Major Incidents, Operations

In the face of Hurricane Harvey, Galveston EMS Delivers Patient Care and More

Issue 3 and Volume 43.

When Hurricane Harvey hit, Galveston EMS was prepared

Patients are evacuated from a nursing home in Wharton, Texas. Photo courtesy Nathan Jung

Every year, EMS, fire, police and emergency managers from across the Gulf Coast review their hurricane plans, conduct drills and make updates as needed.

November, the end of hurricane season, slips quietly by for most—but not for those charged with managing the disaster that ensues with a hurricane. For these people, the passing of hurricane season only offers a short reprieve from wondering when the next storm is going to come.

Developing a plan for a disaster is a very complex process, and it’s a plan you hope you never have to use. With hurricanes, however, it’s not matter of if, it’s simply a matter of when.

Hurricane Harvey was unlike any other storm we’ve faced in recent history, and it demonstrated how important it is to drill and understand a plan—and quickly adapt when the storm doesn’t care about that plan.

Preparation Begins

Although landfall was forecast south of the Houston/Galveston region, it became clear on August 23, that Hurricane Harvey was going to impact our area beyond a few feeder bands of rain.

Our entire management team was called together to start preparing for potential evacuations and to activate crews who could potentially be deployed to assist other communities, in the event our own area wasn’t significantly impacted. Preparing for a major rain event also started, including identifying areas where our hurricane plan didn’t fit.

The National Weather Service started to forecast the potential for historic, heavy rains that would lead to catastrophic flooding. Forecast models were showing the storm turning back toward the Gulf of Mexico and then north along the Texas coast. With most state assets already committed to the communities south of us, the ability to conduct wide-scale evacuations was unlikely. In addition, the analysis we conducted was shifting from facility failure caused by wind, to infrastructure capability to provide care to medical patients.

Over the past few years, the city of Houston has flooded a number of times, and it had become clear that a significant rain event could impact our ability to move patients between Galveston and Houston. It would also have an impact on deliveries of critical items, including oxygen, pharmaceuticals, medical supplies and other necessary items.

We knew we needed to work with the nursing homes, assisted living centers and high-risk patients (e.g., those on ventilators, ventricular assist devices, etc.) to encourage them to heed voluntary evacuation orders. This proactive step was key as the storm progressed.

Galveston EMS and many other agencies in Texas participate in the Texas Emergency Medical Task Force (EMTF) program. After Hurricane Ike, the task force developed a plan to create a safety net—a sort of “9-1-1 for 9-1-1,” that would bring assets from across the state to help a local agency during a time of crisis.

On the morning of August 25, one of the nursing homes in our service area, Gulf Healthcare Center, decided it was best to evacuate, as they were situated only a few blocks off of the seawall on Galveston Island.

Several high-risk patients who reside at home also decided to evacuate due to the potential of limited supplies, loss of power and inability to travel.

Prior to Hurricane Harvey, the Gulf Healthcare Center would have been evacuated with about 15–20 ambulances and two charter buses. The EMTF program had already been activated and was working hard south of us in the Corpus Christi area. We were able to secure an ambulance bus from Atascocita (Texas) Volunteer Fire Department, which allowed us to move all bed-bound patients at once.

Within a few hours of the decision being made, Gulf Healthcare Center was closed. Just a few days later, after some minor repairs and cleanup, the facility would serve as a place of refuge for another nursing home that was evacuated after it flooded.

In our hurricane plan, we prepare to evacuate, secure our facilities and equipment and then shelter in place until operations can resume. As part of the plan, once operations resume, we provide EMS to a much smaller population of residents who didn’t evacuate.

During Hurricane Harvey, however, very few people evacuated, and it became clear early on that the normal plan for a hurricane wasn’t going to fit. We were going to be operating an EMS agency in a coastal area that was still heavily populated and isolated because of catastrophic flooding.

Galveston EMS secured an ambulance bus from Atascocita (Texas) Volunteer Fire Department, allowing the two agencies to evacuate bed-bound patients at Gulf Healthcare Center prior to the arrival of Hurricane Harvey. Photo courtesy Tommy Leigh

The Storm Hits

Hurricane Harvey’s arrival brought heavy rain, but the winds weren’t overwhelming and the flooding wasn’t immediate. Many believed that our region had been spared, and that our neighbors down in Rockport had seen not only the worst of it, but also the extent of it.

The National Weather Service insisted that more rain was to come, and maintained it would be “catastrophic,” “biblical” and other adjectives our staff had never before heard used in weather briefings. In fact, two new color categories for rainfall severity had to be created on the weather maps because of Hurricane Harvey.

The heavy rain came at night, and so did the floodwaters, which made rescue work dangerous. The water rose quickly overnight, and caught many people off guard. Thousands woke up to find water quickly rising in their homes. Soon, Galveston County would be cut off from neighboring counties by flooded roads. Flooding was so intense that it even cut off our own operations on the mainland portion of the county.

As EMS personnel, firefighters, police officers and volunteers within the community worked to rescue those trapped by floodwaters, we learned that the hospitals had become inaccessible by ambulances due to the flooded roadways. Temporary shelters were set up wherever it was safe, and many of our extra ambulance crews found themselves triaging and managing patients until transport to definitive care could be arranged.

Flooding continued, and at daybreak, the overwhelming extent of the flooding was revealed. Help wasn’t coming unless it was by aircraft, and the entire region was devastated. To make matters worse, Hurricane Harvey wasn’t finished with Texas.

Our county was full of residents, many displaced and without transportation. Obtaining supplies from the American Red Cross wasn’t possible, since the Houston warehouse had been flooded.

