Gulf Coast hospital gears up for cat. 5 hurricanes

Researchers from the University of Texas Medical Branch in Galveston retraced events and decisions that occurred within the hospital and radiology department during the approach and landfall of Hurricane Rita, a category 5 hurricane in 2005. While the storm caused relatively minor damage to the hospital, the evaluation helped researchers focus on improving their emergency planning.

Hurricane Rita was scheduled to hit land on Saturday, Sept. 25. Within a 12-hour period on the Tuesday before, the hospital discharged or evacuated 427 patients, using 91 ambulances, 32 helicopters, five planes, and numerous public and school buses.

While the trauma data center remained operational throughout the emergency, the main hospital data center, talk station server, and PACS were shut down on Wednesday as planned, according to Dr. Randy D. Ernst, an associate professor of radiology who presented the study at the 2007 American Roentgen Ray Society meeting.

On Thursday, officials predicted Rita would be a category 5 storm that would directly target Galveston. Hurricane coverage personnel were then given the option of evacuating, Ernst said.

Because of highway gridlock, a backup teleradiology reading station in an imaging center north of Houston could not be staffed. Teleradiology clients transferred their workload to radiologists in other cities. Reports for the remote teleradiology centers were typed into macros and e-mailed to the remote sites that were not affected by the storm. The network for reception of teleradiology images was restored on Monday.

Three of the four emergency coverage radiologists were evacuated on C130 transport planes. One radiologist remained, along with approximately 400 other staff members.

Following Saturday's landfall, the institution remained in emergency mode until the following Tuesday morning. The ER PACS network went down during the storm, and images were read directly from the CR/DR consoles, which delayed access to the separate emergency department PACS archive. The ER network, however, was restored within 12 hours.

The damage on campus and throughout the island was minimal compared with the devastation experienced by colleagues in East Texas, where UTMB operates a number of health clinics, Ernst said. The storm killed seven people directly; many others died during the evacuations, mainly from heat stroke. The UTMB emergency room remained open, operated by generators when power cut out.

Because three of the four ER radiologists had evacuated, the hospital put out e-mail requests for backup. Five responding radiologists were assigned rotating shifts to treat returning city residents. Since emergency CT personnel had evacuated, most patients received ultrasound exams. Radiologists handwrote reports, faxed them to the ordering physicians, and pushed the ultrasound unit from room to room due to the lack of transportation workers.

While the hospital had a comprehensive emergency plan in place before Rita, this evaluation allowed researchers to further refine and implement several improvements:

• An improved offsite location has been identified for continuation of the teleradiology enterprise. The covering radiologist will be released earlier.

• Two laptops have been prepared with voice recognition software for radiologists' dictation. Laptops are equipped with wireless long-range Internet modems.

• The main voice recognition server has been relocated to the trauma data center.

• The teleradiology routing computer has been relocated to a more robust network.

• The network has been upgraded and reinforced.

"The storm caused relatively minor damage to our hospital, but the lessons we learned will help us be better prepared," Ernst said.