The National Emergency Management Summit Louisiana Hospital Responses

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

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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 missing 2 – Estimated 100 billion dollars in LA property damage/loss 3 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 – (Central coastal Louisiana); “Category 2” w/ 105 mph winds – Louisiana storm surges: 10 – 14 feet. – Levee “topping” - No (0) levee breaks – Louisiana Fatalities: 48 storm-related 5 – Estimated 4. 3 billion in LA property damage/loss 9

Disaster Declarations in Louisiana • Katrina Declarations • Gustav Declarations 10

Hurricane Impacts to hospitals • Katrina – Wind – Catastrophic flooding • Gustav – Wind – Minimal flooding 11

Gustav: Hospital Power Outages 6 Hospital Region Hospitals (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 Breakdowns 6 Hospital Region Partial Evacs Complete Evacs Prelandfall Postlandfall Pre + 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 7 0 0 0 8 0 0 0 9 5 7 10 2 12 TOTAL 28 45 57 10 67 13

Louisiana Hospital Evacuations – Katrina vs Gustav 6 Hurricane Katrina Pre Storm Post Storm Total Hurricane Gustav* Pre Storm Post Storm Total Hospital Evacuation 8 26 34 Total Hospital Evacuation 38 7 45 Partial Hospital Evacuation 5 5 Partial Hospital Evacuation 25 3 28 Total 13 39 Total 63 10 73 26 *Gustav - approximately 1000 patients evacuated pre-storm; 223 patients were evacuated post-storm. 14

Hospital Evacuation Times Hurricane Rita – September 2005 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 Evacuations 6 Hurricane Gustav Pre Storm Post Storm Total Complete Evacuation 94 2 96 Partial Evacuation 0 0 0 Total 94 2 96 8, 401 residents evacuated pre-storm; 160 residents evacuated post-storm 17

State Regional Infrastructure Ø Ø 9 -Louisiana DHH Hospital Preparedness Region - Designated Regional Coordinators. Hospitals/EMS/ Nursing Homes/Coroners /… 18

Medical Institution Evacuation Plan War-Game Numbers of potential throughput 6 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 343 - high - 1063 (reasonable “worst case” planning scenarios) 19

Louisiana: Transportation Evacuation Requirements for Hospitals 6 Hospital Census Details NDMS Totals Post. Discharge Census ICU Census Patients Needing NDMS Evacuation 798 59 268 3, 4 316 27 4, 5 601 40 Regions 1, 3, 9 Patients needing Critical Care Transport Teams Vehicle Requirements Ambulances Para. Transit Seats Buses 18 91 264 14 168 10 42 112 1 207 8 68 207 5 Census is for all hospitals that are SIP 2 or 3, and not EVAC Tier 1 20

GUSTAV Medical Institution Evacuation: August 31, 2008 6 • State/ hospitals waited for almost two days before C-130 s 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 3 Moved by ground/air ambulances the NDMS patients and homebound patients to Region 1 Regions 1 AMP Lakefront Airport 302 NDMS patients 81 Homebound patients 21

Repatriation of NDMS patients and Medical Special Needs evacuees Number of Patients Total Number Received Total Patients Deceased Total Patients Left to be Received Total Patients in Care. Flite Que 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 0 560 536 24 0 0 State Total Source: DHH Repatriation Call, October 2, 2008 (Kathy Kliebert) 22

Planning and Responses: Pre Hurricane Katrina • 2002 1. 2. Tropical Storm “Isidore” Hurricane “Lili” • 2003 1. 2. 3. 4. DHH Hurricane Annex “X” DHH – Hospital – Sheltering MOU Hospital CEO Hurricane Checklist Tropical Storm “Bill” • 2004 1. Hurricane “Pam” TTX planning 1. Hurricane “Ivan” • 2005 1. 2. Hurricane “Pam” TTX Hurricane Katrina and Rita AARs 1. 2. 3. 4. Hurricane “Dennis” Hurricane “Cindy” Hurricane “Katrina” Hurricane “Rita” 23

Planning and Responses: Post Hurricane Katrina 7 • 2006 1. 2. 3. 4. 5. 6. 7. 8. 9. Medical Institution Evacuation Plan (MIEP) EMSystem’s – EMResource Patient Tracking Plan “H-Hour Calculator” Louisiana Hospital Emergency Preparedness Network Louisiana/Federal Joint Response Plan EMS DRCs Nursing Home DRCs Katrina and Rita AARs 10. Tropical Storm “Alberto” 11. Hurricane “Ernesto” • 2007 1. 2. 3. 4. 5. 6. 7. 8. 9. 1. 2. 3. Region 1 and 9 MIEP Exercise Region 3 MIEP Exercise Region 5 MIEP Exercise State-wide Hurricane Exercise Louisiana/Federal Joint Response Plan Update Neonatal Evacuation Form Psychiatric Patient Movement Form Private Patient Movement Form Shelter-in-Place Recommendations Hurricane “Dean” Tropical Storm “Humberto” Tropical Depression #10 24

