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1
Louisiana Hospital Responses to Hurricanes Katrina and Gustav
Knox Andress, BA, AD, RN, FAENDesignated Regional Coordinator
Louisiana Region 7 Hospital PreparednessLSU Health Sciences Center ‐
Shreveport
The National Emergency Management Summit
2
Goal ‐
Objectives
• Goal
–– Demonstrate comparisons of impacts and responses
to Hurricanes Katrina and Gustav by Louisiana hospitals
• Objectives
–– Provide a background on storm dynamics and history– Discuss factors influencing hospital evacuation– Discuss numbers of partial and total hospital
evacuations– Discuss impacts to hospitals in a sheltering region
3
4
Katrina Dynamics
• Hurricane Katrina –– Entered Gulf of Mexico –
August 26, 20051
– Predictions: “Category 1”
projected to become a
“Category 5”– Hurricane warnings: Louisiana central coastline to Florida
panhandle– Landfall: August 29, 2005; Burras, LA (Southeast
Louisiana); “Category 3”
w/ 125 mph winds
– Storm surges: 10’
–
19’.
– Levee breaches: = 53; 80% New Orleans & neighboring parishes flooded.
– Louisiana fatalities: 1,464 storm‐related; 135 missing2
– Estimated 100 billion dollars in LA property damage/loss3
5
Katrina: Predictions and History
6
Canal Breeches London Avenue Canal Industrial Canal
7
Hurricane Katrina – New Orleans
8
Gustav: Predictions and History
9
Gustav Dynamics
• Hurricane Gustav
–– Entered: Gulf of Mexico – August 31, 20084
– Predictions: “Category 1”
projected to become a “Category 5”
– Hurricane warnings: Cameron Parish to Ala/Fla
border– Landfall: September 1, 2008; Cocodrie, LA – (Central
coastal Louisiana); “Category 2”
w/ 105 mph winds– Louisiana storm surges: 10 – 14 feet. – Levee “topping”
‐
No (0) levee breaks
– Louisiana Fatalities: 48 storm‐related5
– Estimated 4.3 billion in LA property damage/loss
10
Disaster Declarations in Louisiana
• Katrina Declarations • Gustav Declarations
11
Hurricane Impacts to hospitals
• Katrina– Wind
– Catastrophic flooding
• Gustav– Wind
– Minimal flooding
12
Gustav: Hospital Power Outages6
Hospital Region
Hospitals (G)
Region 1 1
Region 2 12
Region 3 5
Region 4 9
Region 5 0
Region 6 2
Region 7 0
Region 8 0
Region 9 1
TOTAL 30
13
Gustav: Hospital Evacuation Breakdowns6
Hospital Region
Partial Evacs
Complete Evacs
Pre- landfall
Post- landfall
Pre + Post
Evacs
1 8 8 16 0 16
2 1 4 0 5 5
3 3 7 10 0 10
4 6 12 9 3 12
5 5 7 12 0 12
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 5 7 10 2 12
TOTAL 28 45 57 10 67
14
Louisiana Hospital Evacuations – Katrina vs
Gustav6
Hurricane Gustav*
Pre Storm
Post Storm
Total
Total HospitalEvacuation
38 7 45
Partial HospitalEvacuation
25 3 28
Total 63 10 73
Hurricane Katrina
Pre Storm
Post Storm
Total
Total Hospital Evacuation
8 26 34
Partial Hospital Evacuation
5 5
Total 13 26 39
*Gustav ‐
approximately 1000 patients evacuated pre‐storm;
223 patients were evacuated post‐storm.
