Hurricane Exit Plans for Alabama’s Elderly, Sick Upgraded

June 21, 2007

Some of the people whose lives are at stake during a hurricane are lying helpless in nursing homes and hospitals on the Alabama coast, where emergency computer and phone networks have been enhanced to help them when a storm threatens the northern Gulf.

But deciding when to evacuate a hospital or nursing home gets “real tricky,” said Rosemary Blackmon, a spokeswoman for the Montgomery-based Alabama Hospital Association.

“There’s not a magic formula when it comes to evacuation,” she said.

Hospitals and nursing homes near the coast upgraded emergency plans after Hurricane Ivan in 2004, then again after the more powerful Katrina on Aug. 29, 2005, devastated Louisiana and coastal Mississippi and damaged west Alabama from Dauphin Island into Tuscaloosa County.

During brainstorming sessions about “the next big one,” evacuation of pajama-clad hospital patients and nursing home residents remains a top priority.

There are some 3,000 nursing home beds in Mobile and Baldwin counties and more than 2,000 hospital beds.

Health officials say it’s better to ride out a storm in a facility that’s well built and has power generators than to evacuate – unless it’s directly in the storm’s path.

“There’s not 3,000 ambulances to transfer the residents. We have to do what’s in their best interest,” said Brian L. McFeely, the administrator at Cogburn Health and Rehabilitation-Midtown Inc.

In deciding whether to evacuate, McFeely said nursing home operators hope to avoid a tragedy that occurred in suburban New Orleans, where 35 nursing home residents died during Katrina.

“None of us want to see that again,” McFeely, a former Army nurse, said in an interview in his Mobile office.

Indeed, that tragedy has brought closer scrutiny to hurricane-related decisions by health officials.

Bob Lowry, a spokesman for the University of South Alabama Medical Center in Mobile, said if a hospital evacuation is necessary, patients are moved in order of their conditions.

“Those in immediate danger first, ambulatory next, remaining patients assessed as to their ability to survive the move,” Lowry said.

Where would they be taken?

Hospitals trade information on available beds and other disaster needs, using a Mobile-based computer monitored by the Alabama Department of Public Health, the Emergency Management Agency and the Alabama Hospital Association.

USA’s Center for Strategic Health Innovation, or CSHI, developed the Alabama Incident Management System, or AIMS, which collected data from more than 90 hospitals during Katrina and provided 24/7 support to the state Health Department as it responded to the hurricane.

“We are more ready now than we’ve ever been,” said Andy Mullins, program manager for the Health Department’s Center for Emergency Preparedness in Montgomery.

Mullins said last week the AIMS computer was first used during Ivan and most recently during this year’s Enterprise tornado.

“We’ve added a lot of enhancements,” Mullins said.

Today, AIMs serves not only hospitals, but community health centers, nursing homes, medical needs shelters and emergency medical service units.

“So that we could monitor all those during emergency events,” said Mullins.

The computer is located on the USA campus, with a backup server in Huntsville.

CSHI’s David Wallace, the university’s director of bioterrorism preparedness training, said AIMS works as a management tool. During Katrina, it pinpointed hospital beds statewide for evacuees pouring in from Louisiana and Mississippi.

Mike Jordan, a spokesman for the Alabama Nursing Home Association in Montgomery, said a $215,000 state Health Department grant allowed the purchase of 211 Southern Linc phones being delivered this month to nursing homes that need them.

The purpose is to make sure in event of disaster every facility has a redundant form of communication to contact the association, state officials or relatives of nursing home residents, Jordan said.

He said the phones were bought for nursing homes in Mobile and Baldwin counties last year and the system is being expanded statewide.

Infrastructure also has been enhanced at centers for the elderly and ill.

After Katrina, USA’s two hospitals made some changes, including upgrading power supplies. An underground fuel supply provides fuel for employees’ vehicles if they can’t leave their posts.

“Our employees had some terrific ideas, and we worked together to strengthen both our physical plant and our employee and patient needs. We’re better prepared as a result,” said USA Vice President for Health Systems Stan Hammack.

McFeely, the administrator at Cogburn, which didn’t need to evacuate during Katrina, said he installed a large diesel generator after that hurricane struck.

But Allen Memorial Home, with 119 beds for the elderly near downtown Mobile, was without electrical power for four hours and didn’t evacuate as floodwaters sloshed over nearby streets.

The generator that failed in that storm has been replaced with a larger one that will run the air conditioning system, said Cheryl Robinson, the administrator at the Roman Catholic nursing home.

Officials face health risks in moving hospital patients and those in nursing homes, with transportation a major issue. While the hospital association has tried to come up with some guidelines, Blackmon said, the individual health care provider makes the final call.

Robinson said the cost of an evacuation also must be considered.

“The federal government hasn’t allowed any extra money or funding if you have to evacuate. That’s all picked up by the facility,” she said.

Both Robinson and McFeely said an evacuation decision comes down to the safety of the residents.

“Is there a risk of sitting in traffic for 12 hours? It’s a tough decision,” McFeely said.

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