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Hospitals, Physicians Hustle to Prepare for Hurricane Irene
August 26, 2011 — Hospitals and nursing homes up and down the East Coast continued to evacuate their patients today in advance of Hurricane Irene, expected to make landfall sometime on Saturday.

And like other providers, physician practices along the mid-Atlantic braced themselves for high winds, flooding, loss of electrical power, and the potential injuries and disease that the storm will leave behind.

Solo family physician Mark Beamer, MD, in Belhaven, North Carolina, spent Friday sandbagging the front of his office and getting paperwork off the floor in case of flooding.

"We do this almost every year," said Dr. Beamer, whose state is regularly battered by Atlantic hurricanes. "We’re so good at it, we could teach a course on it."

New York City took precautionary action in a Big Apple way, with Mayor Michael Bloomberg ordering the evacuation of 5 hospitals, 8 nursing homes, 1 psychiatric facility, and 8 adult care facilities.

"Obviously, power outages are a big concern," Susan Craig, press secretary for the New York City Department of Health, told Medscape Medical News. "Each facility must prove that it has the ability to care for patients if their first floor is flooded."

Healthcare facilities in neighboring New Jersey also are taking no chances.

Dawn Thomas, a spokesperson for the New Jersey Department of Health, told Medscape Medical News, "Twelve long-term care facilities in the state have evacuated. Palisades Medical Center in North Bergen is beginning to evacuate patients to Englewood Medical Center."

The New York area hospitals, like others in the hurricane zone, are emptying out by discharging as many patients as possible as well as transferring those still needing inpatient care to facilities that are farther inland.

At Staten Island University Hospital, the evacuation began Thursday, "with critical care patients, newborns and others who might require a higher level of care," Terry Lynam, spokesman for Northshore-LIJ told Medscape Medical News. "The evacuation will be total by tonight. There is a partial evacuation at Southside Hospital in Bayshore, NY. We've discharged patients who are well enough to be at home. We've been trying to discharge as many nonacute patients as possible in our 15 hospitals to accommodate the influx of patients from Staten Island and Southside."

Many hospitals, such as those in the AtlantiCare system throughout New Jersey, canceled elective surgeries scheduled for Friday and Monday to reduce the number of patients in its 70 facilities. However, the AtlantiCare Regional Medical Center in Atlantic City will not try to get the number down to zero; some 130 will not be evacuated.

"We have the internal resources to maintain our operations and believe it is in the best interests of these patients for them to stay put," Debra Fox, AtlantiCare’s chief safety officer, told reporters at a news conference. "It’s often more challenging when you have to transfer patients to other facilities. We’re prepared to do that if it becomes necessary."

The hospital’s windows are rated to withstand a category 3 hurricane, Fox said.

The equally sprawling Sentara Healthcare System in southeastern Virginia and northern North Carolina notified the public that it was suspending patient visitation during the hurricane and warned that its hospitals could not perform outpatient dialysis during power outages.

Many physicians, nurses, and other clinicians who have weekend shifts at a hospital in Hurricane Irene’s path may end up sleeping in a hospital bed for a night or two. It may be too dangerous to leave the facility, or else the clinicians who are scheduled to relieve them may not make it in.

For AtlantiCare, "We have enough staff and have provided sleeping quarters for them," Fox said. "We've done enough planning to know that we can sustain ourselves for at least 96 hours. We have enough fuel for generators, pharmacy supplies, and more available to us."

"We're encouraging people who get off work at 7 p.m. on Saturday to spend the night at the hospital," Beth Anne Atkins, a spokesperson for University Health Systems (UHS) of Eastern Carolina, said about her organization's flagship facility, Pitt County Memorial Hospital, in Greenville, North Carolina. "We have the space."

Be Prepared for 2 to 3 Days With No Outside Help

Getting ready for a hurricane means more than nailing plywood over windows, especially for healthcare facilities.

Pitt County Memorial Hospital assessed its blood supply, tied down construction equipment, moved 3 helicopters offsite, and tested its emergency generator. "There’s plenty of fuel onsite," added Beth Anne Atkins.

Up in Newport News, Virginia, the 100-physician Tidewater Physicians Multispecialty Group unplugged computers and covered them with plastic bags in case of roof leaks, said Kent Willyard, MD, who sits on the group's board of directors.

Dr. Willyard's group does not have to worry about a storm blowing or washing away its medical records. Tidewater relies on an electronic health record system, and backs up patient data on a computer hundreds of miles away.

A physician in New Orleans, Louisiana, who lived through Hurricane Katrina in 2005 has some advice for his East Coast colleagues: Stock up on the basics so you can rough it for several days.

"They must realize that they may have to exist 2 or 3 days without any outside help," said Norman McSwain, MD, president of the Orleans Parish Medical Society. "So they need enough food, clothes, water, and medication."

After a Hurricane, Some Predictable Health Problems

Dr. McSwain and others who have witnessed hurricane havoc told Medscape Medical News that East Coast clinicians will see several predictable types of health problems after the winds die down.

Some patients with asthma, chronic obstructive pulmonary disease, and other respiratory problems will experience more symptoms after they go without air-conditioning, and perhaps their medications, for several days, said Dr. Willyard.

There will be a wave of patients who are not injured by the storm per se but by the demolition and construction work that follows. "Chainsaw accidents are one of the largest categories," said Dr. McSwain.

A more insidious cause of morbidity and mortality is the extreme stress experienced by the elderly when they must evacuate a nursing home or private residence and adapt to new quarters, said Dr. McSwain.

"During the 6 months following a hurricane, you’ll see a higher death rate," he said. "Elderly people don’t have a home to return to, or else they’re in a different home, and they don’t know where the kitchen is."

"A hurricane is not an event that comes and goes in 2 days."

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