T-Minus 3, 2, 1…

Turns out that South Carolina is having a busy hurricane season. Just days ago, Charleston County was under a mandatory evacuation in anticipation of Hurricane Matthew. All I-26 lanes were converted into westbound traffic, gas stations were running low on fuel and the local Wal-Mart was out of bottled water. It was T-minus 3 days to the landfall of Hurricane Matthew, with very variable predictions on the trajectory, speed and strength. In the meantime, hurried preparations were being put in place for patients and care team members alike at the Medical University of South Carolina Hospital.

It is times like this that I am reminded of the selfless and stoic nature of healthcare team members. Countless numbers of our team stayed in town and prepared to “defend in place” for an unknown period of time. Many of us were separated from friends and family, unable to look after our kids, homes or pets. But without question, those on the “A” (essential personnel) team reported for duty without a complaint, accepting that this was par for the course for working in an acute care facility. It is times like this that we should reminded of why we are afforded such respect in our society.

T-minus 2, and the storm loomed towards Florida, with several different models predicting vastly different outcomes for Charleston, ranging from a tropical storm to a Category 3 hurricane. Team A remained in high spirits, as we all tried to figure out how we were going to eat and sleep for the next several days. Some inpatient units from the older buildings moved to completely new areas of other buildings, concerned about the integrity of large windows and leaking ceilings. All units double-checked their water supplies, battery stocks and flashlights; facilities and engineering staff ensured emergency plugs were functional and generators were backing up if needed.

Any potential patient discharges were fast tracked; outside hospitals continued to call for transfers into Charleston, as many other hospitals were evacuating up and down the coast. Some patients did not have a family or safe housing to be discharged to, so they were stuck for the duration of the storm. Home health agencies, nursing homes and assisted living facilities all evacuated, bringing some to the ED who were not fit for travel or who otherwise would not make it through the storm. As such, our census remained high – around 600 patients – to care for, regardless of what happens. There was a slightly anxious air about the place, while we all kept ourselves busy to distract us from thinking too much about the possibilities to come.

T-minus 1, and the storm continued on a volatile path, making plans more and more difficult to create and implement. The tidal surge is predicted to be much higher than expected – upwards of 10-11 feet. Noting that most of the Charleston peninsula is at (or even below) sea level, we feared this could pose a major problem for most of the facilities. The campus ambulatory clinic is ~9 feet at it’s entrance, so all first floor equipment and medications were moved to higher ground, including a large fixed pharmacy robot (which is hoisted onto a palate, the best we can do). The first floor of the inpatient psychiatric hospital houses the senior care unit, the most complex and least ambulatory patients in the building. Half were relocated to other units, and the other half stayed and waited to see what the water level will do. The emergency departments, dialysis units and bronchoscopy labs all moved their equipment and supplies from the first to the second floor in case of a water surge into the building. The moving was calm, steady, and quiet. Many care team members tried to sleep in conference rooms and auditoriums on cots. All we could do was wait for the rain, wind and tide to rise…

T-minus 0, and the wind was sustained at 60 mph, with 100 mph maximum gusts and heavy rain for several hours. This was far better than expected and resulted in only minimal tree and building damage. The tidal surge recedes and the rainfall waned, long before the 1pm high tide. All first level floors remained dry! Roof and window leaks, however, abounded, with endless work for the facilities and environmental services crews. A few windows were blown out, and a few elevator shafts took on water. But all in all, our buildings, patients and care team members fared extremely well. But there was no rest for the weary… Team A remained, as the evacuation had not lifted, with most major bridges closed for inspection and many major roads filled with flooding and debris. It would be another 24 hours before relief arrived, equipment and patients could be moved back to their original places and roofs and leaks could be patched and repaired.

Living in a coastal town, this is not the first or last incident command center our hospital team will experience. They’re filled with phone lines, sugary snacks, old coffee, competing TV screens, mixed emotions, projecting best and worst scenarios, avoiding under- and over-staffing, hoping we don’t run out of water or linens and ultimately trying to keep a positive attitude and project confidence, while fighting off uncertainty and fatigue.

But there is no better “team building exercise” than a hurricane incident command center. There are no silos, competing interests or hidden motives. Only clear communication, respectful tones and companionship. Saint Matthew’s name is interpreted as “a gift hastily given”; I view this event as a strange and unwelcome but important gift for our team, long overdue and never to be taken for granted.

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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