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

32 30 35 28 29

30

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 • General Shelters 1. LSU – Shreveport 1. LSU – Shreveport 2. Southern University

2. Hirsh Coliseum 3. Riverview Center 3. CenturyTel Civic Center 4. Century Tel Civic Center

4. Southern University 5. Hirsh Coliseum • Critical Transportation Needs 5. Expo Hall Shelters • Special Medical Needs 1. Sam’s Club 2. The Sports Outlet Mall Shelters • Special Medical Needs 1. Bossier Civic Center Shelters 1. Bossier Civic Center

31 Evacuees Reported in LA Region 7 Hospitals8

32 Region 7/ Gustav Hospital Evacuee Patients Came From…

9 152

Shelter

Home

89 Hospitals 465 NH

33 EMS Transports: Shelters to Shreveport‐ Bossier City Hospitals

Evacuee Impact on Hospitals: Medical Service Runs from Shelters to Area Hospitals, Aug. 30 - Sept. 18 (Fig. B)

80 75

70 63

60 56 53

50

40

Runs 32 33

30

20

10 6

00 0

CTNS Shelter CTNS Shelter SMNS - Red Red Red Riverview - CenturyTel Other -Sports Outlet - Sam's Club Bossier Civic Cross/General Cross/General Cross/General Shreveport Mall Center Shelter Hirsch Shelter LSUS Shelter Southern 34 University Shelter Daily EMS Transports ‐ Shelters to Shreveport –Bossier City Hospitals

Evacuee Impact on Hospitals: Medical Service Runs From Shelters to Area Hospitals, Aug. 30 - Sept. 18, 2008 80

70 67

60 57 57 54

50

40 36

30 Runs Made

20 16 11 10 5 22 2 222 1 1 0 001 0 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

Date 35 Shelter Transports – Complaint Types

Biotel-Routed Shelter Transports Chest Pain 150 124 SOB

100 Diabetic O.B.

50 35 Abd Pain Transport # 22 21 15 14 16 13 Trauma 0 Seizure

Complaint Types Other

36 Sheltering Impact –Hospital Diversion9

37 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?

38 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.

39 References

7. 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/asse ts/docs/searchable/OS/Reports/ 021609ShelterSummitReport.pdf

40 Thank you!

Knox Andress, BA, AD, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospital Preparedness Of (318) 813‐3311; Fax (318) 813‐3318 [email protected]

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