The Medical Center: A Reassuring Presence in the Eye of the Storm

This article describes how people pulled together during Hurricane Floyd and worked to make things better for everyone else. This and other articles may be found in the University Archives.

Citation for this article is: Fortner, Tom. "The Medical Center: A Reassuring Presence in the Eye of the Storm," UHS People, Volume 8, # 8, October, 1999.

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Maybe Dr. John Meredith said it best. Four days after Hurricane Floyd blew through, when the swollen Tar River had cut Pitt County in two, when Pitt County Memorial Hospital was still relying on back up power, and when the entire medical campus had just that morning lost water pressure, the burly emergency medical physican whos erves as PCMH disaster chief set the tone for that day's meeting of emergency personnel.

"We are on an island," Meredith said solemnly, "and the isladn is a desert."

Not a very good spot for a tertiary medical center on which 29 counties rely for advanced health care. It seems elementary to say it, but when you can't even get the toliets to flush, it's a pretty large leap to think about doing brain surgery. In fact, had one or two contingencies played out differently, circumstances may have forced the closing of one of the hospital's bed towers to conserve resources.

But in the end, as has happened so many times before, the people of the hospital, medical school and the broader medical community rose to the occassion. Through some seat-of-the-pants engineering genius, prudent operational decisions, and -- most of all -- a gritty determination on the part of selfless employees, the job got done and done well.

"I'm so proud of our employees. They have never ceased to amaze me in their dedication," said Sharon Bradley, PCMH vice president of patient care services, who heads the disaster team with Meredith. "Even when some of them had not a clue as to the status of their own homes, they were here putting our patients first."

The story of this disaster emerged in many forms:

• Floyd and its aftermath marked the first significant disaster experienced by University Health Systems of Eastern Carolina. Regional community hospitals that were previously on their own in situations of this type found support coming from Greenville and each other.

• The medical center here wasn't merely preoccupied with its own affairs; medical support to occupants of community shelters became a significant focus after the storm blew through.

• Because the flood waters so severely compromised the road system, transportation of staff, supplies and victims took on more importance than in any previous disasters.

• The absence of reliable power and water can quickly bring a tertiary hospital to its knees. Some clever engineering fixes coupled with the support of vounteer fire departments saved the day.

• Finally, the flood is a story of individuals -- some people who lost everything, others whose leadership emerged in the midst of crisis, and many others who were simply there for whatever was needed.

"I am convinced that character is not formed in a crisis, but rather that a crisis reveals character that was there all along," said Dave McRae, UHS chief executive officer, when the floodwaters had begun to recede. "I think that the character that has been on display in this health system over the last few weeks has been nothing short of magnificent."

Prelude to a Disaster

If nothing else, the medical center was well-prepared for Hurricane Floyd. Brushes with three huricanes in the previous two years meant employees knew their disaster manual about as well as they know the Pledge of Allegience.

But as it gained strength off Florida's Atlantic coast and slouched northward, Floyd seemed more ominious than the other storms. For one thing, it was about five times larger, carrying the potential for much more rain. At one point it was also pushing Category 5 status -- the highest -- with winds up to 155 miles per hour.

For the first time in memory, hospital and medical school crews boarded up critical windowsand glass-enclosed walkways as the storm approached on the afternoon of Thursday, Sept 16.

Thankfully, when Floyd finally arrived its winds had lost much of their punch. But what no one else really counted on was all that rain. Combined with the rain that had fallen on eastern North Carolina in the previous week -- about 27 inches in 10 days -- the delunge caused streams and rivers all over eastern North Carolina to swell to near Biblical proportions. Green Mill Run, which cuts diagonally across Greenville and is normally little more than a trickle, intersected with the engorged Tar River to slice Greenville into three pieces, each cut off from the other.

Impact on the Medical Center

A 500-year flood will always be devastating, but Floyd and the rains that it spawned couldn't have hit PCMH at a worse time. The hospital had been dealing with high census all summer. A full house maximizes the demand for patient care, food, housekeeping, supplies and the staff who provide these services.

As an encounter with Floyd grew more likely, the medical and management terms at PCMH began taking measures to decompress the hospital. Patients who could safely go home were discharged. Surgical procedures that could safely be delayed were postponed. PCMH still accepted all trauma cases from the region, but remained poised to begin diverting cases to other medical centers.

"What became apparent was we had to be certain that we could match up the available assets to the patient load that was coming in," said Dr. Michael Rotondo, chief of the trauma service at the hospital. "There was a period of time where we wanted to be sure that all the patients we admitted would have everything they needed to get the best possible care."

To do that, Rotondo and a group of physicians and nurses developed a system that essentially served as the throttle for the activity level of the hospital. That system involved identifying the portals for entry for the hospital -- the emergency department and the cardiology service, for example -- and monitoring those in a more organized way. That mechanism, designed on the spot in a moment of need, worked so well Rotondo expects it will be made a permanent fixure to increase and reduce volume.

