Know When to Fold ‘Em: Hurricanes Always Win · •Great Galveston Storm (1900) killed...

Know When to Fold ‘Em: Hurricanes Always Win

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Know When to Fold ‘Em:

Hurricanes Always Win

Evacuation Operations during Hurricane Florence

Christoph Kaufmann MD MPH FACS DMCCWith thanks to: Matthew Tumbleson NHDP-BCEmergency Operations Manager

Disclosures

2Insert Name of Presentation Here

• None


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September 2018

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Deadliest (and other) Hurricanes

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• Great Galveston Storm (1900) killed 8,000-12,000• Hurricane Maria (2017) killed over 4,600• Okeechobee Hurricane (1928) 3,000• Hurricane Katrina (2005) 1,833• Cheniere Caminada Hurricane (1893) 1,400

• Hurricane Hugo (1989) 61 deaths (the most recent time there was mandatory medical evacuation in South Carolina)

• Hurricane Florence (2018)• At least 57 deaths (30 direct, 27 indirect)• Damage $24 billion in NC and SC


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Deadliest (and other) Hurricanes

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• Great Galveston Storm (1900) killed 8,000-12,000• Hurricane Maria (2017) killed over 4,600 [Puerto Rico]• Okeechobee Hurricane (1928) 3,000• Hurricane Katrina (2005) 1,833• Cheniere Caminada Hurricane (1893) 1,400

• Hurricane Hugo (1989) 61 deaths (the most recent time there was mandatory medical evacuation in South Carolina)

• Hurricane Florence (2018)• At least 57 deaths (30 direct, 27 indirect)• Damage $24 billion in NC and SC

The 1%

Hurricane Florence


• SEP 1 depression becomes a tropical storm• SEP 4-5 becomes a Category 4 – winds 140 mph max• SEP 7 – downgraded to tropical storm status

• SC, NC, VA, GA, MD, DC state of emergency declared• SEP 10 again became CAT 4 major hurricane• SEP 10 and 11 NC, SC, VA mandatory evacuation orders• SEP 13 again downgraded to CAT 1• SEP 14 landfall in Wrightsville Beach NC as a CAT 1


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Hurricane Florence - Facts


• 112 mph wind at landfall• 10 trillion gallons of rain in NC• 36 inches of rain in NC (most ever from single system)• 34 inches in SC (prev. record was 17 inches in 1994)• 14,000 service members deployed• Greater than 500,000 customers without power

Background

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Grand Strand Health is a multi-facility health system in Myrtle Beach SC

• 369-bed Acute Care Hospital with 1 ED

• 2 Freestanding ER Facilities • South Stand Medical Center • North Strand ER

• Various Outpatient Medical Services• Grand Strand Medical Center is a:

• Level I Adult Trauma Center and Level II Pediatric Trauma Center• Advanced Primary Stroke Center• Chest Pain Center• Behavioral Health Unit


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September 2018

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• September 1 Saturday (Census -329)• EOM began initial daily executive leadership briefings for

developing system• Preparedness messaging via closed social media to staff• Local Supply Chain, Food & Nutrition Services and Facilities

began Hurricane Playbook initiation

September 2018

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• September 7 Friday (Census – 376)• Executive leadership began communications to staff• FEOC joined coordination calls at state and corporate levels• Facility submitted for an exemption to Mandatory Medical

Evacuation• Facility Moved to OPCON 4

• September 8 Saturday (Census – 356)• Virtual Opening of the FEOC• Daily reports from all Departments• Facility moved to OPCON 3


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September 2018

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• September 9 Sunday (Census – 323)• Physical opening of the FEOC

• Incident Commander and FEOC Manager• Logistics & Support staff

• September 10 Monday (Census – 325)• Team A/B Notification for Activation• Continued messaging with closed social media groups• Mandatory Medical Evacuation Exemption denied• Evacuation preparations begin at 14:31• Activation of the State Mutual Aid Agreement• Facility moved to OPCON 1• End of Operational Period – 91 patients placed (not yet moved)

Mandatory Evacuation


• SC Governor ordered “mandatory, not voluntary, but mandatory” evacuation of most parts of South Carolina’s eight coastal counties on SEP 10th

• Went into effect Tuesday April 11 at noon • Cellphones buzzed at 3PM saying residents must leave• That’s one million people• Second time in three years for Charleston

• The state law, however, does not prescribe penalties for disobeying the order

• Officials did offer one possible consequence: death!


