Throughout Hurricane Katrina and the subsequent flooding in New Orleans, only three of the region’s 16 acute care hospitals were able to stay open. While one of these facilities, East Jefferson General Hospital, stayed relatively dry, its clinical laboratory staff struggled to operate after the storm knocked out the electricity and communication capabilities for almost a week. This month, Strategies talks to one of East Jefferson’s laboratorians about how the staff kept the lab running and what unexpected situations laboratory directors might not think about, but should expect, during a disaster.
When Katrina descended on New Orleans over the last weekend in August, the clinical laboratory at East Jefferson General Hospital (EJGH) was initially handicapped by the loss of electricity. The facility had two backup generators, but only one was fully functional. Nevertheless, having one working generator meant EJGH, located just outside the city in Jefferson Parrish, was in better shape than many area hospitals.
“Most of the hospitals in the area had to evacuate their patients by helicopter,” explained Beth Mitchell, MT, ASCP, EJGH’s Point-of-Care Coordinator. “Even though we are below sea level, for some unfortunate reason many hospitals in the city chose to put their generators on the first floor. Many flooded and once the generators are flooded, you’re history. I've heard reports from other hospitals said that they had no sewerage system working—for the patients on ventilators, the staff had to hand pump them. We were very lucky that we had at least one generator working the entire time.”
The lack of electricity also meant that the air conditioning shut down, sending temperatures in the lab up to 90°F. Many of the lab instruments can’t run when it’s that hot, even if they are plugged in to generators, said Mitchell. The lab’s disaster team—a rotating staff that stays at the hospital during hurricanes and other potential emergency situations—combined reagents into a minimal number of refrigerators and freezers, which were plugged into generators. Lights were turned off to keep the rooms cool and conserve energy as the staff worked by flashlight.
“Looking in the microscope got to be difficult, so they would flip on lights long enough to look in the microscope, like during a urinalysis or differential, and then flip them back off,” said Mitchell. “The computer system was out, and because our computers are on a lower level of the facility, they had to unplug them and bring them to higher ground. Everything was on manual reporting.” Family members of the disaster team who were staying at the hospital hand delivered the lab reports to the nursing units.
In terms of testing, the nurses began relying on point-of-care (POC) instruments like Accu-Chek glucose monitoring meters, which are manufactured by Roche Diagnostics (Indianapolis, Ind.). Normally, the Accu-Chek instruments are managed by the Medical Automation Systems’ (Charlottesville, Va.) Rals-Plus connectivity program, but since the computer system was down, the lab staff contacted a Roche representative, who helped them reprogram the instruments to allow them to manually continue running without connectivity.
POC Keeps Testing Going
By midweek, the hospital had also lost all telephone service and there was little to no cell phone service. This isolated the already exhausted disaster team, but other staff members who had evacuated the city were hesitant to return to the hospital. “The reports that we were getting outside the city were so sketchy and rumor ridden that you didn’t want to venture in without knowing what kind of situation you were getting in,” said Mitchell, who had evacuated to about 60 miles outside the city.
After speaking to a co-worker who reassured her it was safe to return, Mitchell made her way in to the hospital on Saturday as operations began to normalize. Electricity returned, so the computer and air conditioning systems began operating. When the computers came online, POC connectivity was also restored, and Mitchell was relieved to find that the Accu-Chek meters had stored every result before and during the storm. “I was able to download every bit of information into the computer and it has since been transferred over the lab and hospital information systems, so it’s all documented,” she added.
Getting Ready: Thinking of Everything
In recent years, particularly after the terrorist attacks on Sept. 11, 2001, in New York City and Washington, D.C., there has been more pressure on hospitals and labs to establish emergency preparedness plans. When a natural disaster like Hurricane Katrina and the flooding in New Orleans occurs, the strength of these plans is tested. Mitchell believes that EJGH was ready, even though the lack of electricity and phone communications presented challenges. One of the most important preparation measures is an appropriate staffing plan, like the rotating emergency lab teams at EJGH. “If you are staffed adequately and have people who can really work together, I think that’s extremely important,” she said. In terms of hospital infrastructure, there should be back up communications capabilities, similar to how generators provide electricity back up. Because computer systems are likely to go down with the electricity, it’s important to have manual lab reports on hand, as well as reference ranges.
“We had a list of normal ranges so that when we were doing manual reports we could tell them what the normal ranges were—we rely so heavily on computers that we no longer know all the normal ranges if you are not looking in the computer,” said Mitchell. Another important element to have in place is a water filtration system, since instruments can be ruined and samples compromised by contaminated water.
As New Orleans began to recover from Katrina’s damage, EJGH’s computer and electrical systems came back online, but the hospital had a low census of patients. While that has now normalized, other resources are low. ”The emergency department is extremely busy, but we are working with limited staffing,” said Mitchell. “A significant amount of our employees have permanently relocated and are not returning to work. In other words, it's crazy around here.”
If you would like to share your thoughts on disaster planning for the lab, email the editor. We will post comments here in the near future.
Julie McDowell is the Editor of Strategies. She can be reached by email.