Is your OR prepared for a natural disaster?
Do your hospital disaster drills include natural disasters? What would you do if you lost electricity, steam, and water because of a flood, storm, or other disaster? Do you know about your hospital’s physical plant and how it supports perioperative services?
St Luke’s Hospital in Cedar Rapids, Iowa, faced these challenges when the Cedar River breached its banks in June 2008. Surgical services managers adapted and based on their experience offer advice for others.
“We do disaster drills all the time. Typically, we plan for bus accidents or plane crashes. We had never planned what we would do in case of a flood,” says Janna Petersen, RN, director of surgery operations.
Volunteers help to sandbag at Mercy Medical Center in Cedar Rapids, Iowa, during the June 2008 flood. St Luke’s Hospital became the city’s hub for health care after Mercy evacuated.
Volunteers help to sandbag at Mercy Medical Center in Cedar Rapids, Iowa, during the June 2008 flood. St Luke’s Hospital became the city’s hub for health care after Mercy evacuated.
“The key to our operational success during the disaster was an early response,” says Peg Pickering, RN, director of St Luke’s surgery service lines. St Luke’s set up an emergency command center led by the chief operating officer and chief nursing officer on June 11 as rain kept falling. The command center was staffed 24 hours a day for 2 weeks. The hospital’s plant operations director was in close communication with city officials.
As part of preparedness, the hospital had installed a new 3-tandem emergency generator system the previous year. If 1 generator went out, there were 2 more to take over. The new system included emergency backup for the OR’s temperature control and humidity. Anticipating a loss of power and steam, the hospital ordered a portable boiler, which was operational on June 11.
On the morning of June 12, the hospital lost power when the flood took out headquarters for the city’s power company. The hospital operated on emergency generator power for the next 24 hours. Later that day, the steam plant also went under water. A large electrical generator was received to power chillers not backed up by emergency power.
Meanwhile, Mercy Medical Center, 10 blocks away and on lower ground, lost power and was beginning to take on water. (See August 2008 OR Manager.)
Pickering and Petersen spent much of June 13 and 14 verifying the physical plant’s services so they could respond to the community’s needs.
When Mercy made the decision to evacuate, St Luke’s took over for both, receiving about 52 of Mercy’s patients.
St Luke’s was fortunate that contractors, plumbers, and electricians were on site because of construction. They spent the next 36 hours rerouting the hospital’s plumbing and electricity to the portable boilers. Tankers of potable water also were brought to the hospital in case the city’s pumping stations flooded.
Says Pickering, “We were our own little self-sufficient city. We had our own power and backup water and steam systems.”
The cost was not small. Rental for the electrical generator and 2 boilers ran nearly $65,000 a month. The cost of the diesel fuel for the portable equipment cost $10,000 a day.
“The electrical company had forewarned us that we should plan to be on backup power for a week,” Petersen says.
St Luke’s found office space in the hospital or other buildings for physicians and surgeons who had lost access and power for their office buildings. On June 16, all of those offices opened for business, and St Luke’s began performing surgery for the whole community. Surgeons reprioritized their schedules, and their staffs started rearranging the surgical schedule into one 10-room OR.
Many patients were hard to reach because many were out of their homes. Some could not be reached but arrived at St Luke’s anyway because Mercy was closed. Their procedures were fit into the new schedule.
“We had about 100% room utilization, and operations ran smoothly,” says Peterson.
Surgical cases were limited by the hospital’s inpatient capacity because St Luke’s emergency department was the only one in the area. The endoscopy area was converted to inpatient medical and dialysis units. Endoscopy outpatients were moved to the surgery center 1 block away.
A separate command center managed patient placement and staffing. Nearly 140 staff members were affected by the flood. Many came to work, but more help was needed. Though some of Mercy’s staff were available during the first week after the flood, 20 to 30 traveling nurses were brought in for 3 to 6 weeks.
“Finding housing for a large number of additional staff was another aspect we had not considered in our emergency plan,” says Petersen. The hospital used college dorms not far from the hospital.
To help the affected staff, the hospital’s foundation bought $20,000 worth of $500 gift cards. The hospital staff, matched by funds from the Iowa Health System, raised $677,000, which was distributed through the Christmas holidays to help the affected staff.
“It’s hard to say it was a good experience, but I feel blessed to have been a part of this process, and we definitely feel prepared if another disaster happens,” says Pickering.
–Judith M. Mathias, RN, MA
Emergency preparedness tips for perioperative services:
Know your infrastructure
Collaborating with plant operations is an essential part of disaster planning. Understand your infrastructure and redundancies, such as 3-tandem generators for power. Know where to get boilers and water tankers if needed.
Plan how you will communicate
You must be able to communicate with physicians, staff, off-site services, and other hospitals. Plan how you will communicate without e-mail or office telephones. Cell phones are key.
“We had a few cell phone numbers, but now we have everyone’s,” says Petersen.
During the disaster, runners delivered memos to update managers and staff. Runners were also sent to physicians’ offices to bring them to the hospital for debriefings.
Managers now have numbers for administrators and staff at the city’s other hospital. During the flood, they needed these contacts for information on surgery patients transferred to St Luke’s.
Collaborate
Identify leaders and decision makers early. Have a plan and initiate it. There is no time for meetings and discussions.
Take disaster drills seriously
“During our disaster drills, our safety officer was invaluable at keeping us on task and looking ahead to what could happen in 8 hours and in 24 hours,” Pickering says.
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