Hurricane Ike Feature - November 2008
Tex Med . 2008;104(11):32-38.
By Ken Ortolon
As Hurricane Ike barreled across the Gulf of Mexico toward Galveston in early September, a brave group of about 550 employees of The University of Texas Medical Branch at Galveston (UTMB) prepared to ride out the storm.
Their mission was to ensure that patients, students, residents, and nonessential faculty and staff made it to safety, that vital research specimens and animals were protected, and that the physical facilities on the UTMB campus were secured and as ready as possible to withstand the onslaught of wind, rain, and storm surge.
When the 100-plus mile-per-hour winds, the lashing rain, and a storm surge that threatened to top the seawall had passed, it was clear they had done their job well. Several campus buildings took on water in basements and ground floors and some equipment was seriously damaged, but all patients had been safely transferred to other hospitals. In addition, all research laboratory buildings rode out the storm with minimal damage and no loss of specimens or animals, and all of the students, faculty, and staff survived.
While UTMB officials estimated it would be several weeks before the institution could be fully operational again, the campus was in full recovery mode just days after the storm passed. Cleanup of flooded areas had begun, several UTMB clinics on the nearby mainland were reopening to take care of patients, and a disaster medical assistance team (DMAT) had set up at the trauma center at UTMB's John Sealy Hospital to treat people remaining on Galveston Island.
Ben G. Raimer, MD, professor of pediatrics and senior vice president for health policy and legislative affairs at UTMB, says the efforts of the staff members who weathered Hurricane Ike were nothing short of extraordinary.
"UTMB staff, under the direction of [UTMB President] Dr. David Callendar, are the real heroes," Dr. Raimer said.
Following the Protocol
UTMB spokesperson Raul Reyes says the institution was prepared for Hurricane Ike because living on an island in the Gulf of Mexico demands such preparation.
"We watch storms very carefully," Mr. Reyes said. "We were doing things three or four or even five days before the storm hit to make sure we were protecting laboratory specimens, to make sure we had a plan to evacuate the patients."
Dr. Raimer says UTMB followed its disaster preparedness protocol "by the book."
Students were dismissed on Wednesday, Sept. 10, so they could secure their homes and evacuate the island. Also in the days before the hurricane made landfall, elective procedures and clinical appointments at UTMB hospitals and clinics were canceled, nonessential personnel were released, and 471 patients were discharged and evacuated from UTMB hospitals.
On Thursday, Sept. 11, UTMB officials went on emergency status and began evacuating those patients remaining in their hospitals who could not be discharged.
Between 12:30 pm Sept. 11 and 12:30 am Sept. 12, officials evacuated approximately 296 patients, including 51 newborn infants from the neonatal intensive care unit and 90 prison inmates, by ambulance, fixed-wing aircraft, helicopter, and bus. Dr. Raimer says every patient went with his or her medical records and any medical equipment necessary for a safe transfer. Many of those patients ended up at hospitals in Austin, San Antonio, and elsewhere.
Joan Richardson, MD, chief of emergency preparedness at UTMB, says the large number of neonates posed a serious challenge for the hospital staff.
"You know, when you're transporting a 150-pound adult, you don't need the kind of specialized equipment that we need when we had these little babies," she told National Public Radio (NPR). "Many of these babies were on respirators. Many of those babies were on oxygen. They're all little bitty and so they need incubators to keep them warm, and so the transport of a neonate is a very specialized operation. And we're blessed that all kinds of people showed up to help us move those babies."
After the lessons learned during Hurricane Katrina, where doctors and staff at several New Orleans hospitals sheltered many of their patients in place rather than evacuate, only to lose all backup power to their facilities, Dr. Callendar did not hesitate to order evacuation of all patients at the UTMB hospitals.
"No matter how well you prepare, your facilities and your people are at risk; you do need to be prepared to evacuate all your patients," Dr. Callendar said in an NPR interview. "You need to be prepared to make that decision well in advance of the arrival of the storm. If you can't, for some reason, evacuate patients or you take patients during the storm, you're going to be operating under the most difficult circumstances. Some people might call it battlefield medicine conditions."
Riding It Out
While students and patients were evacuated, approximately 550 UTMB personnel remained behind to secure the premises and to provide emergency care during and after the storm. About half of those who remained included security personnel and support staff from facilities, housekeeping, and food service departments. A number of physicians and nurses in the trauma center also remained on duty to provide emergency care, and some research personnel stayed behind to look after the welfare of research animals and secure vital lab specimens, including packing freezers with dry ice in case of a power outage.
Dr. Raimer says no hazardous materials, such as live viruses, were released as a result of the storm, and all animals and specimens were preserved.
"The research enterprise is stable," he said. "The [Galveston] National Lab was shut down without a problem. The structure was built for weather like we had, and more, so it is just fine - nothing that a bit of soap and water on the first floor cannot correct."
Dr. Raimer says the Shope Laboratory, which houses UTMB's biosafety level 3 and 4 research activities, also weathered the storm with minimal damage and no loss of specimens.
Mr. Reyes says there was some flooding in the basements and ground floors of the research buildings, but all research animals and specimens were moved to higher floors before the storm hit to protect them from flooding.
"Dry ice and emergency generators continue to preserve specimens of value to future research, and the entire research enterprise team has done an extraordinary job in maintaining all systems," Dr. Raimer added.
In addition, he said a team of federal veterinarians is assisting UTMB staff with care for research animals.
However, while the research activities appear to have been spared major damage, that may not be the case for UTMB's clinical operations. Except for the operations of the DMAT team, all UTMB hospitals and clinics on the island were shut down following the storm. A week after recovery began, it was unclear when John Sealy Hospital would reopen.
