Everybody

out!
Tropical Storm Allison

By Paula J. Bowers,
RN,BC, MSN, CNA, CNN;
Margaret Lynn Maguire,
RN, MSN, CNA;
Patricia A. Silva,
RN, MSN, CNA; and
Rhonda Kitchen,
RN, MSN, CPHQ

Will your facilitys

evacuation
procedures withstand
a disaster?

M i c h a e l Tr i n s e y

Abstract: See how one Houston

hospital system continued to
deliver health care while undergoing floods, power failures,
and evacuations. [Nurs Manage
2004:35(4):50-54]

formed quickly and roared ashore on June 5, 2001, in

Galveston, Texas. The storm brought heavy rainfall,
flash flooding, power outages, and widespread damage
to homes and businesses, eventually causing the
deaths of 22 people in
Houston and 47 people
across ten states.
Allison pounded the
Houston area with up to
35 inches of rain in less
than 12 hours on June 8.
Streets and highways were
impassable, making rescue efforts almost impossible.
The storm challenged the spirit of the entire Houston
community, with repercussions felt long after the
clouds lifted.

50 Nursing Management April 2004

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The best laid plans

The Joint Commission on Accreditation of Healthcare
Organizations requires that hospitals maintain disaster
plans.1 Simulated disaster drills provide an opportunity to
prepare for the worst possible scenario.2 But while most hospitals are well-schooled and practiced in disaster drills,
responding to an actual disaster proves arduous.
Disaster plans provide the illusion of preparedness, while
drills offer participants an opportunity to learn the nuances of a
disaster plan when its in place.3 Youll most effectively manage
unexpected incidents that directly impact hospital function if
youve had time to plan, coordinate, and implement your disaster response.4 But dont panic: Although external and internal disasters can overlap, they usually dont result in a fullscale evacuation of facilities.5
Hitting home: Allison and the Texas Medical Center
The largest complex of its kind in the country with more
than 100 permanent buildings, the Texas Medical Center
(TMC) sits on 700 acres less than 5 miles from downtown
Houston. TMC is home to nine academic and research institutions, including the Baylor College of Medicine and the
University of Texas Health Science Center Medical School.
The organization offers 6,041 licensed beds and 426 bassinets
within 12 patient care centers. TMC employs 61,000 individuals, making it the single largest employer in Houston.
Tropical Storm Allison caused an estimated $2 billion in damage to TMC hospitals, libraries, schools, and universities. This
devastation dramatically impacted health care in the greater
Houston area for weeks after the storm subsided. As a result of
extensive flooding, the Baylor College and University of Texas
medical schools lost millions of dollars and years worth of medical research, including the lives of more than 30,000 research
laboratory animals.6 All five TMC hospitals flooded to some
degree as a result of the storm. Of these, three required partial
evacuations and two total evacuations. Emergency department
closings in the flooded buildings seriously strained the
resources of outlying community hospitals. These smaller facilities experienced a 200% to 500% increase in emergency cases.7
The U.S. Department of Health and Human Services (HHS)
sent 150 nurses and physicians to Houston from the HHS
Disaster Medical Assistance Team and opened three ambulatory care centers in various sections of town for those requiring
urgent care. In addition, the 591st Expeditionary Medical
Squadron, part of the 59th Medical Wing headquartered at
Lackland Air Force Base in San Antonio, Texas, opened a temporary Air Force Mobile Combat Hospital for urgent care
needs on June 14, 2001. It was the first time the squadron
deployed to aid civilians after a disaster.8
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51

Everybody out!

Internal and external damage

Each day, employees rely on an intricate network of tunnels
underneath TMC to get from one facility to another. But during Tropical Storm Allison, these tunnels channeled water
from flooded streets and overburdened drainage systems into
countless TMC basements and sub-basements. Memorial
Hermann Hospital and Memorial Hermann Childrens
Hospital bore the brunt of the floodwaters and, of the seven
medical-center hospitals, were the most severely damaged.
The morning after the flood, both facilities were totally evacu-

Working with whats available

How did nurses improvise during the disaster? When the electrical power went out, they turned to battery-operated machines or
battery-powered back-up equipment. Innovative uses of available
resources included:
patient ventilation using intermittent positive-pressure breathing machines
monitoring electrocardiograms of unstable patients using
defibrillators
titrating I.V. rates using I.V. flow-rate devices
using PDAs and cell phones as light sources
using piston syringes for suctioning.

