What I Learned From Hurricane Harvey. Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services Houston Methodist Hospital

Transcription

1 What I Learned From Hurricane Harvey Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services Houston Methodist Hospital

2 Image courtesy of Google Maps

3 What I Learned From Hurricane Harvey Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services Houston Methodist Hospital

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8 US/homerun/cnbc.com/403f26b1f275e64d16ce80a45d73e7bc Accessed

9 Objectives Discuss strategies to lower the risk of having inadequate medication supply during a natural disaster Understand ways to effectively plan for staff coverage throughout a pending natural disaster Discuss ways this particular natural disaster has changed institutional planning for future emergency events

10 Disasters Disaster definition: low probability but high-impact event that causes a large number of individuals to become ill or injured. Red Cross definition: An event that causes more than 10 deaths, affects more than 100 people, or leads to an appeal for assistance by those affected (Bravata et al 2004) Disasters can be natural or man-made Institute of Medicine Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: The National Academies Press. Accessed February 28, 2018

11 Before Harvey TMC Experience 2001 Tropical Storm Allison Over 36 inches of rain within 3 days Massive flooding throughout Texas Medical Center (TMC) Over $1B in damages Improvements in flood barrier strategies and drainage

12 Before Harvey TMC Experience 2008 Hurricane Ike Extensive wind and hail damage Power outages in excess of 2 weeks in some areas Most devastating damage by barrier islands / Bolivar Peninsula Opportunity to employ Ride-out / Recovery teams successfully

13 Houston Methodist Hospital 860 operating beds 78 operating rooms 1,479 affiliated physicians 7,395 employees 36,720 admissions 326,534 outpatient visits 72,399 emergency room visits 1,026 births >12,406 international encounters from 84 countries 36 ACGME-accredited (plus 7 non-acgme) residency programs with 262 ACGME residents and 6 non-acgme residents

14 Houston Methodist (HM)

15 ICARE Values Integrity Compassion Accountability Respect Excellence

16 Pharmacy by numbers - HMH 9 million doses dispensed annually 25,000 doses dispensed per day 10 Pharmacy Areas: Central Pharmacy FICU Satellite (Fondren 3 rd Floor) OPC 22 Oncology Satellite Pharmacy 6 OR Satellites ED Satellite (opened July 5, 2017) North Tower (2018) will create two additional pharmacy locations

17 Week Before Harvey August 19 Accessed

18 By Monday Accessed

19 Incident Command Systems Hospitals must interface with incident command at multiple levels and be prepared to deal with transitions between levels Should have a local Incident Command System to keep all departments centralized in communication of issues and action plans Can also be local, state, or federal levels Existing programs such as the Hospital Emergency Incident Command System (HEICS) aid hospitals in internal preparedness as well as coordination with other levels of Incident Command Institute of Medicine Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: The National Academies Press. Accessed February 28, 2018

20 Institute of Medicine Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: The National Academies Press. Accessed February 28, 2018

21 Plans Should Cover More than Direct Hits Direct hit Structural damage Road closures Power outages Potential for flooding Dirty Side of Storm Excessive Rain / Flooding Widespread damage due to flooding / tornadoes Road closures Potential for power outages

22 Storm Timeline Wednesday 8/23/17 Harvey becomes tropical depression about 500 mi. SE of Texas with 35mph winds First discussion among hospital executives and department leaders about preparation and when storm would make landfall Pharmacy begins making plans to submit advance medication orders and determine strategy for disaster response with disaster policy as guidance

23 Medication Ordering Considerations Anticipate challenges with medication procurement and order accordingly Based on type of emergency, order ample supply of specific medications E.g. immunizations, antibiotics, cardiac meds, fluids Outsourced compounds (HMH TPNs) You will likely be treating patients, visitors, and staff TSBP allowed up to 30-day emergency supplies to be dispensed due to disaster proclamation

24 Storm Timeline Thursday 8/24/17 Harvey quickly strengthens into a hurricane with 85mph winds. 325 mi SE of Texas. Up to Category 2 hurricane by Thursday night (100 mph winds) Pharmacy begins informing staff about pending storm impact and to await confirmation of Emergency Response Plan activation in next hours

25 Staff Coverage Staff should prepare to stay hours, typically HMH Disaster Preparedness plan includes three categories Ride-out staff rides out storm at hospital Recovery team that relieves ride-out team staff Exempt - some team members exempt from either staffing category (e.g. parent of infant children, etc.) Terms Ride-out/Recovery traditionally relate to direct-hits; but are adaptable to multiple emergency types