Planning and Response: Post Hurricane Katrina 7 • 2008 1. 2. 3. 4. 5. 6. 7. 8. 1. 2. 3. Regions 1, 3, and 9 MIEP Exercise Region 4 MIEP Exercise State-wide Hurricane Exercise Hospital Aeromedical Transfer Form Neonatal Transfer form Patient Locator Credentialing Procedures for LPNs, RNs, and MDs Hurricane “Gustav” and “Ike” AARs Tropical Storm “Eduard” Hurricane “Gustav” 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 & Bossier City Claiborne Bossier Webster Caddo Bienville De Soto Red River Natchitoches Sabine 28

Louisiana Region 7: Demographics General Demographics: Ø Region Population: 524, 000 (Census 2000) Ø Largest city - Shreveport: 200, 145 (Census 2000) Ø Planning for surging 264 (500/100, 000) Ø Parishes: 9 in Northwest Louisiana Ø Number of hospitals: 28 (17 “Tier 1” and “ 11 Tier 2”) (Tier 1 = hospitals with emergency departments; Tier 2 = all other hospitals) 29

Region 7 Hospitals in 9 Parishes Claiborne Bossier Webster Caddo Bienville De Soto Red River • CHRISTUS Schumpert Highland (T 1) CLAIRBORNE PARISH • Doctors’ Hospital of Shreveport (T 2) • Homer Memorial Hospital (T 1) DESOTO PARISH • Dubuis Hospital of Shreveport (T 2) • Promise Hospital of Shreveport (T 2) • Life. Care Hospital (T 2) Sabine Natchitoches • LSU-Health Sciences Center (T 1) • North Caddo Medical Center (T 1) BIENVILLE PARISH • Overton Brooks VA Medical Center (T 1) • Bienville Medical Center (T 2) • Specialists Hospital of Shreveport (T 2) BOSSIER PARISH • Shriners Hospitals for Children. Shreveport (T 2) • Bossier Specialty Hospital (T 2) • Cornerstone Hospital (T 2) • Willis-Knighton Bossier (T 1) CADDO PARISH • Brentwood, A Behavior Health Company (T 2) • CHRISTUS Schumpert St Mary Place (T 1) • De. Soto Regional MC (T 1) NATCHITOCHES PARISH • Natchitoches Regional Med Center (T 1) • Natchitoches Parish Extended Care (T 2) RED RIVER PARISH • CHRISTUS Coushatta (T 1) • Willis-Knighton Medical Center (T 1) SABINE PARISH • Willis Knighton Pierremont Health Center (T 1) • Sabine Medical Center (T 1) • Willis-Knighton Health System South (T 1) • Minden Medical Center (T 1) WEBSTER PARISH • Springhill Medical Center (T 1) T 1 = hospitals w EDs; T 2 = all other hospitals 30

Shelters in: Region 7’s Shreveport and Bossier City Katrina Shelters • General Shelters 1. 2. 3. 4. 5. • LSU – Shreveport Hirsh Coliseum Century. Tel Civic Center Southern University Expo Hall Special Medical Needs Shelters 1. Bossier Civic Center Gustav Shelters • General Shelters 1. 2. 3. 4. 5. LSU – Shreveport Southern University Riverview Center Century Tel Civic Center Hirsh Coliseum 1. 2. Sam’s Club The Sports Outlet Mall 1. Bossier Civic Center • Critical Transportation Needs Shelters • Special Medical Needs Shelters 31

Evacuees Reported in LA Region 7 Hospitals 8 25 1200 Hospitals with Evacuees in Hospitals 1033 21 1000 20 15 765 800 15 Hospitals with Evacuees 600 Number of Evacuees in Hospitals 10 400 5 200 0 0 Katrina Gustav 32

Region 7/ Gustav Hospital Evacuee Patients Came From… 33

EMS Transports: Shelters to Shreveport- Bossier City Hospitals 34

Daily EMS Transports - Shelters to Shreveport – Bossier City Hospitals 35

Shelter Transports – Complaint Types 36

Sheltering Impact – Hospital Diversion 9 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. 2. 3. 4. 5. 6. Knabb, R; Rhane, J; Brown, D; Tropical Cyclone Report, National Hurricane Center, December 20, 2005 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 Louisiana Recovery Authority, Briefing, August 24, 2007 Brown, J; Kimberlain, T; Tropical Cyclone Report, National Hurricane Center, January 22, 2009 Hurricane Gustav; Wikipedia; accessed Feb 13, 2009, www. wikipedia. org/wiki/Hurricane_Gustav_(2008) 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/assets/docs/searchable/OS/Reports/ 021609 Shelter. Summit. Report. 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 wandr 1@lsuhsc. edu 41