Stranded outside in the rising waters of Hurricane Harvey, feverish and in great pain, 14-year-old Tyler Frank tried desperately to think of ways to get herself and her family to safety.
And indeed, Siri was smart enough. With one inquiry to the Apple personal assistant — “Siri, call the Coast Guard” — Tyler got her whole family rescued after two days out in the storm. “(A)
“Hurricane Irma is a Category 5 storm expected to make landfall in Florida sometime this weekend, leaving local hospitals to prepare for a possible landfall and catastrophic damage.
Listed below are seven things every healthcare leader should know about the unfolding situation in Florida.
1. Florida Gov. Rick Scott (R) declared a state of emergency Monday for the entire state.
2. Three hospitals in the Florida Keys are beginning to evacuate patients: Key West, Fla.-based Lower Keys Medical Center, Tavernier, Fla.-based Mariners Hospital and Marathon, Fla.-based Fisherman’s Hospital. Monroe County, which encompasses the Keys, is also closing its health department… (B)
“Emergency disaster officials in cities like Baltimore, Boston and Seattle have spent the last week and a half monitoring how Texan government officials and storm-affected residents are responding to a crisis that destroyed homes and disrupted electricity, drinking water and communications.
The causes might be different, but the devastation and social disruption can be similar from disaster to disaster. As such, Houston is offering other cities a real-life run-through of their own emergency plans as well as a stark reminder of the inevitability of such events.” (C)
“Harvey is the first major storm since the federal government revised emergency preparedness standards for hospitals, in response to Katrina and 2012’s Superstorm Sandy. Now, health care institutions that receive Medicare or Medicaid dollars must have disaster preparedness plans, including relocation strategies for at-risk patients and mechanisms to maintain basic power.”
What kind of burden does a storm like Harvey place on local hospitals, and on the health care system?
What challenges should we expect in the storm’s wake? (D)
“Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area…”
“A large-scale World Health Organization (WHO) study out of Europe investigated these health effects of flooding and found that the two-thirds of flood-related deaths are due to drowning, while the remainder are from trauma, electrocution, carbon monoxide poisoning, fire, or heart attacks. Weakened health care infrastructures during natural disasters make seeking care for these immediate injuries and infectious diseases even more difficult. In the case of Harvey, Houston’s biggest level one trauma center, Ben Taub Hospital, is itself being evacuated due to lack of food and flooding.
The need for immediate medical attention aside, basic necessities such as food and clean drinking water become critical for displaced flood survivors, says Koenig. Contamination of drinking water due to failures at water treatment plants and sewage system overloads can lead to outbreaks of diarrheal disease if clean water provisions are not prioritized. Even exposure to flood water itself for prolonged periods of time can lead to health risks ranging from animal bites and wound infections to electrical and chemical hazards. And according to Koenig, once the immediate crisis dissipates, the toll of the natural disaster can persist in the form of chronic disease, worsened poverty, and emotional and mental distress.” (E)
As Texas begins to rebuild its buildings and roadways in the wake of Hurricane Harvey, survivors of the catastrophic storm, along with the medical professionals who treat them, may face psychological trauma from displacement and the loss of homes, property and, especially, loved ones.
The link between a hurricane and mental health struggles has been documented through research on the survivors of Hurricane Katrina, which devastated Louisiana in 2005. A year after the storm, the Resilience in Survivors of Katrina (RISK) Project found that nearly half of the 392 low-income parents they studied reported symptoms consistent with post-traumatic stress disorder (PTSD). An associated study concluded that the rates of probable serious mental illness in low-income parents in New Orleans doubled in the aftermath of the hurricane, a rise that’s likely to be reflected in southeast Texas. (F)
The storm forced hospitals and medical centers in Houston to cancel surgeries, outpatient programs and even evacuate surgeries.
But that still wasn’t enough to help prevent shortages across the city.
Medical centers have had to reevaluate their treatment of patients as food and supply shortages left them overwhelmed.
This is only expected to get worse as more victims of Hurricane Harvey will continue to grow as the storm dies down.
The uninsured will be among them with an inability to pay for medical procedures that were caused from the damaging hurricane. (G)
“But it could have gone a lot worse. To put it into context, there are roughly 120 hospitals in the southeastern section of Texas, according to Darrell Pile, the leader of the Southeast Texas Regional Advisory Council (SETRAC), which operated the Catastrophic Medical Operations Center in charge of leading hospital responses to emergencies. Additionally, in the 25 hospitals that did evacuate, not all of the patients planned to move actually ended up moving. CNN reports that so far, roughly 1,000 patients have been transported to other hospitals. Doctors likely assessed that some patients could actually be safely treated where they are, and that supplies were more secure than they thought (no one ended up going without food at Ben Taub Hospital in Houston, Pile says). Those who were living in the flooded nursing home now are okay in the hospital in which they were placed.” (H)
“Inside the hospital, doctors, nurses, technicians and facilities and food service staff were keeping things running for more than 500 inpatients and their families…
You have a ride-out team, which refers to staff who have agreed to stay put and ride out the storm. How did that work?
We had about a thousand staff here. The unsung heroes in this disaster are our nurses, our lab techs, our pharmacy techs, our food services, our security who kept [everyone] safe.
We had 528 patients who were in the hospital on Sunday morning and probably another couple hundred family members. We were really able to care for these very sick individuals. There was no compromise in our ability to care for them….
Your staff at the hospital is obviously just as affected as everyone else. (I)
“Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area. During the worst of the flooding, hospitals faced critical shortages of food and medicine, people with serious chronic diseases had to make difficult decisions between evacuation and sheltering in place, and hundreds of victims faced prescription shortages and mental-health issues. And based on the health problems people in New Orleans and elsewhere in the region faced after Hurricane Katrina, experts expect major public-health emergencies, environmental illnesses, and outbreaks will only intensify in the aftermath of Harvey.