15
6
9
16
28 2930
32
-
5
10
15
20
25
30
35
Hospital D Hospital G Hospital E Hospital F Hospital A Hospital B Hospital C
Hours for Evaucation
Hospital Evacuation TimesHospital Evacuation TimesHurricane Rita Hurricane Rita –– September 2005September 2005
Benchmarking Hospitals for Hurricane Evacuations; Downey, E; Andress, K; Schulz, C; Prehospital and Disaster Medicine, 2007, V 22, No 3,
16
Impacting Hospitals – Gustav: Nursing Home Power Outages6
Region Nursing Homes
(G)Region 1 0Region 2 12Region 3 2Region 4 0Region 5 0Region 6 0Region 7 0Region 8 0Region 9 1TOTAL 15
17
Hurricane Gustav Pre Storm Post Storm Total
Complete Evacuation
94 2 96
Partial Evacuation 0 0 0
Total 94 2 96
Impacting Hospitals ‐Gustav: Nursing Home Evacuations6
8,401 residents evacuated pre‐storm; 160 residents evacuated post‐storm
State Regional InfrastructureState Regional Infrastructure
9 9 ‐‐Louisiana DHH Louisiana DHH Hospital Hospital Preparedness Preparedness RegionsRegionsRegion Region ‐‐ Designated Designated Regional Regional CoordinatorsCoordinators‐‐Hospitals/EMS/ Nursing Homes/Coroners /…
19
Medical Institution Evacuation PlanWar‐Game Numbers of potential throughput6
Regions 4,5: 624 patients
Regions 3,4:
343 patients
Regions 1,3,9: 1063 patients
Number of Parishes: 12Number of Hospitals: 60+
Anticipated Planning Range: low - high
343 - 1063 (reasonable “worst case” planning scenarios)
20
Louisiana: Transportation Evacuation Requirements for Hospitals6
Hospital Census Details NDMS Totals Vehicle Requirements
RegionsPost‐
Discharge
Census
ICU CensusPatients
Needing NDMS
Evacuation
Patients
needing
Critical Care
Transport
Teams
AmbulancesPara‐
Transit
Seats
Buses
1,3,91,3,9798798 5959 268268 1818 9191 264264 1414
3,43,4 316316 2727 168168 1010 4242 112112 11
4,54,5 601601 4040 207207 88 6868 207207 55
Census is for all hospitals that are SIP 2 or 3, and not EVAC Tier 1
21
GUSTAV Medical Institution Evacuation: August 31, 20086
Region 5 AMPChennault Airport124 NDMS patients Regions 4
Acadiana
Airport34 Homebound patients
Regions 1 AMPLakefront Airport302 NDMS patients 81 Homebound patients
Regions 3Moved by ground/air
ambulances the NDMS patients
and homebound patients to
Region 1
•
State/ hospitals waited for almost two days before C‐130s and AE crews
showed up at Region 5 AMP and Region 1 AMP.
22
State
Number ofPatients
Total Number Received
Total Patients Deceased
Total Patients Left to beReceived
Total Patients in CareFlite
Que
Alabama 9 9 0 0 0
Arkansas 325 304 21 0 0
Kentucky 3 3 0 0 0
Mississippi 98 98 0 0 0
North Carolina 1 1 0 0 0
Oklahoma 30 29 1 0 0
Tennessee 8 8 0 0 0
Texas 86 84 2 0 0
Total 560 536 24 0 0
Repatriation of NDMS patients and
Medical Special Needs evacuees
Source: DHH Repatriation Call, October 2, 2008 (Kathy Kliebert)
23
Planning and Responses: Pre Hurricane Katrina
• 20021.
Tropical Storm “Isidore”2.
Hurricane “Lili”
• 20031.
DHH Hurricane Annex “X”2.
DHH – Hospital – Sheltering
MOU
3.
Hospital CEO Hurricane
Checklist
1.
Tropical Storm “Bill”
• 20041.
Hurricane “Pam”
TTX
planning
1.
Hurricane “Ivan”
• 20051.
Hurricane “Pam”
TTX2.
Hurricane Katrina and Rita
AARs
1.
Hurricane “Dennis”2.
Hurricane “Cindy”3.
Hurricane “Katrina”4.
Hurricane “Rita”
24
Planning and Responses: Post Hurricane Katrina7
• 20071.
Region 1 and 9 MIEP Exercise2.
Region 3 MIEP Exercise3.
Region 5 MIEP Exercise4.
State‐wide Hurricane Exercise5.
Louisiana/Federal Joint
Response Plan Update
6.
Neonatal Evacuation Form7.
Psychiatric Patient Movement
Form
8.
Private Patient Movement Form9.
Shelter‐in‐Place
Recommendations
1.
Hurricane “Dean”2.
Tropical Storm “Humberto”3.
Tropical Depression #10
• 20061.
Medical Institution Evacuation
Plan (MIEP)
2.
EMSystem’s
–
EMResource3.
Patient Tracking Plan4.
“H‐Hour Calculator”5.
