CEO SUMMARY: Literally overnight, Houston found itself dealing with tens of thousands of evacuees fleeing the destruction in New Orleans and surrounding areas. Many evacuees arrived in poor health. The Harris County Hospital District laboratorians of Houston pitched in to create an emergency laboratory support system that was surprisingly sophisticated. Here’s how labs in Houston met the challenge.
HURRICANE KATRINA and its aftermath put the labs at Houston’s Ben Taub General Hospital, Community Health Labs, and Lyndon B. Johnson General Hospital, as well as other healthcare providers, to the test in unprecedented ways when tens of thousands of New Orleans evacuees poured into the Houston Astrodome.
Even two weeks later, it is still chaotic in all the communities surrounding the area affected by Hurricane Katrina, which made landfall on Monday, August 29. THE DARK REPORT offers this intelligence briefing about how the Harris County Hospital District (HCHD) labs in Houston responded to the emergency. This lab’s story is representative of the many hospital laboratories which have taken extraordinary actions to respond to an unprecedented crisis in this nation’s history.
As Hurricane Katrina approached the Gulf Coast, the hospitals of HCHD and others were responding proactively and with remarkable foresight. To set up emergency laboratory facilities, these providers, in turn, relied heavily on the initiatives of a number of IVD vendors, including Abbott Diagnostics, Cardinal Healthcare, Dade-Behring, and Biostar.
One major project was to establish the physical laboratory facilities needed to serve the exploding number of evacuees arriving from New Orleans. At the same time, even as “emergency labs” were created, it was necessary to also establish workflow processes and procedures to assess, diagnose and treat the evacuee population. The situation is best explained by looking, first, at the preparations of labs and vendors to respond to the consequences of Hurricane Katrina, then, second, at the actual implementation of the disaster response plan for laboratory services.
HCHD’s laboratory staff were in the early stages of disaster planning when lab vendors began to call with offers of help. “In particular, Abbott employees were angels in this operation,” stated Sylvia Waller, Administrative Director of Pathology at Ben Taub General Hospital. “We cannot say enough about what they have done to help.
An Unexpected Offer
“Cedrick LaFleur, one of Abbott’s delivery managers here in the Houston area, called on the Tuesday [August 30] when the levee broke in New Orleans,” she recalled. “He told us he was calling at the request of his boss to see what they could do to help. They offered to deploy one of their Architour 18-wheeler “lab on wheels” for us to use as a clinical testing facility.
“They also offered us i-STATs and a Cell-Dyn 1800. I was on the phone with Cedrick at 11:00 p.m. on Wednesday night about this equipment. The Abbott shipment arrived at 4:00 a.m on Thursday [September 1]!” marveled Waller.
“Based on our emergency planning, we selected the cartridges we anticipated we would need. Those arrived Friday morning,” she said. “One of our for- ward-thinking staff anticipated that we would need lots of hand sanitizer. Abbott sent 1,000 bottles. This equipment and supplies played a critical role in allowing us to provide desperately-needed care to the evacuees.
“Employees at Cardinal Healthcare and Biostar were also instrumental. They provided vacutainer tubes and kits of every description. Leigh with Premier sent 1,000 bottles of hand sanitizers. Dade-Behring provided Micro-Scan products, which were useful in diagnosis of the many children with diarrheal diseases,” observed Waller.
Even as laboratory vendors were rushing to support the emergency response laboratory effort, Waller and her colleagues were already dealing with a variety of situations, some expected and some unexpected.
“We had many patients with diabetes to treat,” she continued. “Abbott shipped 1,000 meters, plus strips, lancets and other supplies.
“Two labs were established to accommodate the evacuees,” said Waller. “One was at the George R. Brown Convention Center. Shirley Hall, Director of HCHD Community Health Program Labs and other lab employees were instrumental in setting up the lab in Reliant Arena, at the Astrodome Complex.
“The first two days were very intense for us,” Waller stated. “There were more than 20,000 evacuees at the Astrodome. Nearby, in the Reliant Arena, were another 2,300 evacuees,” she noted. “About half the evacuees at the arena had medical issues. This is the site where I have been working.
“All these patients needed urinalysis and CBCs. The first day we did over 1,000 tests,” she recalled. “We were doing CBCs, differentials, blood gases, troponin, PT, and INR. In addition to the i-STATs that Abbott provided, we have an i-STAT at the hospital, reserved for emergencies. This certain- ly qualified as an emergency.
Testing By Many Methods
“We are doing the CBCs in the Abbott Architour laboratory. About half of the patients required lab glucose—quick glucose. We did testing by urine dipstick, wet mounts, KOH, i-STAT PT and INR, troponin, flu kit, rapid strep, and more.
“There were many sore throats and earaches,” she added. “Many children had cried for so long lying in their cots that the tears had flowed back, causing inner ear infections. Also, many children were suffering from diarrhea.
“Just seven days later, on Thursday, September 8, the evacuee population was down to about 8,500. All patients who were in the Reliant Arena clinic have been moved out. Since the Thursday following the storm (September 1), our labs have been running 24/7. Ten days after the storm, we were triaging about 700 patients per day,” stated Waller.
Troponins In Two Minutes
“Our pathologists and staff have been wonderful. Eugene Banez, M.D., Chief of Pathology Services at Ben Taub General Hospital, has even helped to perform testing. It has been a team effort to accomplish this job,” she added.
Banez told a Wall Street Journal reporter “I’ve never seen an operation like this in my entire career. It’s mind-boggling.” Using on-site diagnostics, colleagues ruled out a heart attack in an elderly man with chest pain, and detected a worrisome blood abnormality in a young woman.
“Physicians at the Astrodome were elated with the laboratory services that we had marshaled together for them. They were thrilled we could do troponins for the cardiac situations. We were able to test with the i-STATs and get results to the physicians with- in two minutes.
“In Reliant Arena, we set up a lab with roving phlebotomists,” explained Waller. “If patients were too ill, we sent our phlebotomists to the bedside and did a glucose, if needed. Pediatric patients we drew ourselves.
“Medical technologists, medical laboratory technicians, and lab staff from other hospitals—including Memorial Hermann Hospital, MD Anderson Cancer Center, Columbia Rosewood Medical Center, to name a few—came to help. We had lots of volunteers. Our pathologists have been running tests themselves. The entire laboratory teams from Baylor and UTMB [University of Texas Medical Branch at Galveston] have all pitched in with significant help and resources,” added Waller.
Emergency planning for laboratory services included a patient identification system, created “on the fly.” “Our IT department set up computers for us,” she explained. “Patients were admitted, given medical ID numbers, and accessioned. Once they were in our hospital system, when they came to the lab, we put them into our MiSys LIS. During this whole operation, we’ve managed to maintain our quality control and documentation procedures.
Working With Red Cross
“A second priority has been working with various government and relief organizations—Red Cross, FEMA, and others,” Waller noted. “The Medicaid DHHS Chief was here on Labor Day. He made rounds of all three of our clinics. FEMA and Red Cross are working out of our building. Social Security is here to cut checks. All of the New Orleans mail is being forwarded to the Astrodome. Tomorrow our congressional delegation will be here.”
THE DARK REPORT believes the bar is being raised for all laboratories and pathology groups when it comes to both emergency planning and disaster relief response. On the following pages, THE DARK REPORT looks at how lab industry vendors responded to the Hurricane Katrina emergency.