ated after experiencing a complete loss of power, utilities, and

water and telephone service. Communication was further
complicated by the loss of service of several cellular phone
companies. (See Working with whats available.)
According to TMC policy, all employees on shift the night
of the flood remained working until the state of disaster was
lifted. Administrators, including medical directors, helped
cancel nonemergent surgeries and expedited the discharge
of patients who could safely be cared for at home. Remaining patients were matched with other outlying facilities,
based on available space and clinical expertise. Staff evacuated patients in the intensive care units first; nurses and
therapists transported their own patients and stayed with
them at the receiving facilities.
The patient evacuees began arriving at system hospitals
and hospitals as far away as 200 miles within hours of notification. Normal hospital procedures for receiving patients
were ineffective, as facsimile machines, copy machines, and
telephones werent working. Patients arrived with their
medical records and, often, a nurse from Memorial
Hermann Hospital.
The system hospitals expanded their capacity as far as
possible without compromising care quality or patient safety. Memorial Hermann Southeast Hospital increased the
number of intensive care beds and opened a pediatric unit.
Memorial Hermann Memorial City opened a stroke unit
and increased its volume of neonatal patients. Memorial
Hermann Southwest Hospital opened beds for trauma and
52

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Everybody out!

transplant patients. Life Flight, the

systems air-ambulance service, relocated to Memorial Hermann Southwest, approximately 10 miles away,
and a helicopter pad was built at the
Southwest campus hospitals.
Staff deployment
Memorial Hermann Hospital physicians received temporary privileges at
the other system facilities, allowing the
University of Texas Medical School faculty, students, residents, and fellows to
follow their patients through the system. Additional Memorial Hermann
Hospital staff traveled to other community hospitals with higher-acuity
patient populations and increased

gleaned valuable lessons regarding disaster management and emergency preparedness in the aftermath of Tropical
Storm Allison. Employees who experienced the event firsthand urge all
health care facilities to take the following disaster preparedness actions:
Designate a central command center.9
Conduct annual disaster drills after
hours and on weekends.10
Create a citywide repository for
medical supplies and equipment.
Establish a community-wide graded
weather alert system.
Devise proactive community evaluation and agreements to match patient
populations with health care facility
expertise and identify staff competency

Memorial Hermann Hospital

physicians received
temporary privileges at the
other system facilities,
allowing the University of
Texas Medical School
faculty, students, residents,
and fellows to follow their
patients through the system.
workloads. These floating employees
were assigned a companion to help
with the various computer systems
and patient forms.
The aftermath
On July 16, 2001, Memorial Hermann
Hospital reopened to partial services
after being closed for 37 days. Additional units were gradually re-opened
as renovations were finished. Memorial
Hermann Hospital was fully operational 125 days after the flood, but total
renovations took approximately two
years.
Memorial Hermann Hospital staff
54 Nursing Management April 2004

to perform duties beyond normal

scope.
Assign staff to specific outlying facilities.
Supply alternate transportation for
staff when roads are impassable.
Provide communication and cooperation with the media.11
In the wake of the flood
Allison challenged Memorial Hermann
Healthcare System and the greater
Houston area in ways never before
imagined. Innovation and teamwork
within the system enabled continued
patient accommodation. Enhanced collaboration allowed staff members to

seize opportunities and choose positive

options. The experience made an
already outstanding system stronger
and ready to weather any storm.

References
1. Milsten, A.: Hospital responses to
acute-onset disasters: A review,
Prehospital and Disaster Medicine.
15(1):33-53, 2000.
2. Miller, C.: Dealing with disasters: What
hospitals learned from recent crisis,
Hospital Security and Safety
Management, pgs. 5-9, 1993.
3. Milsten, A.: loc cit.
4. Campese, C.: Preparation, experience,
and aftermath of Hurricane Floyd,
AORN Journal. 27(1):82, 2000.
5. Peters, M.: Hospitals respond to water
loss during the Midwest floods of 1993:
Preparedness and improvisation, The
Journal of Emergency Medicine.
14(3):345, 1995.
6. Garcia, M.: Hermann and Baylor recovering, Houston Chronicle, July 18,
2001.
7. Turner, A.: The great flood of 2001/
Hermann to reopen trauma unit/
medical center slowly recovering from
storm, Houston Chronicle, July 16,
2001.
8. Lezon, D.: The great flood of 2001/
A case of emergency/Air Force mobile
combat hospital relieves flooded facilities, Houston Chronicle, June 22,
2001.
9. Simpson, D.: Non-institutional sources
of assistance following a disaster:
Potential triage and treatment capabilities of neighborhood-based preparedness organizations, Prehospital and
Disaster Medicine. 15(4):73-80, 2000.
10. JCAHO 2002 Hospital Accreditation
Standards: Accreditation policies standards, intent statements, 212b-226,
2002.
11. Carpenter, D.: When disaster strikes:
Crises test leaders nerve and range of
skills, Hospital and Healthcare
Networks. 74(11):48-56, 2000.

About the authors

Paula J. Bowers, Margaret Lynn Maguire,
and Patricia A. Silva are directors at
Memorial Hermann Hospital in Houston,
Texas. Rhonda Kitchen is risk management
liaison, Memorial Hermann Memorial City
Hospital, Houston, Texas.
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