Even with the best possible planning, an actual hospital evacuation can be a logistical nightmare, according to Tidelands Health Chief Operating Officer Gayle Resetar. During Hurricane Florence, roughly 150 patients were relocated from facilities in Waccamaw and Georgetown. And then Georgetown had to be evacuated a second time because of projected flooding.
“We started by trying to reduce our patient census, but for every patient transferred out, we got another admission from the emergency department,” she said. “You don’t want to close the ED until you absolutely have to, but that’s a significant source of new admissions. By the time we got 50 patients out, we had another 50 admitted.”
Both Tidelands and Grand Strand Hospital tried diverting emergencies to Conway, but that quickly stressed Conway’s capacity.
Another issue was communicating to staff who had to move along with the patients. “Receiving hospitals can’t put patients in unstaffed beds, so we had to tell employees they were going to have to pack up and go to an unfamiliar hospital with different systems and processes,” she said. “Even though we had planned and drilled it, it’s not easy.”
Then there was the challenge of finding places for the employees to sleep. Not all hospitals can provide overnight accommodations, and the evacuation of the general public quickly began filling hotel rooms. SCHA and state officials helped hospitals find a variety of solutions, “but it was another logistical challenge.”
Another challenge emerged when it was time to return patients back to the original hospital or home. Resources such as ambulance buses that had been available to move patients out of harm’s way weren’t there to help them return.
“Companies that have contracts with South Carolina also serve North Carolina, Georgia and Florida, so their priority is to help the hospitals next in the hurricane’s path,” she said. “Some families will drive to Greenville to pick up a family member, but not everyone can or will. And if the patient has to go back to a nursing home, it might not be open.”
Affected hospitals and SCHA are working with state officials to develop better solutions, such as letting hospitals ride out the storm if they’re capable of doing so safely. Tidelands Health had employees shelter-in-place so that they could reopen and ramp up quickly, and they could’ve withstood up to a category 4. They actually had one behavioral health patient shelter with them because they weren’t able to find a hospital to take the patient.
Often, evacuation orders are based on projections that change as the storm gets closer. Originally, the Governor ordered a mandatory medical evacuation for 19 hospitals in nine counties but retracted it 48 hours later. In the end, the order affected only three hospitals in two counties.
A timeline tells the story in numbers. Within 48 hours of the original evacuation order, Tidelands had more than 300 ER visits. By the time they were officially closed, they still had 16.
“I can’t imagine how the original evacuation could have been managed,” she said. “It really needs to be a local decision by people who understand their facility and their community. I understand the desire to mitigate all risk, but they don’t close police or fire departments. They don’t close Santee Cooper. Hospitals should also be considered first responders and critical community services.”
With the first hurricane of the 2019 season named and tracked last week, it's that time of year where we all need to start preparing our own facilities. What should you be doing to prepare? Check out this hurricane preparedness checklist developed by John Williams, SCHA's Director of Emergency Preparedness and Solvent Networks' Pain Points about how they can help when disaster strikes.