October 23, 2017

The Ride-Out Team

Drawing on its experience of past disasters, UT MD Anderson cared for and kept safe patients with complex medical needs.

By Paromita Pain
Population Health Scholar
The University of Texas System
Doctoral Student in Journalism
UT Austin Moody College of Communication


 The photos in the news and throughout social media were chilling. Floodwaters made roadways look like inner-city rivers. Scores of stranded people waited on rooftops for emergency and civilian watercraft to rescue them. Harvey, a Category 4 hurricane that turned into a tropical storm by the time it reached Houston, dropped more than 50 inches of rain on the city, causing some of its most essential institutions to shut down or operate without connection to the outside world.  
UT MD Anderson Cancer Center was an island amid the floodwaters, but an island that was ready for its isolation. Everyone stayed safe thanks to the emergency preparedness of the staff. A ride-out team cared for the critical needs of patients, and support staff helped return operations to normal as quickly as possible once the worst had passed. 
Lessons from Allison

Hurricanes have the potential to significantly damage hospitals and disrupt medical care through power outages, structural damage, and flooding. Dr. Karen Lu, Senior Vice President and Chief Medical Officer at UT MD Anderson, said that thanks to lessons learned from previous storms, Harvey wasn’t the worst the hospital has experienced. 
“Hurricane Allison, which hit southeast Texas in June 2001, was worse,” she says. “There was significant flooding, including in all the laboratories. That had a particularly big impact on the research program. After that event, the Texas Medical Center invested in a large number of floodgates for protecting the buildings. Those floodgates proved their worth during Hurricane Harvey.” 
Matthew L. Berkheiser, Associate Vice President of Environmental Health and Safety at UT MD Anderson, said the biggest effect from Hurricane Harvey was on staff and patient travel.  
“Staff couldn’t travel from their own homes to the hospital,” Berkheiser says. “Patients couldn’t get to us for care.”  

The hospital canceled outpatient appointments from Sunday, Aug. 27 through Wednesday, Aug. 30.  Elective surgery and outpatient clinics were shut down and chemotherapy and radiation appointments for nearly 750 patients had to be put on hold. By Thursday, though, most departments started to function normally—a testament to the hospital’s well-conceived disaster plan, which included preparation, safety training and coordination between various departments and administrative services. Ultimately, the hospital suffered minimal damage, and above all, patients with complex medical needs were cared for and kept safe. 
The Ride-Out Team

Safety preparation for a hospital is more than ensuring “wet floor” signs are put up along just-mopped corridors, or installing enough fire extinguishers and emergency exit signs. Berkheiser said a safety plan has to factor in the welfare of patients and research animals, as well as the protection of buildings and research facilities. When Harvey hit, UT MD Anderson’s top priority was to protect its main building where patients are cared for. This is where the pre-designated ride-out team came into play. Members of the ride-out team ensure facility operations run as smoothly as possible during emergency events, so that patient care can be provided. 
“We always have individuals identified to be part of a ride-out team,” Lu says. “For Harvey, the rain came so quickly, in a few short hours on Sunday morning. In a four-hour period, the Center was cut off. So the ride-out team was comprised of people who were in the hospital. Many of them have been through this before and were well-prepared, so some of them came in on Saturday anticipating that this might happen. Once we go into ride out, we have staff go into shifts. Some of them will sleep while others will work so we can make sure that they get rest.”    
More than 500 inpatients and about 300 of their family members, along with about 1,000 staff members, rode out the storm together. The facilities team also implemented plans for the floodgates surrounding the building, completing activation on Saturday, just before the storm hit. Berkheiser says the hospital planned to be pretty much self-sufficient for several days.  
“We planned functions for 96 hours, like we were pretty much on our own,” he says.   
The Value of Preparation

After every disaster, the team at UT MD Anderson team learns something new to help them prepare for the next one. Berkheiser said he is revising his plan again to try avoid some of the flooding the hospital experienced during the epic storm. 
“We had a few areas in the hospital where water got in,” he says. “From a facility standpoint, we are going to go back and figure out how that happened and fix it. Disaster preparedness is an all-the-time activity, not just when disaster strikes.”   
Disaster preparation is rarely a part of traditional medical training, but Lu says being part of the ride-out team gave her specific communication skills that came in handy during the disaster.  
“I do think that having some training and being able to participate as part of a ride-out team when you are a trainee makes a big difference,” she said.