Louisiana Hospital Emergency
Preparedness Network
6.
Louisiana/Federal Joint
Response Plan
7.
EMS DRCs8.
Nursing Home DRCs9.
Katrina and Rita AARs
1.
Tropical Storm “Alberto”2.
Hurricane “Ernesto”
25
Planning and Response: Post Hurricane Katrina7
• 20081.
Regions 1, 3, and 9 MIEP
Exercise
2.
Region 4 MIEP Exercise3.
State‐wide Hurricane Exercise4.
Hospital Aeromedical
Transfer
Form
5.
Neonatal Transfer form6.
Patient Locator7.
Credentialing Procedures for
LPNs, RNs, and MDs
8.
Hurricane “Gustav”
and “Ike”
AARs
1.
Tropical Storm “Eduard”2.
Hurricane “Gustav”3.
Hurricane “Ike”
26
Primary and Secondary Hurricane Hospital Impacts
1.
Primary
system impacts come from evacuating hospital processes.
2.
Secondary
system impacts originate from supporting:
– evacuating hospitals and
– sheltering evacuee population
27
Sheltering Impact to Hospitals ‐ Indicators
• Numbers of shelters• Types of shelters (Special Medical Needs;
Critical Transportation Needs; General, etc.)• Length of operation• EMS shelter runs to hospitals• Types of medical complaints• “Diversion”
time by local hospitals
• Shelter medical resourcing
28
Louisiana’s – Region 7
Natchitoches
Bienville
Sabine
Red River
De Soto
WebsterBossier
Caddo
ClaiborneShreveport & Bossier City
29
Louisiana Region 7: Demographics
General Demographics:Region Population: 524,000 (Census 2000)Largest city ‐ Shreveport: 200,145 (Census 2000)Planning for surging 264 (500/100,000,000)Parishes: 9 in Northwest LouisianaNumber of hospitals: 28 (17 “Tier 1” and “11 Tier 2”)
(Tier 1 = hospitals with emergency departments; Tier 2 = all other hospitals)
30
CLAIRBORNE PARISH
•Homer Memorial Hospital (T1)
BIENVILLE PARISH
•Bienville Medical Center (T2)
WEBSTER PARISH
•Minden Medical Center (T1)
•Springhill Medical Center (T1)
RED RIVER PARISH
•CHRISTUS Coushatta (T1)
NATCHITOCHES PARISH
•Natchitoches Regional Med Center (T1)
•Natchitoches Parish Extended Extended
Care (T2)
DESOTO PARISH
•DeSoto Regional MC (T1)
CADDO PARISH
•Brentwood, A Behavior Health Company (T2)
•CHRISTUS Schumpert St Mary Place (T1)
BOSSIER PARISH
•Bossier Specialty Hospital (T2)
•Cornerstone Hospital (T2)
•Willis-Knighton Bossier (T1)
SABINE PARISH
•Sabine Medical Center (T1)
Region 7 Hospitals in 9 ParishesRegion 7 Hospitals in 9 Parishes
•CHRISTUS Schumpert Highland
(T1)
•Doctors’
Hospital of Shreveport (T2)
•Dubuis Hospital of Shreveport (T2)
•Promise Hospital of Shreveport (T2)
•LifeCare Hospital (T2)
•LSU-Health Sciences Center (T1)
•North Caddo Medical Center (T1)
•Overton Brooks VA Medical Center (T1)
•Specialists Hospital of Shreveport (T2)
•Shriners Hospitals for Children-
Shreveport (T2)
•Willis-Knighton Medical Center (T1)
•Willis Knighton Pierremont Health Center (T1)
•Willis-Knighton Health System South (T1)
Natchitoches
Bienville
Sabine
Red RiverDe Soto
WebsterBossier
Caddo
Claiborne
T1 = hospitals w EDs;
T2 = all other hospitals
31
Shelters in: Region 7’s Shreveport and Bossier City
Katrina Shelters
• General Shelters1.
LSU –
Shreveport
2.
Hirsh Coliseum
3.
CenturyTel Civic Center
4.
Southern University
5.
Expo Hall
• Special Medical Needs
Shelters1.
Bossier Civic Center
Gustav Shelters• General Shelters
1.
LSU –
Shreveport2.
Southern University 3.
Riverview Center 4.
