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

• Knox Andress, BA, AD, RN, FAEN
• Designated Regional Coordinator
• Louisiana Region 7 Hospital Preparedness
• LSU Health Sciences Center - Shreveport

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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

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(No Transcript)
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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
  missing2
• Estimated 100 billion dollars in LA property
  damage/loss3

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Katrina Predictions and History
6
Canal Breeches

• London Avenue Canal

• Industrial Canal

7
Hurricane Katrina New Orleans
8
Gustav Predictions and History
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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-related5
• Estimated 4.3 billion in LA property damage/loss

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Disaster Declarations in Louisiana

• Katrina Declarations

• Gustav Declarations

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Hurricane Impacts to hospitals

• Katrina
• Wind
• Catastrophic flooding

• Gustav
• Wind
• Minimal flooding

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Gustav Hospital Power Outages6
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
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Gustav Hospital Evacuation Breakdowns6
Hospital Region Partial Evacs Complete Evacs Pre-landfall Post-landfall 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 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
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Louisiana Hospital Evacuations Katrina vs
Gustav6
Hurricane Gustav Pre Storm Post Storm Total
Total Hospital Evacuation 38 7 45
Partial Hospital Evacuation 25 3 28
Total 63 10 73
Hurricane Katrina Pre Storm Post Storm Total
Total Hospital Evacuation 8 26 34
Partial Hospital Evacuation 5 5
Total 13 26 39

Gustav - approximately 1000 patients
evacuated pre-storm
223 patients were evacuated post-storm.
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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,
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Impacting Hospitals Gustav Nursing Home
Power Outages6
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
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Impacting Hospitals - Gustav Nursing Home
Evacuations6
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
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State Regional Infrastructure

• 9 -Louisiana DHH Hospital Preparedness Regions
• Region - Designated Regional Coordinators-
  Hospitals/EMS/ Nursing Homes/Coroners /

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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)
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Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6 Louisiana Transportation Evacuation Requirements for Hospitals6
Hospital Census Details Hospital Census Details Hospital Census Details NDMS Totals NDMS Totals Vehicle Requirements Vehicle Requirements Vehicle Requirements
Regions Post-Discharge Census ICU Census Patients Needing NDMS Evacuation Patients needing Critical Care Transport Teams Ambulances Para-Transit Seats Buses
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
Census is for all hospitals that are SIP 2 or 3,
and not EVAC Tier 1
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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 Lakefront Airport 302 NDMS patients
81 Homebound patients
Regions 3 Moved by ground/air ambulances the NDMS
patients and homebound patients to Region 1
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Repatriation of NDMS patients and Medical
Special Needs evacuees
           
State Number of Patients Total Number Received Total Patients Deceased Total Patients Left to be Received Total Patients in CareFlite 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
Total 560 536 24 0 0
Source DHH Repatriation Call, October 2, 2008
(Kathy Kliebert)
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Planning and ResponsesPre Hurricane Katrina

• 2002
• Tropical Storm Isidore
• Hurricane Lili
• 2003
• DHH Hurricane Annex X
• DHH Hospital Sheltering MOU
• Hospital CEO Hurricane Checklist
• Tropical Storm Bill

• 2004
• Hurricane Pam TTX planning
• Hurricane Ivan
• 2005
• Hurricane Pam TTX
• Hurricane Katrina and Rita AARs
• Hurricane Dennis
• Hurricane Cindy
• Hurricane Katrina
• Hurricane Rita

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Planning and Responses Post Hurricane Katrina7

• 2007
• 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

• 2006
• Medical Institution Evacuation Plan (MIEP)
• EMSystems 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
• Tropical Storm Alberto
• Hurricane Ernesto

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Planning and Response Post Hurricane Katrina7

• 2008
• 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

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Primary and Secondary Hurricane Hospital
Impacts

• Primary system impacts come from evacuating
  hospital processes.
• Secondary system impacts originate from
  supporting
• evacuating hospitals and
• sheltering evacuee population

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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

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Louisianas Region 7
Shreveport Bossier City
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Louisiana Region 7Demographics

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

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Region 7 Hospitals in 9 Parishes

• CLAIRBORNE PARISH
• Homer Memorial Hospital (T1)

• CHRISTUS Schumpert Highland (T1)
• Doctors Hospital of Shreveport (T2)
• Dubuis Hospital of Shreveport (T2)
• Promise Hospital of Shreveport (T2)
• LifeCare Hospital (T2)
• LSU-Health Sciences Center (T1)
• North Caddo Medical Center (T1)
• Overton Brooks VA Medical Center (T1)
• Specialists Hospital of Shreveport (T2)
• Shriners Hospitals for Children- Shreveport
  (T2)
• Willis-Knighton Medical Center (T1)
• Willis Knighton Pierremont Health Center (T1)
• Willis-Knighton Health System South (T1)

• DESOTO PARISH
• DeSoto Regional MC (T1)

• NATCHITOCHES PARISH
• Natchitoches Regional Med Center (T1)
• Natchitoches Parish Extended Extended Care (T2)

• BIENVILLE PARISH
• Bienville Medical Center (T2)

• RED RIVER PARISH
• CHRISTUS Coushatta (T1)

• BOSSIER PARISH
• Bossier Specialty Hospital (T2)
• Cornerstone Hospital (T2)
• Willis-Knighton Bossier (T1)

• SABINE PARISH
• Sabine Medical Center (T1)

• WEBSTER PARISH
• Minden Medical Center (T1)
• Springhill Medical Center (T1)

• CADDO PARISH
• Brentwood, A Behavior Health Company (T2)
• CHRISTUS Schumpert St Mary Place (T1)

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Shelters in Region 7sShreveport and Bossier
City

• Katrina Shelters

• Gustav Shelters

• General Shelters
• LSU Shreveport
• Hirsh Coliseum
• CenturyTel Civic Center
• Southern University
• Expo Hall
• Special Medical Needs Shelters
• Bossier Civic Center

• General Shelters
• LSU Shreveport
• Southern University
• Riverview Center
• Century Tel Civic Center
• Hirsh Coliseum
• Critical Transportation Needs Shelters
• Sams Club
• The Sports Outlet Mall
• Special Medical Needs Shelters
• Bossier Civic Center

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Evacuees Reported in LA Region 7 Hospitals8
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Region 7/ Gustav Hospital Evacuee Patients Came
From
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EMS Transports Shelters to Shreveport- Bossier
City Hospitals
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Daily EMS Transports - Shelters to Shreveport
Bossier City Hospitals
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Shelter Transports Complaint Types
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Sheltering Impact Hospital Diversion9
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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?

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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 _at_ www.dhh.louisiana.gov/offices/p
   age.asp?ID192Detail5238
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.

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References

• Hurricane Information for Hospitals HHS
  Emergency Preparedness Louisiana Hospital
  Association accessed January 28, 2009
  www.lhaonline.org/displaycommon.cfm?an1subarticl
  ebr337
• Hurricane Gustav and Ike, Region 7 Hospitals
  After-Action-Report Shriners Hospital for
  Children October 9, 2008 Shreveport, LA
• ED Status Report Shreveport-Bossier City Tier 1
  hospitals, EMSystem EMResource, for August 28
  September 6, 2008
• 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/021609ShelterSummitReport.pdf

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Thank you!

• Knox Andress, BA, AD, RN, FAEN
• Designated Regional Coordinator
• Louisiana Region 7 Hospital Preparedness
• Of [phone] Fax [phone]
• wandr1_at_lsuhsc.edu