26 Storm Timeline Friday 8/25/17 Harvey upgraded to Category 3 hurricane (120 mph winds) 75 mi from Texas. By 6pm, Category 4 storm (130 mph winds) 45 mi from Corpus Christi Hospital discharges as many patients as safely possible in anticipation of weekend storm impact Pharmacy leadership met with staff to discuss potential landfall of storm on Friday with rains impacting Houston by Saturday, and to make arrangements for Emergency Response Plan to be activated sometime on Saturday

27 Storm Timeline Friday 8/25/17, 10 pm Harvey makes landfall in Rockport, TX, near Corpus Christi

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29 Storm Timeline Saturday 8/26/17 Storm downgraded to Category 1 by 5 am. Dueling front systems threaten to keep storm over Texas, prompting fears of massive flooding Pharmacy leadership awaits hospital administration to activate Emergency Response Plan Because rain was light and steady most of Saturday, it was difficult to make a call

30 Storm Timeline Saturday 8/26/17 (9 pm) Rain has not let up, area roads and freeways beginning to flood Night shift had made plans to come in early and have personal supplies prepared to stay over the next hours. Some evening shift employees made similar arrangements. By 10 pm, decided evening shift required to stay, due to dangerous conditions

31 Storm Timeline Sunday 8/27/17 Devastating floods impact Houston after inches of rain. US Coast Guard saves > 1,000 people. Several area evacuations made mandatory. Emergency shelters created at NRG Arena and George R Brown Convention Center to hold displaced flood victims Emergency Response Plan officially activated 7am. Few staff were able to traverse waters to get to the hospital to work Sleeping areas and scrubs in short supply, due to some isolated power outages and inability to send out laundry

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33 Storm Timeline Monday 8/28/17 Number of rescues exceeding 6,000 in Houston area Some staff able to come in as waters began to recede in isolated areas All elective procedures canceled; only emergent cases in ORs Infusion clinic appointments canceled for the week With limited power outages, several staff able to remote-in electronically to manage protocols/verify orders No supplies and medication deliveries since Sunday

34 Storm Timeline Tuesday 8/29/17 Rescues of 13,000+ people overall since Sunday. Waters receding in isolated areas. Harvey moves back to Gulf as Tropical Storm More staff able to come in and help relieve some who had stayed since Saturday, assuming it was safe to travel to their home Medication delivery Tuesday evening by truck Staff living nearby opened their homes for staff who needed to rest

35 Accessed 3/15/18

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37 Storm Timeline Wednesday 8/30/17 Harvey makes second landfall in western Louisiana. Houston spared from second impact. Waters continuing to recede in isolated areas More staff able to come in, beginning to see larger waves of staff being relieved from duty Some staff left work, checked on their homes, and then went to NRG Park or GRB shelter to volunteer Decision to keep all elective procedures canceled through rest of the week

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40 Hurricane Harvey by the numbers Category 4 Storm $125B in Damage (2 nd highest) Affected 13M people in TX, LA, MS, TN, KY Over 100 deaths attributed to Harvey Made landfall 3 times in 6 days 39,000 people displaced into shelters 203K homes damaged, 12,700 destroyed Est. 80% of Houston flood victims did not have flood insurance Over 50 inches of rainfall in Houston area

41 Considerations for future Go with our gut Pharmacy knows what Pharmacy needs Communicate early and often Discuss need for preparation to ride-out pack supplies/sleeping gear ahead of time Plan out where folks will sleep if no extra rooms available Ensure adequate onsite leadership presence Sustenance Remote access?

42 True of False? A hospital-declared disaster status (e.g. Code Gray) must occur before Pharmacy deploys disaster procedures for medication procurement. False

43 Multiple Choice What term describes a staffing group that must stay at the hospital through the duration of an emergency event until relieved? A. Recovery Team B. Ride Out Team C. Exempt Team D. None of the Above

44 Multiple Choice What must one consider when ordering medications in anticipation of an emergency event? A. Type of emergency B. How long it may take to resume regular operations C. Any patient-specific items the institution currently outsources D. All of the Above

45 Key Takeaways Order plenty of supplies/medications ahead of the storm Your disaster policy is only as good as your last disaster Stay positive; don t underestimate your team s resilience

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47 Key Takeaways Order plenty of supplies/medications ahead of the storm Your disaster policy is only as good as your last disaster Stay positive; don t underestimate your team s resilience Take care of your caregivers Patient care comes first but you cannot care for patients without your team

48 What I Learned From Hurricane Harvey Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services Houston Methodist Hospital