourceful, quick actions of faculty and staff. In our case, we had the best.” Dr. Robinson agreed. “Just getting to the medical center via flooded streets was a challenge early that Saturday morning,” he said. “Driving in, I stopped at a larger grocery store to bring in some supplies. Despite lines 40 individuals long, the store manager heard my situation and allowed me up front and on my way. In hindsight, I can think of batteries and a number of items I wish I had purchased more of at that time.” Successfully evacuating 540 patients on backboards down unlit, hot, and humid stairwells by flashlight was a feat that could only be accomplished with teamwork. “My last trip up was to the ninth floor to evacuate dialysis patients, and the last patient on a backboard was a gentleman over six feet tall and about 300 pounds,” said Dr. Robinson. “Rank and title issues went out the window as chairmen, senior administrators, students, faculty, staff, and, volunteers worked together. What mattered was that we get those patients down to the ground where they could be discharged or transferred by ground or air to another facility.” At the same time, said Dr. Robinson, a temporary emergency department was established by the front window of the emergency center as the growing number of individuals moving down stairwells necessitated a ready facility in the event of an internal accident or patient emergency. An extension cord was snaked in the door from somewhere, he noted, and the tiny source of power stood ready for an emergency department that fortunately was never needed. Donated Resources Outside the hospital, a street had been cleared for LifeFlight, the hospital's air ambulance service, to land. LifeFlight was joined by the Army National Guard and Coast Guard helicopters in a joint effort to move patients. Cell phones proved an invaluable resource, and played an important role in timing the portage of patients to the street with the arrival of helicopters. At one point, hospital administrators delivered a full box of cell phones ready to go, all made possible by the generosity of a local vendor. “When one cell tower went down, and half the phones went out for a while, we realized just how dependent on cellular communication we had become,” Dr Robinson said. “I knew this was not going to be a typical Saturday morning on the job.” Dr. David Robinson “Times like these simply bring out the very best in our profession and remind us what patient/physician relationships are all about.” Dr. Brent King “It was surreal when we finally had time to look outside and see a lake where streets once existed.” Dr. Sally Awad With no power or computer database at hand, personnel had to create a paper trail on each patient and where they were sent. Tom Flanagan, the administrative director of Memorial Hermann's LifeFlight air ambulance operations, with his colleagues triaged and coordinated the transportation of patients on the sidewalk and street outside the hospital. The entire stroke team, under the direction of James Grotta, MD, could be seen searching the sidewalk patient-staging area outside the hospital to locate and reassure patients while recording destinations for follow-up. “Times like these simply bring out the very best in our profession and remind us what patient/physician relationships are all about,” Dr. King said. The UT-Houston Medical School's Department of Emergency Medicine is the only program in Houston with an emergency medicine residency program, Dr. King said. For that reason, the department of emergency medicine, with 15 faculty and 18 residents, represented a sizeable resource during the first hours and days following the event. City Perspective Richard Bradley, MD, a UT faculty member in emergency medicine, proved an important resource given his background in disaster medicine and his role as the assistant medical director for the Houston Fire Department. “I was at the city's emergency operating center that night monitoring the situation. We have a flood-control board with electronic sensors located throughout the city along the bayous. The board lit up like a Christmas tree for a three-hour period with everything on the board flashing,” he recalled with a bit of amazement still in his voice. On the phone with Texas Medical Center officials, Dr. Bradley had his eye on a monitor linked to a webcam showing the flow of runoff from the Harris Gully, which runs under the medical center in 15-foot box culverts. “I watched the culverts fill to 13 feet, turned away from the monitor and looked back to see nothing but water. Things were happening just that fast. In fact, from 3 a.m. to 9 a.m. that Saturday, the entire city of Houston had no emergency response capabilities for ambulance or fire. Emergency vehicles out there had to find high ground and sit.” Dr. Bradley, from his city perspective, played a key role addressing the emergency medicine needs of the entire city. “My advice to all emergency medicine physicians is to look at your community's disaster plan from a systems perspective. Health care facilities need to be partners in the plan's design and execution, not simply resources to be called upon by government officials,” he said. Dr. Bradley not only helped orchestrate outside support, including Army and Coast Guard helicopters for immediate assistance to evacuate hospitals, he was instrumental in getting the Air Force's 25-bed Expeditionary Medical Support unit (EMEDS) set up at Houston's Reliant Astrohall. “This is a fully staffed 25-bed hospital that is assembled and staffed within 72 hours. It was the first-ever employment of the unit outside of training exercises. With only one functioning Level I trauma center, Ben Taub, left to handle the needs of the fourth largest city in the U.S., the arrival of that unit to alleviate the load was essential as we approached the July 4th holiday weekend. They accepted many patients brought in by ambulance and performed life-saving surgeries while in operation,” he noted. Local media pitched in by holding press conferences to educate the public regarding safety during the post-flood period when emergency care facilities citywide were severely strained. In the days that followed the initial crisis, emergency medicine faculty were given hospital privileges at hospitals throughout the Memorial Hermann Health Care System and other hospitals in the area. The Houston VA hospital deserved special commendation, noted several faculty, for opening doors and helping an entire city in time of need. “In the weeks that followed, we teamed our residents and faculty and had no trouble staying busy, logging more service hours in other hospitals than in previous months in our own,” said Dr. Robinson. At Memorial Hermann Southwest, located about 12 miles west of the medical center, a patch of ground was quickly paved to make a LifeFlight helipad, and trauma surgery teams led by the UT Medical School's Dr. Red Duke set up shop and within a matter of days were providing Level I services where none existed. ‘The Very Best’ “Events such as these can bring out the very best in health care professionals, and I'm convinced that the best disaster plans are only as good as the innovative and resourceful skills of the personnel,” Dr. King said. “We learned many important lessons from this event, including the importance of cell phones and having enough flashlights with batteries when the unthinkable happens and lives are at stake.” Dr. Bradley added: “From a systems perspective, I'd add the important roles volunteer ham operators can play. It would be nice to further develop our volunteer ham radio operators and Internet capabilities linking all hospitals across the city to support the community in times of disaster. From a city perspective, there is much to be gained by organizing ahead of time these vital communication resources with our hospitals in mind.” “In times like these,” said Dr. Robinson, who also is the medical director for the hospital's Diagnostic Observation Center, the broad range of skills offered by emergency physicians rise to the forefront. From triaging patients during the flood to the many decisions that had to be made in weeks following when the city's emergency department capabilities were severely tested, emergency medicine specialists were there and made a difference. “I couldn't be prouder to be a part of this specialty and of the people I work with,” Dr. Robinson said.