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It was about 2 a.m., Sept. 16, when Hurricane Ivan roared into Pensacola, FL, with 130-mph winds, battering the boarded-up windows of Sacred Heart Hospital, knocking out the electricity and forcing the hospital to operate on emergency generators.
"It was pitch-black outside, and we heard the awful sound of that wind, but we couldn’t see anything," recalls Susan Kearney, LCSW, manager of social services. Although the windows were boarded up, staff were concerned they might buckle and decided to move the patients from their rooms and into the halls. At the same time, the hospital staff became concerned about hundreds of visitors who were sleeping in the lobby, which had large, vulnerable windows. They woke them up and moved them to the basement, where it was quieter and safer.
The next few days called for creativity and patience on the part of the staff and patients, Kearney says. The hospital regained electricity fairly quickly, but neither the staff’s cell phones and pagers nor the hospital’s e-mail system worked in the early days after the storm.
Communication system challenged
"The communication system was really challenged," says Mike Burke, public relations manager for the 449-bed acute-care facility, which includes Sacred Heart Hospital, Sacred Heart Children’s Hospital, and Sacred Heart Women’s Hospital.
Managers and leaders from all over the hospital gathered every four hours in a central area to share information about what was happening. "This is one of the most helpful things we did as a team. This allowed us to be in constant communication with each other, and we could take what we learned back to the staff who were hungry for information in a time of crisis," Kearney says.
Marketing and public relations staff attended the meetings, typed up a summary, and walked through the hospital distributing them to all staff. "All of the essential functions of the hospital kept going during the storm. We delivered babies, did heart catheterization, and emergency surgery," Burke says.
In the two weeks after the storm, the hospital’s emergency department (ED) visits went up by 40%. Among the injuries were 40 patients injured by chain saws and other serious injuries from falling limbs and falls. The Federal Emergency Management Agency sent a Disaster Medical Assistance Team to the hospital. It set up tents outside the ED to handle minor injuries.
As soon as the storm was over, the social workers and case managers started trying to determine which nursing homes could take patients who were ready for discharge and which patients could be discharged to home safely. They made calls to area grocery stores, pharmacies, home health care agencies, and durable medical equipment companies to compile a list of available resources for patients and employees.
They went over the list of patients ready for discharge on a case-by-case basis and thoroughly documented the medical records when the patients couldn’t be released because they had no home to go to or no electricity and water. It took as long as 12 days for electricity to be restored to some parts of Pensacola and more than a week before the water was declared safe to drink.
Will insurance pay?
The hospital still is waiting to learn whether the extra days will be covered by the patients’ insurance. "We wouldn’t have done it any differently. These patients couldn’t go home, and we have plenty of documentation as to why their discharge was delayed," Kearney says.
About a week before Hurricane Ivan struck the Florida panhandle, the hospital started preparing to implement its disaster plan and assigned duties for when the hurricane hit. Four days before the hurricane hit, the hospital began discharging as many patients as it could. Patients who were not ambulatory and who lived in areas that are vulnerable to flooding stayed in the hospital. "When discharges were postponed, we documented as carefully as we could as to the rationale," she says.
The day before the hurricane, the social workers and case managers shifted their attention to the duties they were assigned to handle during the storm. The social work department was assigned to staff the hospital day care center during the time they were no longer needed for duties on the floor.
The case managers were assigned to the ED to direct people who did not need to be admitted to the hospital to special-needs shelters and other facilities. "We had a lot of frail elderly and people who were on oxygen who came to the hospital because they were afraid. The case manager’s role was to direct these patients to appropriate shelters and assist in getting them safely to those shelters," Kearney says.
Her first advice to hospital staff: Accept the fact that a disaster may happen and plan accordingly. Although the hospital was well prepared for the storm, Kearney contends her department could have been better prepared. She would have stocked up on powerful flashlights, batteries, bottled water, and food for her department. "Although the hospital fed employees at no cost for two weeks after the storm, we all wished we had planned ahead. We had little flashlights, and trying to make our way around a dark hospital with those little lights was a real challenge," she says. "Prepare as if the disaster is going to hit you head-on."
Communication is the most vital part of preparation, and hospitals should prepare to operate without their usual communication equipment, Kearney adds. Make sure your staff have up-to-date information about where the shelters are, what kind of patients they can accommodate, and what kind of patients they can’t take, she advises.