Houston ER Doc: These Were Our Vital Steps in Aiding Hurricane-Affected Patients

Robert Glatter, MD; Neil A. Gandhi, MD


September 07, 2017

The following interview took place on Thursday, August 31.

Robert Glatter, MD: Hi and welcome. I'm Dr Robert Glatter, assistant professor of emergency medicine at Northwell Health and attending physician at Lenox Hill Hospital in New York City. As I speak, tens of thousands of Houston residents are being housed in shelters after their homes were destroyed or made unreachable as a result of the destructive force of Hurricane Harvey.

The hurricane, which began Friday evening, has caused devastating flooding in large swaths of Texas. At the beginning of the week, as soon as flood waters receded around his home, Dr Neil Gandhi, medical director of the emergency department at Houston Methodist San Jacinto Hospital, jumped into his car and headed to work.

Dr Gandhi is currently treating patients at NRG Stadium, which opened on Tuesday [August 29] as a shelter with a capacity to house up to 10,000 people.

He has agreed to speak to us about what the situation is like there. Dr Gandhi, welcome. Thank you so much for joining us.

Neil A. Gandhi, MD: Thank you, Dr Glatter. Over the past 4 days, we've rapidly been able to move from a ride-out phase to a recovery phase now at this point. Things, while still chaotic, are settling down here a bit in Houston.

My story really began on Sunday morning, as the city was inundated with water and flood waters began to rise. As soon as the water went down, our first move as medical directors with the Houston Methodist system was to hop into our cars and get into the hospitals. The hospitals were quite chaotic for the first 72 hours—Monday, Tuesday, and Wednesday—dealing with a whole host of transport issues and some other complications in order to get patients and treat them in a normal fashion.

Dr Glatter: I can imagine that this is just an overwhelming situation for you to deal with, both personally and on a professional level. When things started to heat up, what were your key elements of how you organize this in your head?

Dr Gandhi: Our first move on Sunday morning when the storm hit was to assess which hospitals needed our help the most. Our group staffs six major hospitals in the Houston metro area. As you may recall, with this hurricane, one of the unique features was that the hurricane kept on moving in a counterclockwise fashion. All of our hospitals throughout the region—north, south, east, west, and in the center of town—were hit, and all of them were being hit at different times.

Our first move was to assess where our assets, where are physicians, were; find out what the needs were; and then get folks into place in order to take care of patients—not just for the next 24 hours, but the next 72 hours. What complicates this storm or really makes it unique, as opposed to some previous incidents, is the length of this. Typically in emergency medicine, we're well prepared to handle disasters, if you think about the explosions that we've had before out west in Oklahoma; previous tornadoes; any type of mass-casualty events, like the Boston bombing. We're typically pretty well equipped to handle an emergency for 24 hours or 48 hours. At 72 hours or 96 hours, there are a lot more different elements at play, including getting rest time for your staff and bringing in new providers.

Dr Glatter: Right. That also hits on, almost, compassion fatigue, where your personnel, your physicians, your nurses, really need that key rest to regroup and continue on, so to speak.

Dr Gandhi: Absolutely. As soon as I was able to make it into my hospital in Baytown, my first order of business was to relieve the three physicians who were on duty at that point, to make sure they had a chance to eat and get some rest. We really weren't sure when other replacements were going to arrive. The most important thing in a prolonged disaster is to make sure that you get all of your staff onto a schedule and get them onto a schedule quickly.

The most important thing in a prolonged disaster is to make sure that you get all of your staff onto a schedule and get them onto a schedule quickly.

Frequently, everyone's adrenaline is running extremely high. People are ready and they're looking forward to taking care of as many patients as they can. From a provider perspective, that can be a quite narrow focus. It's important for us to have a long-term view.

Dr Glatter: Why don't we touch upon some of the injuries and illnesses you're treating? Can you discuss some of this? Also, is access to medication one of the key things that you're finding is limiting care, especially for elderly patients?

Dr Gandhi: Absolutely. In the first 24 or 48 hours of our disaster response, we were primarily seeing the things that you'd expect to see in a flooding type of event: a lot of trauma, people being injured by debris, houses with flooding, and they may be running into items and objects that they normally weren't expecting to be in a certain place. As we shifted after the first 24 hours, and flood waters were still rising, a lot of our medical infrastructure throughout the city was crumbling.

