As winds exceeding 100 miles per hour and rising floodwaters swept through the Houston area during Hurricane Harvey’s destruction, operations were up and running at St. Joseph Medical Center.

The hurricane lasted for five days, but the hospital never shut down or lost power. It did, however, experience its fair share of challenges, including a staffing shortage, working without an MR scanner and the need to expand emergency services.

“Our census here grew dramatically,” Mary Posern, director of cardiology and imaging services at St. Joseph Medical Center, told HealthCare Business News. “A lot of people who were sick ended up with us because there was nowhere else to go. Imaging was pretty extensive during the storm.”

The summer of 2017 will be remembered as one in which the U.S. took an historic beating from hurricanes. First, Harvey rolled into Texas, making landfall on Aug. 25. Irma followed roughly two weeks later in Florida, and on Sept. 20 Maria began clobbering Puerto Rico.

For Texas and Florida, mobile imaging units have played a vital role in keeping radiology departments up and running. Companies like Shared Medical Services were busy working with customers to secure mobile fleets, pulling units to higher ground to avoid water damage and making sure that in-house units were securely bolted down.

When Irma hit Florida, Paul Zahn, director of sales and interim services at Shared Medical Services, says the company was unable to retrieve one of its mobile CT units because of the hurricane.

“We tried to get it out, but we couldn’t get any drivers down there that would have got it out in time to where we wanted it,” says Zahn.

Luckily, the system was protected by a building it was tucked behind and was in Miami, avoiding the full impact of the storm, the brunt of which fell upon the west coast of the Sunshine State.

Hospitals, their imaging departments and mobile imaging companies are still picking up the pieces in the wake of these natural disasters, but many important lessons have already emerged. The front-line successes and failures of individuals who worked together to keep patients safe and equipment operable during and after the wet summer of 2017 will pave the way for smarter emergency decision-making when the next big hurricane makes landfall.

The calm before the storm
The key for any imaging or radiology work area in the path of a storm is to have a game plan in advance, according to Brad Felt, director of service for service provider GE Healthcare in Florida.

He and his team began phoning and advising their customers days before Irma arrived on how best to protect equipment. These suggestions included moving portable equipment above ground floors and placing devices in different rooms to prevent all from incurring damage in one area.

“Make sure you have contingencies in place for what large storms like Hurricane Irma can mean in terms of flooding, water intrusion from above and windows, wind damage, hospital structural damage and long-term power outages,” he told HCB News. “Think about what the imaging department expectations are in the event the hospital needs to be evacuated either before the storm or possibly after the storm due to damage or complete power loss.”

The team also traveled to customer sites to assess equipment – particularly MR units, which are vulnerable during long-term power outages because of their superconductivity and dependence on liquid helium – and advised clients on post-storm tactics for equipment protection should the team be delayed from returning due to mandatory evacuations or unsafe road conditions.

Mobile imaging companies followed a similar protocol, working with customers in Texas and Florida days before the storms arrived to retrieve mobile units and relocate them to higher ground or areas outside the storms’ reach.

Insight Imaging, a provider of mobile imaging solutions, assessed units in the potential path of both storms and relocated them to storage areas. Customers with bolted down fixed units were advised to keep emergency power equipment nearby while other units that could not be taken from harm’s way were placed between buildings and held down with hurricane straps.

“There are always variables that you can’t take into account,” Steve Richter, senior vice president and general manager of the mobile division at Insight Imaging, told HCB News. “We just made sure that any unit that we could get out we got out of the path of the storm and then tried to get back in as fast as possible to service our customers.”

Imaging and radiology departments also planned ahead by consulting and bringing in staff members in advance, relocating equipment and making plans to counter anticipated damage.

St. Joseph Medical Center, for example, put in place alternative plans to move operations if wind from Harvey disrupted the ability to use walkways that join buildings of the hospital.

“I spoke to the facilities engineer here because I had never been in this building and asked, ‘What are the things that I need to know way out in advance, about 48 hours in advance?’ ” says St. Joseph’s Posern.

Barbara Gonzalez-Falla, a practice director at Singleton Associates, a Radiology Partners practice in Texas, says that hospitals usually have a standard protocol for assessing needs during disasters.

“Hospitals are well prepared for natural disasters and have inclement weather policies that keep existing staff in the hospital until relief is able to get into the facility,” she says. “These policies are put in place for emergencies like this and to prevent interruption in patient care.”

Facing the beast
Tampa Community Hospital was one of many that shut down during Hurricane Irma, with staff ordered to leave in advance of the storm by Hillsborough County officials through the initiation of a Flood Zone A evacuation order.

