Planning keeps patients safe in the face of extreme storms

Tampa General Hospital facilities staff anchor the AquaFence into the concrete along the hospital’s perimeter in preparation for hurricane season.

Image courtesy of Tampa General Hospital

Earlier this year, the National Oceanic and Atmospheric Administration predicted an 85% chance that the 2024 Atlantic hurricane season would be above normal, and it was right.

In what is considered a normal year, the Atlantic hurricane season spanning from June 1 to Nov. 30 produces about three major hurricanes of a Category 3 or higher. As of press time, four major hurricanes have hit the Southeast United States, with more than a month left before the season ends.

Two of those hurricanes, Helene and Milton, made landfall in the U.S. within two weeks of each other, prompting hospitals to make crucial decisions to either pre-evacuate and suspend services or to continue services and activate emergency management plans if necessary.

Activating an evacuation

The 10-bed Unicoi County Hospital, based in Erwin, Tenn., and part of the Ballad Health system, decided to continue services for its small Appalachian community, knowing that it had well-rehearsed evacuation plans in place in case of flooding.

The hospital was built in 2018 at the same elevation level of a nearby interstate to protect against possible flooding from the Nolichucky River, which typically sits at a depth of around 2 feet. On Sept. 27, when Hurricane Helene hit, the river crested at nearly 34 feet, almost 10 feet higher than its former record hit in 1901. The Unicoi County Emergency Management Agency sent notice to the hospital to evacuate.

But the surrounding flooding occurred so quickly that ambulances could not safely approach the facility. The hospital’s leadership and the Tennessee Emergency Management Agency moved to its backup plan to evacuate via swift-water rescue boat, but the fast-moving water rendered that solution impossible.

Molly Luton, Ballad Health’s chief marketing and communications officer, says the river was running at more than 1.4 million gallons per second. Niagara Falls, for comparison, runs at 700,000 gallons per second, she says. The Tennessee Valley Authority, a local electricity provider, called the flood a 1-in-5,000-year event, which means there was less than a 0.02% chance of this occurring.

With ground and boat evacuation no longer viable, the hospital swiftly moved to evacuate by helicopter instead. By 12:27 p.m., the hospital safely moved staff and patients to the roof of the building as water surrounded much of the floors beneath. However, the high winds created such a hazard that helicopters could not immediately fly safely to the area. Forty-three staff cared for 11 patients upon the rooftop until three Blackhawk helicopters were able to evacuate everyone safely four hours later.

Luton says regular evacuation drills and disaster preparedness exercises with local emergency management and first responders helped prepare the hospital’s staff for an event that not many conceived would occur. Communication, she says, played a crucial role in the rescue.

“The incident commander on-site, also a practicing emergency medicine physician and Eagle Scout, Dr. Sean Ochsenbein, and hospital administrator and nurse Jennifer Harrah remained in communications with the Ballad Health Corporate Emergency Operations Center and, together with the local emergency management team, assessed the developing situation and did what was best to keep civilians safe,” she says. “Innumerous individuals were required to help safely evacuate patients, team members and civil servants from the rooftop of Unicoi County Hospital on Sept. 27, but together, the calm, methodical thinking of leaders who put service above self and the cooperation of community saved lives that day.”

The hospital remains closed until further notice while Ballad Health assesses damages and develops a permanent plan to continue serving its community. In the interim, patients are being treated at one of the health system’s 24/7 advanced urgent care centers, which is staffed by Unicoi County Hospital employees.

While Unicoi County Hospital is located in an area where hurricanes as strong as Helene are not as frequent, other Southeastern states are more accustomed to the heavy rains and winds that come with a Category 3 or higher.

Hospitals in Florida, for instance, which were also hit by Hurricane Helene and then two weeks later by Hurricane Milton, report extensive preparations ahead of hurricane season with the aim of remaining operational.

That was the plan for HCA Florida Largo Hospital, part of the HCA Healthcare West Florida Division. While five of its sister hospitals along Florida’s west coast were in mandatory evacuation zones and transferred patients via air and ground, Largo Hospital remained open during the storm. However, it moved forward with evacuating 236 inpatients when the overflow of a nearby lake resulted in flash flooding in the hospital’s basement, where critical power infrastructure is housed.

In the days preceding Hurricane Milton, staff performed internal sheltering and evacuation drills and moved all intensive care unit patients to interior locations on the ground floor to streamline a potential evacuation.

“The live drills involved moving patients, which proved to be extremely beneficial,” says HCA Florida Largo Hospital Chief Executive Officer Sebastian Strom. “Strong relationships with local government and emergency management officials, supported by HCA Enterprise Emergency Operations coupled with access to sister hospitals and a centralized transfer center, all contributed to the successful evacuation.

“Once all patients were safely transferred, the hospital closed for repairs, and remediation teams are now on-site,” Strom continues. “Ahead of the storm, HCA Healthcare prepositioned construction materials and remediation teams in the area to support a quick response to any impacted hospitals.”

The hospital opened a mobile medical unit on its property to provide emergency services to the community and plans to reopen its emergency department in November and the rest of the hospital in early December. 

Weathering the storm

Another Florida hospital, Tampa (Fla.) General Hospital (TGH), was able to weather both storms and remain operational with the help of a modular floodwall called the AquaFence, an industrial-grade protection system created by a Norwegian company of the same name. TGH purchased an AquaFence back in 2019.

The water-impermeable barrier can withstand storm surge up to 15 feet above sea level. Last year, TGH worked to further strengthen the system by installing resin anchors and concrete attachment points to prevent the floodwall from lifting. It took the facilities management staff three days to install the AquaFence ahead of the impending hurricanes Helene and Milton, but it was well worth it.

After Hurricane Milton, officials at the 981-bed hospital report experiencing only minor leaks that did not affect patient care and were “not unexpected given the severity of the weather experienced in this region,” a hospital official says.

Once the threat of a storm surge subsides, TGH’s protocol is to reopen pathways and resume normal service hours to the public but keep the majority of the floodwall in place for the remaining hurricane season and close any pathways before a storm hits.

“Preparing for Hurricane Milton was an incredible effort by the entire team and a true test of our resources, but it ensured we could continue to provide exceptional care for our patients in a high-quality, safe and uninterrupted environment before, during and after the storm,” says John Couris, president and CEO of TGH. “Tampa General is open to support communities impacted and particularly our first responders.”