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Louisiana Hospital Responses to Hurricanes Katrina and Gustav

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Louisiana Hospital Responses to Hurricanes Katrina and Gustav The National Emergency Management Summit Louisiana Hospital Responses to Hurricanes Katrina and Gustav Knox Andress, BA, AD, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospital Preparedness LSU Health Sciences Center ‐ Shreveport 1 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 2 3 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 4 Katrina: Predictions and History 5 Canal Breeches London Avenue Canal Industrial Canal 6 Hurricane Katrina –New Orleans 7 Gustav: Predictions and History 8 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 –(Centra l 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 9 Disaster Declarations in Louisiana • Katrina Declarations • Gustav Declarations 10 Hurricane Impacts to hospitals • Katrina • Gustav – Wind – Wind – Catastrophic flooding – Minimal flooding 11 Gustav: Hospital Power Outages6 Hospital Hospitals Region (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 12 Gustav: Hospital Evacuation Breakdowns6 Hospital Partial Complete Pre- Post- Pre + Region Evacs Evacs landfall landfall 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 13 Louisiana Hospital Evacuations – Katrina vs Gustav6 Hurricane Pre Post Total Hurricane Pre Post Total Katrina Storm Storm Gustav* Storm Storm Total 8 26 34 Total 38 7 45 Hospital Hospital Evacuation Evacuation Partial 5 5 Partial 25 3 28 Hospital Hospital Evacuation Evacuation Total 13 26 39 Total 63 10 73 *Gustav ‐ approximately 1000 patients evacuated pre‐storm; 223 patients were evacuated post‐storm. 14 HospitalHospital EvacuationEvacuation TimesTimes HurricaneHurricane RitaRita –– SeptemberSeptember 20052005 Hours for Evaucation 35 32 30 29 30 28 25 20 16 15 9 10 6 5 - Hospital D Hospital G Hospital E Hospital F Hospital A Hospital B Hospital C Benchmarking Hospitals for Hurricane Evacuations; Downey, E; Andress, K; Schulz, C; Prehospital and Disaster Medicine, 2007, V 22, No 3, 15 Impacting Hospitals – Gustav: Nursing Home Power Outages 6 Region Nursing Homes (G) Region 1 0 Region 2 12 Region 3 2 Region 4 0 Region 5 0 Region 6 0 Region 7 0 Region 8 0 Region 9 1 TOTAL 15 16 Impacting Hospitals ‐ Gustav: Nursing Home Evacuations6 Hurricane Gustav Pre Storm Post Storm Total Complete 94 2 96 Evacuation Partial Evacuation 0 0 0 Total 94 2 96 8,401 residents evacuated pre‐storm; 160 residents evacuated post‐storm 17 StateState RegionalRegional InfrastructureInfrastructure ¾ 99 ‐‐LouisianaLouisiana DHHDHH HospitalHospital PreparednessPreparedness RegionsRegions ¾ RegionRegion ‐‐ DesignatedDesignated RegionalRegional CoordinatorsCoordinators‐‐ Hospitals/EMS/ Nursing Homes/Coroners /… Medical Institution Evacuation Plan War‐Game Numbers of potential throughput6 Number of Parishes: 12 Number of Hospitals: 60+ Regions 4,5: 624 patients Regions 3,4: 343 patients Regions 1,3,9: 1063 patients Anticipated Planning Range: low - high 343 - 1063 (reasonable “worst case” planning scenarios) 19 Louisiana: Transportation Evacuation Requirements for Hospitals6 Hospital Census Details NDMS Totals Vehicle Requirements Patients Post‐ Patients needing Para‐ Regions Discharge ICU Census Needing NDMS Critical Care Ambulances Transit Buses Census Evacuation Transport Seats Teams 1,3,9 798 59 268 18 91 264 14 3,4 316 27 168 10 42 112 1 4,5 601 40 207 8 68 207 5 20 Census is for all hospitals that are SIP 2 or 3, and not EVAC Tier 1 GUSTAV Medical Institution Evacuation: August 31, 20086 • State/ hospitals waited for almost two days before C‐130s and AE crews showed up at Region 5 AMP and Region 1 AMP. Region 5 AMP Chennault Airport 124 NDMS patients Regions 4 Acadiana Airport 34 Homebound patients Regions 1 AMP Regions 3 Lakefront Airport Moved by ground/air 302 NDMS patients ambulances the NDMS patients 81 Homebound patients and homebound