For the most part, Harvey didn’t impact Galveston Island, and many who were rescued were brought there because there were no passable routes north to one of the large shelters in Houston. The hurricane was still lurking in the Gulf of Mexico, so a large-scale evacuation by air was organized using Air National Guard C-130 airplanes.

Galveston EMS evacuated patients on C-130s from Scholes International Airport. Photo courtesy Kory Dominy

Patient Care & More

Despite evacuation efforts, routine 9-1-1 calls were still coming in. Calls included chest pain, respiratory distress, cardiac arrest and even a few shootings. It was like a normal day—except there was water everywhere.

Prior to the start of hurricane season, Galveston EMS increases the amount of on-hand medical supplies and pharmaceuticals to ensure the ability to operate for an extended period.

What wasn’t factored in during Harvey, however, was that patients who received supplies from home health providers would remain, exhausting their medical supply cache and in need of assistance with everything from basic suctioning supplies to breathing treatments.

Hospitals were becoming more accessible and mobility in the county was improving with each day, but new issues were mounting. One municipal service was low on supplies, several were low on oxygen, availability of diabetic supplies was becoming an issue, prescription medications were in need of refills, and every EMS agency and hospital was faced with the ever-increasing need of finding a solution to providing dialysis. Within a few days not receiving treatment, the number of calls related to dialysis patients started to rise sharply. Dialysis patients became the largest patient population impacted by the storm.

As a result of Harvey, Galveston County Health District and the University of Texas Medical Branch are now working on a better way to manage dialysis patients in a disaster, along with ways to get dialysis treatment centers open more quickly.

There was still no passable route between Galveston and the Texas Medical Center in Houston. A few of the nursing homes throughout Galveston County had to be evacuated because of flooding, and their patients were being housed in temporary shelters. Hospitals were holding patients because there was nowhere to be discharged, medical shelters were unreachable and home health services couldn’t deliver supplies to all their patients.

EMS was quickly filling a new role, which included setting up a mobile station at a county shelter to augment our mobile clinic’s capabilities—a concept we had only briefly sketched out on paper before the storm.

In the face of Harvey’s unpassable floodwaters, Galveston EMS set up a mobile station at a county shelter—a concept only briefly sketched out before the storm. Photos courtesy Nathan Jung

Hurricane Harvey took aim at Texas for the final time, and set a course for the Golden Triangle (an area of Southeast Texas between the cities of Beaumont, Port Arthur, and Orange). Galveston Island once again found itself receiving medical evacuees.

First, it was a nursing home that had be evacuated due to rising water. After several hours on the road, two charter buses and more than 10 ambulances were unloaded at Gulf Healthcare Center in Galveston. This incredible feat took less than 53 minutes.

The next day we received several neonatal ICU patients from Beaumont and facilitated a large move from Scholes Airport to the University of Texas Medical Branch (UTMB) with the assistance of the Galveston Fire Department and Galveston Police Department.

Neonatal ICU transports from Baptist Hospital in Beaumont arrive at Scholes International Airport in Galveston. Photo courtesy Nathan Jung

Challenges & Lessons Learned

Hurricane Harvey was a worst-case scenario, using nearly every ambulance in Texas and requiring the assistance of neighboring states. It impacted almost the entire Texas coast, paralyzed one of the nation’s largest metropolitan areas, and will be recorded as one of the costliest natural disasters in U.S. history.

The storm didn’t follow our plan, but we adapted, overcame and achieved so much during this storm and the days that followed.

Since ambulances aren’t equipped for high water, it was difficult to transport patients in the traditional manner following rescue. Our personnel frequently work on boats, in the water, and in isolation for extended periods of time, but it was still difficult. The cardiac monitor, the jump bags, and just about everything else we use isn’t supposed to get wet.

Additionally, the water wasn’t clean, we couldn’t see where we were walking, and modern stretchers are equipped with electronics that are easily damaged by the brackish water.

Our hurricane plan calls for the removal and relocation of most of our physical assets. During Harvey, that wasn’t done, and staffing wasn’t reduced. Assets were left in place to continue running a fully functioning 9-1-1 service with additional units to support rescue operations, shelter operations and flight operations.

This was stressful and exhausting for everyone. Some staff were unable to get back into the region to provide relief, while others were stuck in their homes. Mandatory downtime for crew rest in a shelter simply isn’t the same as being able to rest at home.

Though none of our ambulances were a total loss, nearly all of them had been through high, brackish water, often operating for hours partially submerged in floodwaters. As the days went by, electrical issues started to occur and sometimes led to mechanical failures. It wasn’t until December that we were finally able to complete repairs on our entire fleet.

Although Galveston County was isolated by flooding, the power grid remained intact, as did the ability to communicate by radio and cellphone. This made a significant impact, but the biggest difference between Harvey and past storms was that social media played an integral role in disseminating information.

With a few clicks, someone could let their family know they were safe, see which roadways were passable, and learn which grocery stores were open.

When the need for more diabetic supplies arose, we were able to quickly locate a pharmacist as well as medical volunteers looking to help.

For years, Galveston EMS has worked with the Galveston County Office of Emergency Management on disaster preparation. It’s rare that EMS gets involved at this level, but we’ve done this to prepare our agency to respond. It’s important to understand the role that EMS can provide, the role we’re expected to provide, and the limitations that come with this.

Hurricane Harvey showed us that plans are good to have; however, having the ability to adapt to the changes is also important. Proper preparation and training is paramount, and ensuring that the knowledge is communicated throughout the organization is a must.

A disaster doesn’t mean that patient care needs to suffer, but it certainly makes it more difficult. Hurricane Harvey presented challenges that were unique, but ultimately manageable.