Hospital safety: Texas dodged a bullet

Hurricane Ike was just one disaster among many in 2008, a year in which 235 816 people died in such events--Cyclone Nargis in Myanmar and the Sichuan earthquake in southwestern China being the most notable. Hospital safety has been under the spotlight this year with the World Disaster Reduction Campaign, World Health Day and the International Day for Disaster Reduction on 14 October 2009 all highlighting the importance of safe hospitals during disasters. While high winds and earthquakes tend to grab the headlines, it is flooding that most frequently devastates, as has been demonstrated by the recent typhoon in the Philippines. It was flood water that wrecked the John Sealy Hospital. Wedged in among the buildings of the University of Texas Medical Branch (UTMB) on Galveston Island, the twelve-storey hospital was hit by a wall of water driven across the island by winds of up to 180 kilometres per hour in the early hours of 13 September 2008. Gushing in through doors and windows, it inundated the basement and ground floor, destroying the blood bank, sterile processing laboratory and pharmacy and taking out the electrical and ventilation systems, along with phone lines, computer systems and elevators. [ILLUSTRATION OMITTED] Surprisingly nobody was injured. Credit for this goes in part to local authorities for issuing a mandatory evacuation order in time for a pre-agreed evacuation plan to be carried out. Hospital and city employees shut down the entire UMTB campus, secured laboratories and made arrangements to send around 400 patients, including 51 newborns from the neonatal unit and 14 organ transplant patients, by ambulance or helicopter to waiting hospitals further inland. Dr Luca Cicalese, director of the Texas Transplant Center at John Sealy, headed up a team responsible for getting the organ transplant patients out, some of whom were still in intensive care as the storm closed in. "We had just a few hours to complete the evacuation," says Cicalese. "Patients were out by Thursday and the storm made landfall Friday [night]." Despite the time pressure, there was no panic or confusion because of what Cicalese terms, "excellent leadership, communication and coordination". His wife, Dr Cristiana Rastellini, director of Cell Transplant and Transplant Research at John Sealy, cites orderliness and speed as having been crucial for saving transplant patients, who were hooked up to "every kind of machine". She also stresses the importance of forward planning for saving her laboratories. One reason UTMB survived the storm so well is that it had been through it all before. Back in 2005, hurricane Rita passed close enough to the island to trigger Galveston's evacuation plan, an event that Mike Megna, one of two Institutional Emergency Preparedness officers at UTMB, says taught staff and administrators several important lessons. "We have reassessed our vulnerability to flooding and consequently [since Ike] have not returned any mission-critical functions to first floor [ground floor] space," says Megna. He also stresses the importance of having an adaptable game plan, and making sure personnel are not just mentally but also physically prepared for post-hurricane conditions, including the challenge posed by the shut-down of elevators, air-conditioning and water supply. Running up and down a twelve-storey building in 40[degrees]C heat is not for the faint-of-heart or the out-of-shape. Preparing staff for water loss in a flooded hospital may seem odd on the face of it, but it goes to the heart of one of the biggest challenges faced by hospitals in crisis situations triggered by natural disasters. …