As of Thursday evening, Hurricane Matthew had killed more than 280 people in Haiti and was poised to hit the Florida coast and make its way north to Georgia and the Carolinas. Hospitals throughout the Southeast U.S. are taking cover and preparing for the aftermath.
Governors in Florida, Georgia, North Carolina and South Carolina declared states of emergency, ordered mass evacuations of coastal areas and called in thousands of National Guard members. President Barack Obama declared a federal state of emergency in both Florida and South Carolina on Thursday, directing aid to those states.
Eight Florida hospitals evacuated this week because of their coastal locations, while inland hospitals prepared to face the storm, stocking up on supplies and coordinating staff to quickly respond once the Category 4 hurricane hits.
Cape Canaveral Hospital, a 145-bed hospital in Cocoa Beach, Fla., has evacuated over 90 patients since Tuesday. It discharged more than 30 and transported 59 others to the three other hospitals within the system. The hospital, which is located on a barrier island, was taken off the power grid Wednesday in case of a surge, and no more than five facility managers and security personnel will remain on-site, said Matthew Gerrell, vice president of marketing and communications for the hospital's parent system, Health First.
The majority of the hospital's employees worked right up to the closure and were instructed to return to the hospital as soon as it is cleared for occupancy. After the storm, they may be joined by a roving team of employees that is shared by the system's four hospitals.
Health First will send a team to assess the condition of the hospital, which usually sees a spike in visitors after a storm. That's not just from patients seeking medical help: when a bad storm hits, survivors sometimes come to the hospital looking for a hot meal, which the hospital can provide in most cases, he said.
"We have had to ration food to make sure patients get fed before the public, but we can serve the public,” Gerrell said.
Because it also owns a health plan, Health First had to notify the CMS that it was canceling seminars for open enrollment. The system also runs pharmacies and companies offering hospice, home care and private-duty nursing services and durable medical equipment, all of which have had to prepare employees and patients for the storm. Most medical offices were closed, and noncritical elective surgeries were canceled throughout the system, Gerrell said.
Health First also owns four gyms, all but one of which are closed because of the weather. The system's gym in the Viera area has been converted into a refuge for employees who live nearby. It includes a daycare center.
Orlando (Fla.) Health said Wednesday that its emergency departments and Level 1 trauma centers would remain fully operational throughout the storm, though all physician practices would close and all diagnostic or elective procedures would be canceled. “Orlando Health is fully prepared to successfully maintain operations throughout the storm's duration,” the system said in a statement.
John Wilgis, director of emergency management for the Florida Hospital Association, said he's confident hospitals are adequately prepared. FHA is more concerned that too many residents may risk their lives by staying in their homes. Republican Florida Gov. Rick Scott warned residents that this storm “will kill you.” Matthew is expected to be the strongest hurricane to hit the state since Andrew in 1992 killed 55 people.
“For several years we've been concerned about complacency with the public, including people who have moved here who haven't been through a storm,” Wilgis said.
North of Florida, other coastal states have more lead time to prepare.
According to the South Carolina Hospital Association, 17 hospitals were granted exemptions from evacuation orders as of Thursday afternoon so they could provide shelter. As of Thursday evening, Hilton Head Hospital, on Hilton Head Island, and Beaufort (S.C.) Memorial Hospital were the only hospitals evacuating in South Carolina. The state is expected to be hit by Hurricane Matthew on Saturday. Other hospitals are discharging and transferring patients while considering an evacuation, a spokesman for the association said.
Charleston, S.C.-based Roper St. Francis hospital system said it's minimizing the number of patients and staff at its three area hospitals. The system canceled elective procedures and surgeries and limited new patients to only true emergency cases. They stockpiled four days' worth of hospital supplies, food and emergency fuel for generators, said Matt Severance, chief operating officer of Roper St. Francis and CEO of Roper Hospital.
The system also dismissed non-essential staff so they can evacuate. However, staff members involved in patient care, such as nurses and operating room staff, will remain in the hospital from Friday morning until after the hurricane passes, working in shifts and sleeping on empty hospital beds and in meeting rooms.
Meanwhile, about 3,000 staff members at Charleston-based MUSC Health, the clinical side of the Medical University of South Carolina, will remain in the hospital for 96 hours of emergency operations beginning Thursday, MUSC Health COO Matt Wain said. The hospital started intense planning for the hurricane early in the week. While it typically has 750 to 775 patients' in-house daily, the hospital released any patients ready for discharge. As of Thursday afternoon, just 623 patients remained, Wain said.
Keeping care-team members informed is essential, Wain said. The hospital set up an incident command center to make sure operations are most effective. Every four hours, MUSC Health leaders run through any operational and safety issues. A week's worth of diesel and water tankers, thousands of gallons of bottled water, and medical and pharmacy supplies are at the ready, Wain said. The hospital is prepared to operate for a full week without power, water or food being delivered. If the hurricane hits directly, MUSC Health will open up community clinics for urgent care. They are also prepared to use telehealth services, he said.
In Georgia, only one hospital—Southeast Georgia Health System in Brunswick— was evacuated, according to the state's hospital association. But a spokeswoman for the health system said more than 120 staff volunteered to stay from Thursday evening through noon Saturday to care for patients who couldn't be transferred. The hospital has so far moved 70 of the 190 patients who were at the hospital and is moving more.
At Savannah, Ga.-based Memorial University Medical Center, an incident command system team consisting of staff from medical, nursing, security, communications and other departments, has been meeting several times daily. No patients were evacuated and physicians, nurses and other clinical staff will remain at the hospital, a hospital spokeswoman said. The facility will have 100 law enforcement officers and paramedics on-site and able to assist, she said.
A Georgia Hospital Association spokesman said the state's hospitals have a system that makes them aware of bed capacity at other health systems. The association is coordinating patient transfers from coastal hospitals to facilities in the southern and western parts of Georgia.
Coastal hospitals likely will be at their busiest in the aftermath of Hurricane Matthew.
“If there's damage, people get out and start trying to restore their properties,” Severance said. “That's when we see people getting hurt. It could be chainsaws (or you) hurt your back trying to pick something up to move.”
MUSC Health starts planning for hurricane season right after Memorial Day. The hospital brings in local meteorologists to talk to staff and the response plan is updated every year to reflect changes in the hospital's capabilities and technology, Wain said.
“Each time we have an incident, we get a little smarter,” Wain said. “Some of the flooding from tropical storms that came through about a month ago was great preparation for us” and allowed the hospital to identify areas that needed to be strengthened.
"Our coastal hospitals are always preparing for something,” said Schipp Ames, executive director of communications and marketing at the South Carolina Hospital Association.
Because deliveries are often halted during and after a storm, suppliers, distributors and group purchasing organizations have helped providers stock up and prepare.
Regional staff for Premier, the Charlotte, N.C.-based group purchasing and performance improvement company, are working with providers and suppliers to secure orders and get providers what they need, according to Del Jackson, vice president of contract operations. The GPO operates a toll-free support center that triages issues such as shortages or delivery disruption. Contract managers and product planners are available around the clock during disasters.
Premier doesn't just help health systems with supplies. During flooding that hit Louisiana in August, hospitals told the GPO they were short on staff. Premier worked with medical staffing firms to quickly secure temporary employees.
“Often, responding locally can be difficult in the midst of a disaster,” Jackson said. “It helps to have a national focus.”
But hospitals' true test may come after the storm. The National Weather Service Thursday warned that hurricane Matthew "could lead to some locations being uninhabitable for weeks or months."