Hospitals in the Carolinas prep for Hurricane Florence

(Updated at 5:15 ET)

Hospitals in South Carolina and North Carolina are testing generators, stockpiling supplies and evacuating patients as they prepare for Hurricane Florence to batter the coast later this week.

With Category 4 Florence still gaining strength and aiming for Wilmington, N.C., both states have declared states of emergency. The National Hurricane Center said Florence, which was upgraded from a Category 3 to 4 hurricane on Monday, will carry winds near 130 miles per hour that are expected to extend up to 40 miles from the center of the hurricane. It's expected to make Thursday night or Friday morning. Late Tuesday night, HHS Secretary Alex Azar declared that both states were facing public health emergencies.

South Carolina Governor Henry McMaster ordered the mandatory evacuation of coastal counties where 17 hospitals are located. In North Carolina, six counties have ordered mandatory evacuations.

Coastal hospitals that have long endured threats from hurricanes have launched into time-tested emergency preparations this week, while inland hospitals are gearing up to take in acute patients to be transferred from the coast.

"Hurricane preparedness is something we live with every year. We are always in preparation mode," said Amy Stevens, vice president of marketing and communications at Tidelands Health, a three-hospital system with 50 outpatient facilities dotting the coast from Georgetown, S.C., to North Myrtle Beach, S.C.

Stevens said the system went through an intense review over the last several months that included structural engineers and weather experts to understand their geography and the hospital's structure. That made them confident they could withstand Hurricane Florence.

However, Tidelands Health's request for an exemption from the mandatory evacuation was denied by the state, so the hospital system is in the process of transferring about 100 patients to inland facilities before it is required to close midday Thursday. Physicians and other support staff will evacuate with the patients so they can continue to care for them. The system's hospitals in evacuation zones have already stopped taking new admissions and outpatient facilities are closed.

A small crew of clinical staff, security personnel, and management will take shelter at Tidelands hospitals to care for patients too ill to be moved and to re-open the facilities as quickly as possible after the storm passes, Stevens said.

New Hanover Regional Medical Center, a level II trauma center with 885 beds in Wilmington, N.C., is busy working on transferring patients to areas less likely to bear the brunt of Hurricane Florence.

A New Hanover spokeswoman said the medical center is minimizing the number of patients there and ensuring it has adequate staff and supplies, but it won't completely evacuate because it is the region's trauma center.

Further south, Charleston, S.C.-area health systems MUSC Health and Roper St. Francis are preparing for strong winds and flooding. MUSC Health, the clinical side of the Medical University of South Carolina, has already accepted ICU-level patients and others from hospitals on the northern coastline of the state.

MUSC Health, the clinical arm of the Medical University of South Carolina, will deploy a retired military tactical vehicle able to drive through six feet of water to transport clinicians after the storm. (Alexis Simmons/WCSC-TV Live 5 News)

The 800-bed medical center was exempted from the mandatory evacuation, and while outpatient clinics will close and elective operations will be canceled starting Wednesday, emergency rooms will remain open. By the end of Tuesday, MUSC Health will have stockpiled enough water, food and medicine to sustain operations for a week or more, said Matt Wain, chief operations officer. The health system also will offer free telehealth visits for all citizens from Tuesday through the duration of the storm.

MUSC will also for the first time deploy a retired military tactical vehicle able to drive through six feet of water to transport clinicians during the storm. It had used boats to transport staff during previous hurricanes.

"A challenge for Charleston specifically is flooding hits us very hard," Wain explained. "We wanted to be able to have a vehicle that could safely transport providers and staff throughout our hospitals to meet patient needs."

For Roper St. Francis, a three-hospital system that also is exempted from the mandatory medical evacuation, preparation started a week and a half ago.

"The most important thing you can have is food, water and fuel, and so we really made sure we have those core things and that we are able to respond to any physical incident," said Joshua Bates, Roper's emergency manager, adding that each department from IT to food services has its own checklist of preparations.

Moving inland, Columbia, S.C.-based Palmetto Health is working with Greenville (S.C.) Health System to accept patients being evacuated from hospitals and skilled nursing facilities on the coast. Greenville Health System said it expects to receive about 40 patients, while Palmetto Health has already received 16 patients and doesn't expect anymore. The South Carolina Hospital Association is helping to coordinate patient transfers.

Hospitals are also taking care of their own employees. Palmetto Health and Greenville Health System have both taken steps to allow staff members to stay at the facilities overnight if transportation is difficult. Tim Fitzgerald, operations executive for Palmetto Health, said the system is also providing a day camp through Friday for employees' children who attend schools that have canceled classes due to the hurricane.