CEO SUMMARY: Hurricane Charley not only validated long-standing laboratory emergency contingency plans, but it introduced new issues. Even two weeks after the hurricane, hospital labs in the most affected communities continue to deal with storm-related problems. One issue is that damaged physicians’ offices are closed, making it a challenge to report lab test results on patients who visit the ER.
WHEN HURRICANE CHARLEY blew into Florida on Friday, August 13, it significantly damaged hospitals located dead-center on its storm track.
Laboratories in these hospitals, already operating in an emergency mode, found themselves challenged in several unexpected ways. New lessons in crisis planning for laboratory testing services emerged from their experience.
Hurricane Charley was a Category 4 storm. When it hit the west coast of Florida, it was packing sustained winds of 145 m.p.h. and the storm surge was 13 to 15 feet. The eye passed over Punta Gorda and Port Charlotte. These cities suffered the worst damage.
Charley moved northeast across Florida, losing strength as it went. Still, sustained winds of 105 m.p.h. were recorded in Orlando. Storm damaged lessened the longer Hurricane Charley moved across Florida.
All three hospitals in Punta Gorda were significantly affected by high winds and the power outage. Charlotte Regional Medical Center, Fawcett Memorial Hospital, and Bon Secours-St. Joseph Hospital all had varying degrees of damage.
Hardest hit was Charlotte Regional Medical Center (CRMC). Windows were blown out in gusts that topped 175 m.p.h. Officials closed the hospital, except for the emergency room and patients were evacuated to other hospitals after Hurricane Charley passed.
In anticipation of potential coastal flooding, the laboratory at CRMC established a temporary laboratory on the second floor of the hospital prior to Charley’s arrival. This lab could do basic chemistry, hematology, electrolytes, urinalysis, and similar tests.
Full Service Maintained
Generator power cut in when power lines failed and the lab told THE DARK REPORT that the planned level of lab test services was continuously maintained. Full clinical services were restored at the hospital on Monday, August 30.
Inland from Punta Gorda, the town of Arcadia took a beating from Hurricane Charley. DeSoto Memorial Hospital, a 49-bed facility, took minimal damage and was used by the Federal Emergency Management Agency (FEMA) as a medical emergency resource.
“Our laboratory infrastructure was not damaged,” stated Julie West, Administrative Laboratory Director at DeSoto Memorial Hospital (DMH). “We implemented our contingency plan. Everything stayed up during the storm and the cut-over to power generators was accomplished without incident.
“With some water leakage into the building, we were forced to move special chemistry into my office,” she noted, “but there was little disruption to our planned level of testing.”
Lab Lessons Learned
Several lessons were learned during the hurricane emergency at DMH. “While the storm was overhead, water was coming into the building and getting into the air conditioning ducts. This would set off fire alarms located in the ducts,” stated West. “The lab is responsible for checking fire alarms during these types of crises. So, about every five minutes during the hurricane, another alarm would go off and lab staff would need to go check that location. This was a necessary, but unwelcome distraction, during that time.”
FEMA’s presence in Arcadia was immediate. “Two med techs from the Miami VA Medical Center were assigned to us the day of the hurricane,” explained West. “They mostly did blood draws. They were replaced halfway through the third day by permanent FEMA staff from Iowa and Ohio. We were assigned two phlebotomists and one med tech.”
One of the first agencies to show up after the hurricane was the Agency for Health Care Administration (AHCA), Florida’s laboratory licensing and regulatory agency. “AHCA was here to inspect the entire hospital (including the laboratory) and insure that clinical services were up to standards,” observed West. “Our lab was, as we had maintained our procedures throughout the emergency. But AHCA’s visit was a lesson that good laboratory practices cannot be ignored.
FEMA’s Lab Personnel
“When FEMA-supplied lab personnel arrived, they were given a full, but rapid, orientation to our laboratory. We also documented everything. Even with all the stresses of this emergency, the laboratory staff continued to follow appropriate procedures,” she said.
Another lesson from the emergency was to look at the downstream impact of the disaster and how it affects the flow of patients into the hospital. “The first surge of patients during the hurricane were chest pain patients,” explained West. “Then patients injured by the wreckage came in. Days later, some cases of diarrhea, apparently caused by living in the storm shelters, showed up.In the two weeks since the storm itself, we’ve seen lots of dehydrated individuals—both disaster workers and people cleaning up their property. There is also a steady flow of people injured during clean up, whether from chain saws, clearing debris, or other accidents.”
Lab Directors in other Florida hospitals described a similar range of patient cases when contacted by THE DARK REPORT. In fact, the downstream impact of Hurricane Charley was the next lesson mentioned by West.
Hurricane Charley also had an impact on the ability of hospital laboratories to reach laboratory staff at home and call in substitutes and additional help.