Running a 731-bed hospital on a desert island has its challenges. The most pressing in any disaster is staffing. With all roads into Greenville blocked and some parts of the city blocked off from others, getting people to and from work was a major concern.

The hospital was adequately staffed when the hurricane blew through, according to Peggy Edmondson, senior pateint care coordinator. The real problem with Floyd and its flood was in relieving the group that was here, many of whom were concerned about their homes and families.

"What was unique (about this disaster) was trying to maintain everybody's stamina and still be supportive of their needs to find out how the storm had affected them personally," said Edmondson. "Whenever possible, people were allowed to leave to check on their belongings. That went a long way toward alleviating the stress."

By the weekend, however, critical relief staff who were cut off from Greenville were being flown in by helicopter. The use of the choppers in this way was a first for the helicopter to her knowledge, said Edmondson.

Getting supplies to PCMH and its sister hospitals in the towns of Windsor and Tarboro, which were almost completely under water, also proved challenging.

Pete Appoloney, PCMH administrator for materials services, said that although a supply block that can meet the hospital's that can meet the hospital's basic needs for 14 days during a disaster was available on site, many additional needs arose that were harder to anticipate, including supporting the shelters and community hospitals.

Dealing with these needs wasn't easy. The hospital's chief supplier has a warehouse in north Greenville barely five miles from PCMH but across the Tar River and its flooded bridges.

Once again, helicopters came to the rescue. National Guard aircraft and others charted by PCMH transported members of the Materials Services staff to the warehouse, where they remained for several days to pull orders. Once orders were filled, they were flown back to PCMH or to the outlaying hospitals. Over a four-day-period, the National Guard flew more than 100 packages a day for the medical center.

"That was a saving grace," said Appoloney. "Without the helicopters, it wouldn't have worked."

Other PCMH services were challenged by the flood and the havoc it caused.

Food and Nutrition Services had ample supplies heading into the storm, but could not be restocked when the weather cleared because its main supplier in Rocky Mount was under water and no roads out of Grenville were open.

"We had to scramble for alternate sources," said Administrator Jim Wallace, who ultimately opened an account at Sam's Club to fill the void.

Working with approximately half of its normal personnel complement, intermittent power and bottled water, Wallace's staff served pizza, hamburgers and fries, salads, and other convience foods to a larger than normal crowd that included hospital patients, staff and visitors, the county command center, patient shelters, the National Guard and even many local hotel guests who showed up at the hospital when all the restaurants in town were closed.

"We basically operated two pharmacies, one for the hospital and one for the shelters," said John Stallings, PCMH pharmacy administrator. He said kits that had been pre-packaged for use in the shelters were totaly inadequate to meet the need.

Home care patients served by HealthAccess, UHS company, were especially vulnerable during the storm and its aftermath. A special needs shelter was established at PCMH to meet of those patients as well as discharged patients who could not leave the hospital.

Physicians from the medical staff were a ubiquitous presence around the PCMH command center throughout the crisis. Seen frequently in impromptu strategy sessions were Drs. Paul Bolin, Ernest Larkin, Clyde Brooks, Marcus, Albernaz, Herb Garrison, and Tom Irons, along with Meredith and Rotondo. Dr. Chris Ohl, an infectious disease specialist with the medical school, was among several School of Medicine faculty members who appeared in the media on a regular basis to provide advice to the public about such issues as exposure to floodwaters, prenatal care, post-crisis mental health needs and support for the HIspanic population.

Road to Recovery

Most everyone agrees that the hospital disaster plan worked extremely well, although many small improvements can be made, particulary as the plan evolves from meeting the needs of PCMH to those of an entire system. Jim Riggs, the hospital safety administrator who is charged with the care and feeding of the disaster plan, agreed that the dry run from Hurricane Dennis just two weeks before Floyd was beneficial.

"Practice can be a double-edged sword," he said. "It helps to have run it through a couple of times, but that can also create a sense of apathy. I really felt that we did take it seriously, and we really dug in the even harder to get through this."

For John Meredith, the plan worked extremely well, largely because of the human element.

"The way people pulled together and worked together was extraordinary," he said. "It was a time of crisis for our institution, and without everybody working together, we never would have made it through this."

Yet despite the success of the plan, Dr. Paul Bolin, chief of the PCMH medical staff, pointed out the difficutly of feeling satisfied when so many people, including many co-workers, remain in such dire need.

"You and I can go back to our homes and feel good about the way things went," Bolin said. "But I have to say this crisis is not over for some people. A lot of folks, including people who work in our hospitals, are still out there suffering."

In short, this chapter in the history of UHS and its affiliates is far from over.

"I don't think there is any question that this catastrophe will have repercussions that will continue to be felt for months or even years," said Dr. James Hallock, ECU vice chancellor for health sciencs and dean of the medical school. "We have rallied together to meet this initial challenge, but the way we respond over the long haul will play a large part in determining how quickly our community and our region recover from this tragedy."