By Kristin Rothwell, NurseZone feature writer
Friday, June 8, 2001, will always be remembered in the minds of those who endured the pandemonium brought on by Tropical Storm Allison in Houston, Texas. Among the affected were the nurses, staff and administrators at Texas Children’s Hospital Integrated Delivery System. They worked tirelessly—non-stop for 24 hours—to continue providing service to the patients, all the while alert to the new dangers from the storm, knowing it was their duty to maintain a calm and safe environment.
Calm Before the Storm
On Tuesday, June 5, Tropical Storm Allison began making its way along the Gulf Coast of Mexico. Aware of the storm but unsure of its wrath, Texas Children’s Hospital’s Pat Perry, vice president for information services and the administrator on-call for the week, issued the first Carla Alert (the hospital’s emergency response code named after Hurricane Carla, which hit Houston in 1961) to notify staff of the approaching storm.
In preparation for the worst, staff rushed to put scrubs together, stocked food and made hotel arrangements (for staff to stay at during their breaks or in case they couldn’t drive home due to flooding). However, the storm moved north and the Carla Alert was cancelled the following morning.
“By Friday we were all exhausted, saying, ‘Thank god, this week’s over,’ ” said Dana Nicholson, RN, MSN, MBA, director of special care areas at Texas Children’s.
But it wasn’t quite over yet…
“Houston, We’ve Got a Problem…”
Early Friday evening, phone calls began to pour in from hospital staff who warned that they wouldn’t be able to make it to work, the storm was returning. Texas Children’s administrators on-call immediately began determining what steps should be taken.
“Since a Carla had been called on Tuesday, we were a little ‘gun-shy’ now,” said Nicholson. “Nevertheless, staff were held from going home and by 8:30 p.m. an alert was called. By this time, there were only two units that had day shift staff remaining who were able to stay the night.”
Taking every precaution for what was to come, hotels were arranged once again, food was stocked, toiletries (toothbrushes, toothpaste and deodorant) were purchased and calls were made (to staff members scheduled for Saturday and those listed on the Carla directory) to request that they take registered rooms at the nearby hotels.
Meanwhile the storm raged.
Outside of the hospital, flash flooding was causing a nearby bayou to white-cap and the rain wasn’t letting up. By 1:42 a.m., a full CARLA Alert was dispatched. And everything was about to get worse.
The Drama Never Seems to End
The nearly 200 staff members who took refuge at nearby hotels, which were just two blocks from Texas Children’s, were stranded. The streets between the hotels and the hospital were flooded. Coach buses that had been reserved by Texas Children’s to bring medical personnel to and from the hotels were flooded. And several staff members who had been called to work were stuck on roads that had turned into lakes. This meant that staff who had begun their shifts on Friday would have to continue to work through Saturday.
Things were really heating up.
Susan M. Distefano, RN, MS, vice president of patient services, was at the center of planning and strategizing the next steps.
“Under these tight conditions, the staff managers met with the medical residents to ask that they reduce patient care orders to minimal needs and work at crisis level—only providing medication, patient assessment and procedures to those patients most in need,” said Nicholson. “Charge nurses were asked to put half of their staff to bed and to get patient care needs down to the basics.” The staff would sleep in four hour blocks within the hospital.
Staff at Texas Children’s soon discovered they weren’t the only hospital enduring flood problems.
A Houston fireman, whose truck had stalled in the rising waters outside the hospital while en route to an accident scene, informed staff at Texas Children’s Emergency Center that Memorial Hermann Hospital, which is also located within the Texas Medical Center, was in the process of “losing everything and needed to evacuate.” Texas Children’s immediately went on standby to receive patients from Memorial Hermann. However, when Texas Children’s attempted to notify Hermann that it could take in patients, Hermann had already lost all communication.
And when it seemed that conditions couldn’t get any worse, smoke began seeping through the vents. But from where? The hospital lost most of its power and was now running on emergency generators—leaving some areas without any lights. Since there was no where for people to go and no way to call the fire department, Texas Children’s relied on its own staff. Traversing the dark hallways with flashlights, facilities personnel found the source of the smoke. It was caused by the diesel fuel running the emergency generators.
Just as one issue was being resolved another issue would arise.
Water began flowing into Texas Children’s basement where the telemedicine equipment was stored.
“Though only three inches of water had come into the basement, we didn’t know if it was going to get worse,” said Nicholson. “The flood doors had been dropped early at our hospital but water was still coming in, so we quickly began moving the equipment out of the basement.