Dr. Raimer says there was extensive equipment damage from the flooding, including such items as MRI scanners and radiation oncology equipment. An initial estimate of the storm's cost to UTMB was put at more than $700 million, including $335.3 million for facilities and infrastructure restoration, $88.7 million for equipment replacement, $276.4 million for operational loss, $5.1 million to relocate educational activities, and $4.2 million in evacuation costs. While final estimates were still being prepared, dollar estimates of the damage should be partially offset by $100 million in potential insurance coverage, UT officials say. But Dr. Raimer says the costs still could go higher.
"The early estimates I got have already doubled," he said.
Picking Up the Pieces
While the hospitals remained closed as of early October, UTMB had already made arrangements for the continuity of care for their patients. For example, UTMB's transplant program and general surgery department were temporarily relocated to St. Joseph Medical Center in Houston.
"We have some alumni there who were the first on the phone to say come here immediately, we will welcome you," he said.
Meanwhile, UTMB physicians were doing their best to get clinics on the mainland up and running so that patient care could resume. On Sept. 18, UTMB reopened three of its mainland clinics. UTMB officials also reported on Sept. 19 that clinics in Stafford, Orange, and Beaumont also were open on a limited basis, even though they did not have electrical power.
While UTMB was attempting to get its clinical operations back up to speed, officials also were moving quickly to get the institution's educational operations up and running. Dr. Raimer said classes for first- and second-year students were scheduled to resume in mid to late October. And, he said, residency director Tom Blackwell, MD, and Associate Dean Steve Lieberman, MD, were "working around the clock" to find alternative rotations or residency positions for third- and fourth-year students and residents displaced by the hurricane.
Dr. Raimer says UTMB has had offers from residency programs across the country to take on some of its residents, "but we're trying to keep people as close to home as possible."
What the students and faculty returned to when classes resumed in October, however, was a shock. Ashley Agan, a second-year student who is president of the UTMB Medical Student Section, says most second-year students were not on the island when the storm hit because they had begun a short break the week before. Consequently, many had no opportunity to collect their books, notes, clothes, or other items from their homes or apartments.
Some of those students went back when Galveston officials opened the island briefly for a "look and leave" opportunity for residents to assess damage to their homes. Those who did return have posted photographs of their homes and those of other students on Facebook, a social networking Web site.
"My friends have posted pictures of mud in their houses," Ms. Agan said. "It's just heartbreaking."
She says she is among the lucky ones. While her apartment suffered some minor damage from a leaky roof, she still has a home to which to return, she says.
"I still basically have everything and I'll have a place to go back to," she said. "I'm very, very fortunate."
Dr. Raimer recognized that housing was going to be a problem for both students and faculty members when classes resumed in October. He says UTMB officials were working with the students to help them resolve their housing situation before then.
The Road to Recovery
Not only has UTMB sustained hundreds of millions of dollars in damages to its facilities and equipment, the loss of revenue from its hospital and clinic operations will be a substantial blow to an institution already facing an uncertain financial future.
"Obviously, with no patients, there's going to be an impact to our bottom line," Dr. Raimer said.
But UTMB carries insurance against such disruptions of its revenue stream that should help, and Dr. Raimer says the institution had already developed a very strong financial recovery plan before the storm that now likely will be implemented even sooner. That plan includes construction of a new hospital on the mainland, as well as expansion of some of its clinics on the mainland, he says.
"We have an obligation to patients and an obligation to our employees, and we are certainly going to meet those obligations," Dr. Raimer said. "We have an obligation to the community in preserving the health of the community, and we're going to do that."
Overall, he says, Galvestonians are optimistic people and real survivors. UTMB is going to survive, too.
"After the 1900 storm, the dean of the UTMB Medical School suggested to the UT System chancellor that the school should close," Dr. Raimer said. "The chancellor's response, 'The University of Texas stops for no storm.' After 108 years, the message is the same. We have not stopped and we do not intend to do so. This recent testing of our mettle has only reaffirmed our vision to create the future of health care for our people. It will be better; it will be relevant; it will be innovative; it will be strong. It will last through any of life's calamities."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.
Ike Has Minimal Impact on Houston Medical Schools
While their colleagues at The University of Texas Medical Branch at Galveston are looking at weeks' worth of recovery efforts before they can get back in business, officials at Houston's two medical schools say disruption of their operations as a result of Hurricane Ike likely will be minimal.
Kevin Dillon, MBA, CPA, chief operating officer and chief financial officer for UT Health Science Center at Houston, said officials there still were assessing damage to their facilities, but he expected them to be slight, compared with the $150 million in destruction that Tropical Storm Allison wreaked on the Houston campus in June 2001.
"Compared to UTMB and compared to what we had with Allison, we are fortunate people," Mr. Dillon said.
He says there was some minor flooding and some wind damage, such as blown-out windows, to some buildings, but UT-Houston never lost electrical power and neither did Memorial Hermann Hospital, UT's primary teaching hospital.
Classes at UT-Houston were canceled for about a week after the storm but reopened on Sept. 22.
Mr. Dillon says he is proudest of how the medical faculty performed during the crisis. Many UT physicians, including the medical school dean, rode out the hurricane at Memorial Hermann or LBJ Hospital.
"We performed well, so urgent clinical care certainly continued."
At Baylor College of Medicine, damage also was slight. Baylor spokesperson Lori Williams says there was minimal building damage and no effect on research activities. She also says there was some disruption of medical school classes because of utility and transportation issues in the days immediately following the storm but that classes resumed quickly.
Baylor Clinic also was without power after the hurricane, so some outpatient appointments had to be rescheduled.
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