patients to Region 1 21 Repatriation of NDMS patients and Medical Special Needs evacuees Total Patients Number of Total Number Total Patients Total Patients Left to be Patients Received Deceased in CareFlite Que State Received 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 Source: DHH Repatriation Call, October 2, 2008 (Kathy Kliebert) 22 Planning and Responses: Pre Hurricane Katrina • 2002 • 2004 1. Tropical Storm “Isidore” 1. Hurricane “Pam” TTX 2. Hurricane “Lili” planning • 2003 1. Hurricane “Ivan” 1. DHH Hurricane Annex “X” 2. DHH –Hospital –Sheltering • 2005 MOU 1. Hurricane “Pam” TTX 3. Hospital CEO Hurricane 2. Hurricane Katrina and Rita Checklist AARs 1. Tropical Storm “Bill” 1. Hurricane “Dennis” 2. Hurricane “Cindy” 3. Hurricane “Katrina” 4. Hurricane “Rita” 23 Planning and Responses: Post Hurricane Katrina7 • 2006 • 2007 1. Medical Institution Evacuation 1. Region 1 and 9 MIEP Exercise Plan (MIEP) 2. Region 3 MIEP Exercise 2. EMSystem’s – EMResource 3. Region 5 MIEP Exercise 3. Patient Tracking Plan 4. State ‐wide Hurricane Exercise 4. “H ‐Hour Calculator” 5. Louisiana/Federal Joint 5. Louisiana Hospital Emergency Response Plan Update Preparedness Network 6. Neonatal Evacuation Form 6. Louisiana/Federal Joint 7. Psychiatric Patient Movement Response Plan Form 7. EMS DRCs 8. Private Patient Movement Form 8. Nursing Home DRCs 9. Shelter‐in‐Place 9. Katrina and Rita AARs Recommendations 1. Tropical Storm “Alberto” 1. Hurricane “Dean” 2. Hurricane “Ernesto” 2. Tropical Storm “Humberto” 3. Tropical Depression #10 24 Planning and Response: Post Hurricane Katrina7 • 2008 1. Regions 1, 3, and 9 MIEP Exercise 2. Region 4 MIEP Exercise 3. State‐wide Hurricane Exercise 4. Hospital Aeromedical Transfer Form 5. Neonatal Transfer form 6. Patient Locator 7. Credentialing Procedures for LPNs, RNs, and MDs 8. Hurricane “Gustav” and “Ike” AARs 1. Tropical Storm “Eduard” 2. Hurricane “Gustav” 3. Hurricane “Ike” 25 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 26 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 27 Louisiana’s –Region 7 Shreveport & Claiborne Bossier City Bossier Webster Caddo Bienville De Soto Red River Natchitoches Sabine 28 Louisiana Region 7: Demographics General Demographics: ¾ Region Population: 524,000 (Census 2000) ¾ Largest city ‐ Shreveport: 200,145 (Census 2000) ¾ Planning for surging 264 (500/100,000,000) ¾ Parishes: 9 in Northwest Louisiana ¾ Number of hospitals: 28 (17 “Tier 1” and “11 Tier 2”) (Tier 1 = hospitals with emergency departments; Tier 2 = all other hospitals) 29 RegionRegion 77 HospitalsHospitals inin 99 ParishesParishes Claiborne Bossier •CHRISTUS Schumpert Highland (T1) CLAIRBORNE PARISH Webster Caddo •Doctors’ Hospital of Shreveport (T2) •Homer Memorial Hospital Bienville (T1) •Dubuis Hospital of Shreveport (T2) Red DESOTO PARISH De Soto River •Promise Hospital of Shreveport (T2) •DeSoto Regional MC (T1) •LifeCare Hospital (T2) NATCHITOCHES PARISH Sabine •LSU-Health Sciences Center (T1) Natchitoches •Natchitoches Regional Med •North Caddo Medical Center (T1) Center (T1) BIENVILLE PARISH •Overton Brooks VA Medical Center (T1) •Natchitoches Parish Extended Extended Care (T2) •Bienville Medical Center (T2) •Specialists Hospital of Shreveport (T2) RED RIVER PARISH BOSSIER PARISH •Shriners Hospitals for Children- Shreveport (T2) •CHRISTUS Coushatta (T1) •Bossier Specialty Hospital (T2) •Willis-Knighton Medical Center (T1) SABINE PARISH •Cornerstone Hospital (T2) •Willis Knighton Pierremont Health •Sabine Medical Center (T1) •Willis-Knighton Bossier (T1) Center (T1) WEBSTER PARISH CADDO PARISH •Willis-Knighton Health System South •Minden Medical Center (T1) •Brentwood, A Behavior Health (T1) Company (T2) •Springhill Medical Center (T1) •CHRISTUS Schumpert St Mary T1 = hospitals w EDs; Place (T1) 30 T2 = all other hospitals Shelters in: Region 7’s Shreveport and Bossier City Katrina Shelters Gustav Shelters • General Shelters •
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