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Evacuation

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September 2018

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• September 11 Tuesday (Census – 142, Evac/DC – 183)• Evacuations continue• Census at 142

• Patients continue to be placed with both HCA & Non-HCA facilities• State and Local Operations moved to OPCON 2

• September 12 Wednesday (Census – 50, Evac/DC – 275)• Evacuations continue

• Final patient evacuated Sept 12, 2018 at 23:45• Patient Story

Evacuation

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Non-HCA Receiving Hospitals:• Spartanburg• Providence• Greenville• Carolina Pines• AnMed• Self Regional• Palmetto Health• St. Francis• MUSC


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Evacuation

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HCA Receiving Hospitals:• Coliseum Medical Center• Doctors Hospital of Augusta• Orange Park• Memorial Savannah• Memorial Satilla• North Florida Regional• Colleton• Fairview Park• Memorial Jacksonville• Eastside

Evacuation

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• Patient Volumes• Initial Census - 325• Discharged – 129• Evacuated – 196

• EMS Support• Ground (Ambulance, Ambu-Bus)• Air (Rotor-wing, Fixed- Wing)

• Transport Considerations• Food and Supplies for patients on long transports• Downtime/Feeding for transport staff


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Evacuation


• Region has 2 evacuation buses• State has 10 more• Air transport 33 patients (rotor plus fixed)• LTACs and nursing homes had to evacuate 700 • Other local hospitals evacuated another 100

September 2018

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Final patient evacuated Sept 12, 2018 at 23:45Total elapsed Evacuation time: 57 hours, 14 minutes


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During the Storm

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Kenopsia

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• n. the eerie, forlorn atmosphere of a place that’s usually bustling with people but is now abandoned and quiet—a school hallway in the evening, an unlit office on a weekend, vacant fairgrounds—an emotional afterimage that makes it seem not just empty but hyper-empty, with a total population in the negative, who are so conspicuously absent they glow like neon signs.

During the Storm

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• Communications• Coordination Calls/WebEx

• Internal HCA• State/Local/Regional

• Transfer Center/Patient Line• FEOC Staff

• Incident Command & Support• Facilities mitigation of storm related damage• IT&S Rounding• Supply Chain Management


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During the Storm

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During the (Slow) Storm - Wind shift

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SEP 14 0500SEP 14 2046

SEP 14 1944SEP 15 0457


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During the Storm = Hurrication

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After the Storm = Hurrication

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Food Distribution Center

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400 Staff totaling1261 Family

Members

Food Distribution Center

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Reopening SEP 16 0800

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Post Storm

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• September 15 (Census – 0)• SC DHEC deemed facility safe for re-entry & authorized service

to resume • Re-opening communications to staff and community• Distribution Center for Staff/Family

• September 16 (Census – 36 ED, 17 IP)• Patients Return• Main ED re-opened 8:00 am • Inpatient Services 11:00 am

• September 17 (Census – 32 ED, 49 – IP)• South Strand Campus re-opened at 7:00 am


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Post Storm

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• September 18 (Census – 56 ED, 117 IP)• North Strand FSED re-opened at 7:00 am

• September 19 (Census – 276 IP)• All services re-opened

• September 20 (Census – 288)• Food Distribution on-going• Hope Fund – FEMA expert• EAP return to on-site

• Evaluation/AAR process

Repatriation


• Of the 196 inpatients evacuated, only 78 were repatriated

• My patient story


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A Tragic Story

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• SEP 19: Two female South Carolina mental health patients (ages 43 and 45) drowned in a prison transport van when floodwater overtook the vehicle being driven by sheriff’s deputies across a flooded Little Pee Dee River bridge

Presidential Visit

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• President visits the disaster area• Secret Service & White House Medical Unit were in-house at Grand Strand for this visit


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Wind AND Rain

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Aftermath = Flooding

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Aftermath

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• Usual number of lanes of traffic in and out of Myrtle Beach = 16

• Decreased to 2 lanes

• Was almost like the Berlin Airlift

• C5A in AL was loaded and ready

Aftermath

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Aftermath

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Before & After the Storm

Before

After


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After the Storm Sunrise

Grand Strand Health

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None of our Emergency Operations efforts are effective in a vacuum. It

takes a phenomenal team of experts in their respective fields.

Build your team. Train your team.Accomplish the Unimaginable.


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For More Information:

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Matt TumblesonEmergency Operations ManagerGrand Strand Health

Email: [email protected]: (843) 692-4990

Know When to Fold ‘Em: Hurricanes Always Win · •Great Galveston Storm (1900) killed...

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Transcript of Know When to Fold ‘Em: Hurricanes Always Win · •Great Galveston Storm (1900) killed...