“…one key public-health issue that attends the early stages of any disaster is the set of risks facing people who are disabled or elderly and face special health needs. “With our push towards home health-care and taking care of more Americans in the home,” Gentry said, “it quickly turns into ‘can we get their home health-care needs taken care of,’ with everything from oxygen to prescription meds to getting them clinical access, especially for dialysis. Those types of clinical worries compound as many days as the water stays up.” (J)
“Due to the failure of the city’s water pump, it is in the best interest of our current patients to transfer to other acute care facilities,” Baptist Hospitals of Southeast Texas said in a statement Thursday morning. “Due to the city-wide lack of services, we have no other alternative but to discontinue all services which will include emergency services. This is being done immediately.”
“The hospital needs about 50,000 gallons of water a day to run,” hospital medical director Ali Osman told weather.com. “The hospital administration tried to procure that water from water tankers, state and local resources. So far, we are unable to.”
“We started with maybe 260 patients, we are down to 193 patients,” he added. “We are evacuating the sickest of our patients first, intubated patients, patients who need dialysis. Things are serious … come Saturday or Sunday, we still don’t have any water, the bad situation will turn into a disaster.” (K)
““Just like their members, health plans are a part of their communities and deeply committed to the wellness and safety of those who live there,” America’s Health Insurance Plans said in a statement. “When a community is impacted by a tragic, disastrous event like we’re seeing unfold with this storm, plans connect immediately with state and local officials to offer support and ensure those impacted have swift access to the healthcare, resources and medical services they need.”
Here’s a look at what some major health plans are doing:
Cigna is lifting prescription refill restrictions; waiving prior authorization requirements for acute care; and forgiving late payment of premiums for customers in affected areas. It is also offering a free 24/7 telephone help line through which members can speak to a clinician about issues like coping with loss, anxiety, stress resulting from the hurricane. Finally, the insurer noted that MDLIVE, which provides telehealth services to Cigna customers, is offering one free medical consultation through Sept. 8. (L)
“Tom Bossert, the official leading the White House’s response to the disaster, estimated that 100,000 homes in Texas and Louisiana had been damaged or destroyed, and said that President Trump would soon seek billions in aid.
Mr. Bossert said that rescuers would provide aid to the estimated 500,000 undocumented immigrants in the Houston area, and that federal officials would not round up those whose only offense was entering the country illegally. But undocumented immigrants would likely not be eligible for long-term aid, he said, including subsidies to replace damaged housing.” (and what about health care?) (M)
(A) Siri saves sick girl from Harvey floodwaters, by Elizabeth Cohen and John Bonifield, http://www.cnn.com/2017/09/04/health/siri-harvey-rescue-sickle-cell/index.html
(B) Florida hospitals prepare for Hurricane Irma: 7 things to know Wednesday, by Leo Vartorella, http://www.beckershospitalreview.com/patient-flow/florida-hospitals-prepare-for-hurricane-irma-7-things-to-know-wednesday.html
(C) In Houston, a Terrifying Real-Life Lesson for Disaster-Prone Cities, by ADAM NAGOURNEY and JESS BIDGOOD, https://www.nytimes.com/2017/09/05/us/houston-harvey-disaster-lessons.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(D) A Doctor Who Weathered Katrina Now Tends Victims Of Harvey, by SHEFALI LUTHRA, http://www.npr.org/sections/health-shots/2017/09/05/548626760/a-doctor-who-survived-katrina-now-tends-victims-of-harvey
(E) Beyond infrastructure dangers, the survivors of Harvey will likely also face serious health hazards, Farah Naz Khan, https://www.self.com/story/health-crises-that-follow-horrific-floods
(F) From The Mental Health Wreckage Of Katrina, Lessons To Help Harvey’s Victims, by Kaeli Subberwal, http://www.huffingtonpost.com/entry/hurricane-harvey-mental-health_us_59a9f092e4b0354e440a7b3f
(G) Now the hospitals are going to have to figure out how to treat the many uninsured who need medical care because increased hospital admissions always happen after a natural disaster, by Danielle Zoellner, http://www.dailymail.co.uk/health/article-4840574/Hurricane-Harvey-crippled-health-system.html
(H) Houston hospitals kept patients safe during Harvey thanks to years of forced team bonding, Katherine Ellen Foley, https://qz.com/1066787/hurricane-harvey-how-houston-hospitals-handled-the-storm/
(I) An ‘Army Of People’ Helps Houston Cancer Patients Get Treatment, ANDREA HSU, http://www.npr.org/sections/health-shots/2017/08/31/547539504/an-army-of-people-helps-houston-cancer-patients-get-treatment
(J) Hurricane Harvey’s Public-Health Nightmare, https://www.theatlantic.com/politics/archive/2017/09/hurricane-harveys-public-health-nightmare/538767/
(K) Harvey Beyond Houston: Beaumont Residents Wait in Mile-Long Lines for Bottled Water, by Sean Breslin, https://weather.com/storms/hurricane/news/beaumont-texas-loses-water-supply-due-to-neches-river-flooding
(L) How health insurers are helping members, employees affected by Hurricane Harvey, by Leslie Small, http://www.fiercehealthcare.com/payer/how-insurers-are-helping-members-cope-hurricane-harvey
(M) New Hazard in Storm Zone: Chemical Blasts and ‘Noxious’ Smoke, by JULIE TURKEWITZ, HENRY FOUNTAIN and HIROKO TABUCHIA, https://www.nytimes.com/2017/08/31/us/texas-chemical-plant-explosion-arkema.html