(Readers, I present the first guest blog here. Dr. Kenneth L Mattox is a world-renowned leader of trauma and cardiothoracic surgery and a key coordinator of disaster management in hospitals. He is one of the editors of a leading textbook of surgery (Sabiston’s Textbook of Surgery). His laurels are far too many to detail now. Here is his perspective, as a leader of Disaster Management at Ben Taub General Hospital, the referral center for Hurricane Ike victims at Houston, Texas. Note that his attention is largely on the disaster management aspect of the event, based on his experience with Hurricane Katrina.)
Houston is the 4th largest city in the US. The Houston/Galveston greater area has upwards of 4.5 million people, depending on just where you draw the line. It is safe to say that NO ONE in this area is untouched by this storm. NO ONE. Galveston was totally under water from both the gulf and the bay. UTMB and its famous burn center was evacuated. Bolivar Island is still “off limits” to anyone visiting it. The beach houses of West Galveston Island were under water and many destroyed. The famous Balinese Room of Galveston is GONE. The Galveston Sea Wall is 17 feet above sea level and the sea ran over it. This was a wind and SEA SURGE storm, not particularly a wet storm.
(pic: National Geographic)
From Galveston to Houston one travels Interstate 45, and that is the route that IKE took. The areas of NASA, Kemah, Seabrook, are yet to be fully assessed.
Over 95% of the area lost electrical power in the entire greater Houston area, and most are still without electricity. NO HOME or yard is without some sort of damage, either shingles, an entire roof, glass broken, fences down, or trees fallen and limbs broken. I do not mean just any tree. Many huge Oak trees over 100 years old are broken like match sticks or up rooted. The many faithful health workers were at work despite their homes being blown apart.
First, I must give tremendous credit and recognition to thousands of individual health heroes who were here at the Ben Taub General Hospital and many other hospitals for many hours straight. They gave and gave and then gave more of themselves so that others would have a place to receive health related attention.
Second, I was impressed by the leadership of the State Government both during Gustav and IKE in the days before the storms hit, in creating a 5000+ person 2-3 times a day conference call to address known course of storm, local needs, evacuation, gas, search & rescue (SAR), and recovery. Both State, County, Local governments were on this conference call as well as other assets such as hospitals, EMS agencies, etc. It appeared that most items were covered and addressed. It was obvious that jurisdictional turfs existed.
At the LOCAL area, different jurisdictions set up in different locations: Galveston, Transtar (Harris County), HEC (City of Houston) and assets of the State, such as Texas Task Force 1 set up in several different locations. Ownership of various assets was under different, but communicating agencies. What we did not have during IKE, but did have during Katrina was a region wide JOINT UNIFIED COMMAND. We really needed that during and for the first 2 days after IKE hit.
At the hospital and emergency room level, every hospital in the area did their part, but all entered the hours of the storm with full ICUs. We (and everyone else) had patients ready to be dismissed from the hospital, but we would have sent them to an area of high risk of flooding. That would not have been good, but we did need their bed for new ER patients. No local “medical” home health care type shelters were set up in the Greater Houston area. We must address this next time. In my view, this would be an excellent role for DMAT teams, to be both up front for some few minor problems and to establish an up-to 500 bed “medical” observation shelter as opposed to a “clinic” or hospital. We really do not need mobile hospitals, what we need is the intermediate “medical” shelter to unload the existing local hospitals.
(pic: Huffington Post/AP)
By 12 hours after the storm had cleared the area, the mass property destruction was noted and people began to clear their property (including using chain saws they had never read the instructions on) and climbing ladders. We had lots of falls. Also many hospitals wanted to “evacuate” merely because their rooms were warm and humid as they were only on emergency generators. The water for the entire community was feared to be contaminated due to low water pressure. Therefore, we were requested to receive patients with relatively minor conditions, such as a need for a lower-temperatured room and nasal oxygen in an elderly patient. Some such patients came by outside the area contracted private ambulances who knew nothing about the working of the local EOCs (Emergency Operations Center?- Ed.), although those were multiple. We really needed the DMAT type run medical holding area shelter for these type of patients, who never needed to come to the hospital to use the hospital as a shelter. One of more DMATs were set up in the Greater Houston area, but initially coordination with existing Trauma Center facilities was sparse. If there was coordination, it was with one of the many supervisory silos.
It became interesting to me that within 24 hours after the storm cleared, many of the persons in each of the silos (including representatives and press people, who by now were very tired) began to point fingers and to try to get credit for what was done right and dodge when there was a criticism for what went wrong. I could write a book on this subject.
In the 5 state area around Texas there is a fantastic trauma network among the trauma centers and trauma surgeons, headed up by Dr. Ron Stewart in San Antonio. This excellent integrated disaster network is as sophisticated as ANYTHING I have seen from the well funded federal programs, and it costs NOTHING. The doctors and nurses on this network and the network itself are well known to each of the federal, state, regional, county, and city EOS silos in the 5 state region. However, neither for planning, implementation, evacuation, or recovery do these silos utilize this very mature sophisticated trauma network. It is almost as if the hands on trauma personnel who in at least 6 of the cities of the network (Houston, Galveston, San Antonio, New Orleans, Oklahoma City), who have a composite experience of active involvement in more disasters than any group that I know about in the country are purposefully omitted from the government run silos. In my humble opinion, this disconnect between the governmental mandated EOS silos and the JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) mandated trauma center communications led by the American College of Surgeons and their trauma center and disaster committee MUST somehow get together as has happened in the state of Connecticut.
We are approaching 48 hours since it has been able to move around after the storm. There is lots of frustration and depression. Criticism that the government did not move fast enough to clear the roads, turn back on the power, “bring me water”, etc. is distressing. Even by FEMA rules, such response is not required until 72 hours. If there is gas available, and if the electricity is back on, many complaints will disappear.
I have tried to write concurrently with my frank feelings and observations of the real time. Sometimes I was more frustrated than others. On the whole I have been very proud of my local community, proud of the citizens, and so very proud of the FANTASTIC TEAM OF MEDICAL PROFESSIONALS AT THE BEN TAUB GENERAL HOSPITAL. This team could put a man on Mars in a week. This team seeks to be a resource to take care of the sickest of the sick, that no one else wants, especially during a crisis. This team could reach the illusive peace in the Middle East in 5 days. Congratulations to the many many unsung heroes at every unit level of this team.