“Fortunately, Hurricane Irma had a minimal effect in Hillsborough County and the hospital was able to reopen with no significant damage to the facility and patients returned the day following the storm,” E. Dianne Cueto, director of diagnostic imaging, respiratory therapy and EEG at Tampa Community Hospital, told HCB News.

Other facilities were not as fortunate.

Sugar Land Surgical Hospital in Texas closed for three days while Memorial Hermann Pasadena Imaging Center, also in Texas, was closed for 17 consecutive days.

Shutdowns such as these not only endanger people who are sick or in need of aid from disaster-related injuries, but also put increased pressure on providers that are able to stay open, providing medical care to a higher volume of patients, often with limited resources.

The closing of hospitals throughout Houston and other parts of Texas led to an influx of patients seeking treatment at St. Joseph Medical Center.

Facing the need to extend emergency services, the nursing department set up a triage site in the bay, or loading dock, and brought in a portable Philips DR X-ray to assess patients. The hospital’s IT department then extended its wireless connection to the area so that DR images could be transmitted to the PACS system.

“We would have had to take them from the bay, up the elevator, to the imaging suite that was in our ER,” said Posern. “This way, it was point of service and it made things flow much better.”

She says that imaging, particularly the portable X-ray, played a significant role in assessing and treating storm-related injuries.

“What we saw was a lot of orthopedic injuries from people walking in water and trying to do things they normally don’t do fast to get out of trouble,” she said. “I saw quite a bit of X-rays I probably wouldn’t have seen otherwise.”

Service providers and mobile imaging companies tried to remain in contact with customers throughout Irma and Harvey. But, for the most part, did not return units or deploy extras until after the storms had passed and damage could be assessed.

Damage control
Overall, medical facilities confronted with Irma and Harvey did a remarkable job minimizing damage and downtime, but the hurricanes still left their calling cards. One provider in Houston faces the challenge of getting its in-house MR system back up and running after it sustained water damage from Harvey.

The task could take about a month and a half, but while that system undergoes repairs, a mobile unit deployed by Shared Imaging is providing interim imaging capabilities.

The company has also deployed two additional units to Texas, according to Larry Siebs, the president and CEO of Shared Imaging, and has retrieved 11 units that had been stationed there.

But the need for interim imaging solutions has not been widespread following Harvey and Irma.

“I am not aware of any mobile trailers that have been brought in because of the hurricane,” T.J. Webb, a director of service for GE Healthcare in Florida, told HCB News three weeks following Irma. “That said, this would probably be the week we would start seeing systems with ongoing issues and facilities that may explore that alternative.”

One reason for a possible delay in seeking assistance is damage to roads. With many routes closed, blocked off by debris or destroyed, mobile imaging units are unable to access destinations safely.

In addition to this, it takes time to assess hurricane damage and decide whether an interim solution is necessary. Some facilities are only now opening their doors and taking stock of the situation.

“It’s not even like you could bring in something that would make a difference because they’re not even functional,” said Shared Medical Services’ Zahn.

While Siebs contends there will always be a need for mobile imaging units during disaster relief efforts, he says improvements in hospital infrastructure and the relocation of imaging departments and equipment to higher floors have reduced the need for units over the years.

“Ten to 15 years ago, we probably would have had 40 to 50 units deployed,” he told HCB News. “Now, probably a couple dozen have been deployed in all.”

While many hospitals that were shut down during and after the storms have since reopened and are back to treating patients for everyday problems, hurricane-related injuries have created a new demographic in their patient populations, especially as survivor recovery efforts are still underway.

What to do next time
Although the impacts of hurricanes Harvey and Irma – and especially Maria, which destroyed much of Puerto Rico’s infrastructure – are still being realized, they have caused hospitals, service providers and mobile imaging companies to ask important questions about their disaster preparation policies and consider changes that will help them withstand future storms more efficiently.

“Daily roll calls are critical, and you need to know where the team is and who needs immediate help,” Jeff Grimsley, a field team engineer leader for GE Healthcare in Texas, told HCB News. “Encourage the team to prepare for a minimum of one week without power, food, water or fuel.”

For Posern with St. Joseph, MR exams were not possible during Harvey for a number of reasons, including safety concerns and the technologist was unavailable. Lacking that diagnostic tool put the facility at a unique disadvantage.

“We had some different trauma issues as a result of the storm,” she says. “People had some pathology or things that MR would have been helpful for at that time to speed up the process for getting treatment.”

Looking back, she would have put more staff members in place to help relieve doctors and nurses faster and for longer periods of time.

While everyone agrees that limitations will always exist in what can be done to mitigate the damage of a hurricane, advanced planning and good communication are the cornerstones of a winning strategy.