“In Arcadia, a large number of patients see doctors in Port Charlotte,” stated West. “But the doctors’ offices in that town are destroyed and closed. So they came to our emergency room (ER). That forced DMH to set up a second ER. But then our laboratory has the challenge of how to report the test results to their primary physician. We are working our way through this problem.”
Delivering Test Reports
This situation was confirmed by staff at Fawcett Memorial Hospital (FMH), in Port Charlotte. “With roof damage to our hospital, we were forced to evacuate patients after the storm. Just as our hospital was damaged, a large number of physicians’ offices across Port Charlotte are unusable,” stated an employee of FMH, who declined to be identified. “Our hospital is setting up portable buildings in the parking lot so that physicians have a place to see their private practice patients.”
With a leaking roof at the hospital during Hurricane Charley, med techs were forced to create an “umbrella arrangement” to shield lab instruments from water damage and allow them to continue operating. The laboratory had already moved some equipment in anticipation of possible flooding from the hurricane.
Another lesson gained from the experience of this hurricane is the need for certain areas of the laboratory to be air conditioned after the switch-over to power generators. At Fawcett Memorial Hospital’s laboratory, the switch-over to generator power went smoothly. The problem was the lack of air conditioning in the laboratory. Summer heat levels made it difficult to properly operate the chemistry instruments. The lab responded to that situation by sending certain specimens across the street to another hospital laboratory for a day or two.
Back-Up Air Conditioning
This “crisis lesson” mirrors a similar one learned during the electrical blackout of August 14, 2003 that affected the entire Northeast United States. At that time, several laboratories interviewed by THE DARK REPORT explained that, although generator power had switched on as planned, where labs were not on generator-powered air conditioning, it was difficult to maintain the conditions needed to properly perform laboratory testing.
Lack of generator-powered air conditioning in computer rooms was another lesson, as was, in one case, the inability to produce de-ionized water for certain laboratory tests. (See TDR, August 18, 2003.)
Hurricane Charley also had an impact on the ability of hospital laboratories to reach laboratory staff at home and call in substitutes and additional help. This was caused by the widespread lack of electricity in the community and the failure of both regular telephones and cellular telephone systems.
One of the Punta Gorda hospital labs said that it was forced to physically send couriers to laboratory employees’ homes. That was the only way to notify them of scheduling changes or if they were needed to fill in for absent employees.
The widespread power outage in residential areas also had another effect on laboratory operations. Lab staff living in areas without power had no way to do laundry and other necessary chores of daily living.
At Fawcett Memorial Hospital’s laboratory, staff living in Sarasota, which still had full power, were doing laundry for lab employees living in areas without power. They would also bring in water, and help with clean-up efforts at other lab employee’s damaged homes. FMH also established a day care center within the hospital as a way to help employees during the emergency.
FMH staff picked up another category of illness attributable to the effects of Hurricane Charley: respiratory cases caused by mold in homes. Without power and air conditioning, worsening mold conditions in residences were contributing to a growing number of ER visits by affected individuals. There was also a case of six family members suffering carbon monoxide poisoning from the genera- tor operating within their home.
Some of these lessons are reminders. For instance, contingency plans should allow lab instruments and LIS to operate with both power and air conditioning as necessary.
Hospital laboratories on the periphery of Hurricane Charley had a relatively easier time. For example, DSI Laboratories was farther south on the coast. Located in Fort Meyers, Florida, it survived high winds with minimum damage to its laboratory facility.
“DSI’s main laboratory did lose power and its telephone connections,” stated Martha Sunyog, Director of Laboratories at Naples Community Hospital, one of the labs in the DSI network. “This happened at 2:00 a.m. the next morning, after Hurricane Charley had passed by. It meant no access to the computer system, so there was lots of hand entry of orders and results.
“Courier services were maintained and our contingency plans help up well,” she added. “DSI’s patient service center in Port Charlotte was damaged. It was relocated and phlebotomy services in that area were maintained.”
THE DARK REPORT notes that this was a difficult story to research. Even two weeks after Hurricane Charley blew through Florida, hospital laboratories in the communities most affected by this storm have yet to return to any semblance of normal. Laboratory directors are still responding to extraordinary demands and needs.
Appreciation And Thanks
So it is with much appreciation that THE DARK REPORT would like to thank all who took time to stop and contribute to this story. Their willingness to share the management lessons learned is much appreciated by all our clients and regular readers.
Some of these lessons are reminders. For instance, contingency plans should allow lab instruments and LIS to operate with both power and air conditioning as necessary. But others are insights often overlooked.
Does your laboratory have a contingency plan to contact lab staff at home, after an emergency, if they don’t have electricity or telephones? Is your laboratory ready to deal with an evolving range of patient visits to the ER which mirror the longer-term consequences of a natural disaster? These are valuable issues to consider now, while there is time to craft a solution into your lab’s contingency plan.