“When we returned to the command center, there was concern that we were going to lose emergency generated power in the Abercrombie Building (a member of the Texas Children’s campus).”
This meant patients from all of Abercrombie’s Level II (premature nursery) neonatal unit would have to be evacuated to the West Towers (a member of the Texas Children’s campus) Level III neonatal intensive care unit.
“Within 15 minutes, 22 babies were evacuated—each staff member carrying two—first checking name bands and grabbing charts before taking them to the NICU,” said Nicholson. “Not even 10 minutes after evacuating the babies, [the Abercrombie building] lost all power.”
But it didn’t stop there.
One of the telephone switch closets located on the B1 floor of the Abercrombie building, which was still generating power, was close to where water was beginning to seep in. Since Texas Children’s couldn’t afford to lose its communications system, staff members began loading sand bags obtained from outside the hospital to protect the closet.
“But when we looked down the hall, we saw that our efforts would soon be lost,” said Nicholson. “Water was rolling down the hallway towards the switch closet.”
In the midst of all of this, Texas Children’s had also lost the use of the elevators in the 20-floor high-rise.
“Though we were losing one thing after another, we were still thinking about Memorial Hermann that had lost all power and the ability to make outside contact,” Nicholson said.
Meanwhile, medical staff were arranging a system to prioritize patients—setting up a bagging system for those children who would need oxygen manually if ventilators stopped working, then waking up and asking for help from family members. "We made the arrangements, but fortunately we did not have to use the plan" said Nicholson.
Going the Extra Mile
By 6 a.m. on Saturday, Texas Children’s was sustaining on emergency lighting, but was still without access to elevators, water or the use of air conditioning. Since Allison was a tropical storm, temperatures were in the high ‘70s with heavy humidity. The storm dropped 20 inches of water between Friday and Sunday.
“It was like being in a third world country,” said Nicholson. “People were sleeping in hallways. It was hot and everyone was just pouring with sweat—especially since they were helping to carry things up and down the stairs.”
Between 9 a.m. and noon, many hospital staff members were making their way to work to help Texas Children’s get back on track.
One staff member rode his bike as far as he could from home and then walked/waded through almost five feet of water to get to work.
“A lot of people made heroic efforts to get to work, especially knowing that their peers had been there all night,” said Nicholson. “Several employees flooded their own cars to get to work. About 80 cars and 40 homes owned by Texas Children’s staff were destroyed by the floods that night.”
But spirits remained high.
Non-medical staff, including patients’ family members, formed a human chain in the stairwells to carry boxes of food that had been stocked and/or donated by local restaurants to each floor. A daycare center was set up for hospital personnel who could get to the hospital but needed a place to bring their children while they did their jobs.
“We really encourage hospitals to set up a daycare in disaster situations ,” said Nicholson. “It really helped staff members feel secure and comfortable.”
Several members of Texas Children’s staff helped manually carry water and feed food to the patients and their families. Mark A. Wallace, president and chief executive officer, made a plea to the press asking that community members please bring batteries, flashlights, pumps and diesel to continue running the emergency generators.
One local woman brought bags upon bags of sportswear for the nursing staff while another woman brought hundreds of batteries and flashlights. Others brought food, pumps and fuel.
“There was a heartfelt response,” said Nicholson. “People would come by, drop off their goods and drive away. We don’t even know who they were.”
Lessons Learned
Following the first Carla called on Tuesday, a meeting was held to discuss emergency plans that needed to be modified.
“What we didn’t know is that these plans needed to be modified 36 hours later,” said Nicholson. “There were lessons to be learned and we were blessed to have had the experience from Tuesday night. Probably the best lesson learned is to be proactive—calling the Carla early and making plans every step of the way including, what we could lose next and what we would do if we lost use of the elevators and water.
“Texas Children’s will have no problem calling a Carla now,” said Nicholson.
In fact, Texas Children’s pediatric census stood at 415 patients, well over the hospital’s maximum capacity, mainly because the hospital was unable to discharge any patients due to the flooded streets. Despite being overpopulated, Texas Children’s accepted 22 critically ill adult patients from nearby St. Luke’s Episcopal Hospital and two bone marrow transplant patients from The Methodist Hospital.
“It might have been a once in a lifetime experience but the camaraderie that we got out of it was unbelievable,” said Nicholson.
“We all lived a different experience that night,” she said. “I’ve never experienced anything like it and I hope never to again—none of us do.”
The Carla alert was lifted on Sun., June 10 at 4:19 p.m.
August 24, 2001© 2001 NurseZone.com. All Rights Reserved.