Century Tel Civic Center5.
Hirsh Coliseum• Critical Transportation Needs
Shelters1.
Sam’s Club2.
The Sports Outlet Mall• Special Medical Needs
Shelters1.
Bossier Civic Center
32
Evacuees Reported in LA Region 7 Hospitals8
33
Region 7/ Gustav Hospital Evacuee Patients Came From…
465
89
152
9
Shelter
Home
Hospitals
NH
34
EMS Transports: Shelters to Shreveport‐
Bossier City Hospitals
75
5356
32
0 0
6
63
33
0
10
20
30
40
50
60
70
80
CTNS Shelter - Sports Outlet
Mall
CTNS Shelter - Sam's Club
SMNS -Bossier Civic
Center
Red Cross/General Shelter Hirsch
Red Cross/General Shelter LSUS
Red Cross/General
Shelter Southern University
Riverview -Shreveport
CenturyTel Other
Run
s
Shelter
Evacuee Impact on Hospitals: Medical Service Runs from Shelters to Area Hospitals, Aug. 30 - Sept. 18 (Fig. B)
35
Daily EMS Transports ‐
Shelters to Shreveport – Bossier City Hospitals
1
67
5754
57
36
16
52 2 1 0 2
11
2 2 2 0 0 10
10
20
30
40
50
60
70
80
8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7 9/8 9/9 9/10 9/11 9/12 9/13 9/14 9/15 9/16 9/17 9/18
Run
s M
ade
Date
Evacuee Impact on Hospitals: Medical Service Runs From Shelters to Area Hospitals, Aug. 30 - Sept. 18, 2008
36
Shelter Transports –
Complaint Types
3522 15 14 21 16 13
124
0
50
100
150
Complaint Types
Tra
ns
po
rt #
Biotel-Routed Shelter TransportsChest Pain
SOB
Diabetic
O.B.
Abd Pain
Trauma
Seizure
Other
37
Sheltering Impact – Hospital Diversion9
38
Issues• Patient tracking processes• Hospital data collection and reporting• Repatriation –
instate; out‐of‐state
• Infrastructure (HVAC, fuel, ice, etc) for hospitals sheltering‐in‐place (“SIPing”)
• Pharmaceuticals for shelters• Level‐of‐care delivery in shelters• Patient size (bariatric issues)• Question ‐
Future hurricane evacuations?
39
References
1.
Knabb, R; Rhane, J; Brown, D; Tropical Cyclone Report, National
Hurricane Center, December 20, 2005
2.
Hurricane Katrina, Deceased reports, Louisiana Department of
Health and Hospitals; accessed February 2, 2009 @
www.dhh.louisiana.gov/offices/page.asp?ID=192&Detail=5238
3.
Louisiana Recovery Authority, Briefing, August 24, 2007
4.
Brown, J; Kimberlain, T; Tropical Cyclone Report, National
Hurricane Center, January 22, 2009
5.
Hurricane Gustav; Wikipedia; accessed Feb 13, 2009,
www.wikipedia.org/wiki/Hurricane_Gustav_(2008)
6.
Hurricane Gustav and Ike, Louisiana ESF‐8, Health and Medical
Response After‐Action‐Report; Louisiana Department of Health
and Hospitals; November 5, 2008.
40
References7.
Hurricane Information for Hospitals; HHS Emergency
Preparedness; Louisiana Hospital Association; accessed January
28, 2009;
www.lhaonline.org/displaycommon.cfm?an=1&subarticlebr=337
8.
Hurricane Gustav and Ike, Region 7 Hospitals After‐Action‐
Report; Shriners Hospital for Children; October 9, 2008;
Shreveport, LA
9.
ED Status Report; Shreveport‐Bossier City Tier 1 hospitals,
EMSystem EMResource, for August 28 – September 6, 2008
10.
Louisiana Shelter Summit Report; Department of Social Services;
October 27, 2008; Shreveport, LA; accessed February 10, 2009;
http://www.dss.state.la.us/assets/docs/searchable/OS/Reports/
021609ShelterSummitReport.pdf
41
Thank you!
Knox Andress, BA, AD, RN, FAEN
Designated Regional Coordinator
Louisiana Region 7 Hospital Preparedness
Of (318) 813‐3311; Fax (318) 813‐3318