Several hospitals were going offline. A lot of community resources, like dialysis centers, were shutting down. We had multiple sick patients, medically sick patients, with really nowhere to go. Now as we are moving into the recovery phase, we've finally been able to partner with some local pharmacies and start getting our patients back on their medications, back on their prescriptions, and back to a lot of their regular routine.

Dr Glatter: Have you started to encounter any patients with gastrointestinal illness, diarrhea, vomiting, or even flu-like symptoms, being that this is almost on the cusp of flu season at this point?

Dr Gandhi: I think we're extremely fortunate that, for most of Houston, our water supply was not compromised. Since we're used to having some flooding and disasters down here, being a lowland coastal region, most individuals have plenty of access to bottled water and some safe sanitation. Once the storm hit, we were able to evacuate a fair amount of patients to either shelters or alternative residences. Fortunately, we haven't seen a high amount of gastrointestinal illness or things you'd see in other outbreaks.

Dr Glatter: That's good to hear. How about mental health? Are you seeing patients who are having some early signs of PTSD, or those who already suffer from anxiety or depression having an exacerbation?

Dr Gandhi: We're definitely seeing an influx of patients who are coming in with mental health issues. The most acute need was a lot of our patients who are on chronic or long-term medications, as they may have fled or sought shelter during this storm. A lot of them had a short supply or no supply of their medications. As they've been off of them, obviously their underlying symptoms have become exacerbated.

We're also seeing a fair amount of anxiety. I think PTSD and those types of symptoms are probably setting in now. People are still exhausted at this point. I really expect to see more of that in the coming weeks.

Dr Glatter: How about children? Are you seeing any children suffering after-effects of this storm, whether mental health or just medical at this point?

Dr Gandhi: We've seen a fair amount of pediatric patients. We took care of a little girl two evenings ago who was submerged in flood water for an extended period of time. She had a fair amount of bites and some cellulitis on her body from that. I think the exposure—and prolonged exposure for a lot of our patients—to the elements, which were so unpredictable, has left them particularly vulnerable to different types of illness.

Dr Glatter: Are there any big takeaways so far that you've gleaned personally from caring for patients from the storm that you can share with our viewers?

Dr Gandhi: The biggest takeaway that I've seen has really been the compassion and the ability for folks to jump in and volunteer. When this storm hit, our group—we staff emergency departments throughout the city of Houston, and due to that we have physicians who live in different parts of the city—physicians were calling and texting me nonstop, offering to drive in, volunteer, work extra shifts.

Physicians were also willing to shuttle patients around. We've had an outpouring of volunteers throughout our city [who are taking] in individuals who have lost housing, preparing meals for first responders. If anything, I would say that a storm like this has reaffirmed my affirmation in the goodness of people and the goodness of our citizens of Houston.

Dr Glatter: That's always good to hear. In terms of social media, has that been an aid to you during the storm in terms of images and texting? Would you say that's been one thing that's aided your ability to care for patients?

Dr Gandhi: Social media has been a two-edged sword. On the positive, it has allowed us to communicate information quickly. It's allowed patients to find up-to-date information and really granular or micro neighborhood location as far as flood waters rising, safe routes, and ways for people to drive around the city and avoid water.

On the back end of that is that social media has also led to a lot of scares and a lot of panic. A lot of individuals thought that certain roads were impassable when they were not. There were also some false rumors regarding shutting down water supplies and hospitals being closed when in fact they were open. I would say that the big takeaway with social media is that it needs to be social media from a trusted provider, and maybe not someone who, while they are a concerned citizen with good intent, their dissemination of information can sometimes be tricky, especially with first responders trying to provide such a big response.

Dr Glatter: Absolutely. I think that's a great point you made. There has to be a trusted source when you're getting this information. I want to thank you so much for your time, and I really appreciate your insight, Dr Gandhi. This is of immense benefit to all of us.

Dr Gandhi: Thank you.

Dr Glatter: I think the devastation from the flooding as a result of Hurricane Harvey and the massive amounts of rain has really taught us several important lessons: that communication and cooperation, and certainly using technology, can all help us throughout this difficult process. The past few days have been an incredible experience for so many people who have helped others—people in difficult situations that were often insurmountable. But we all came together. In the coming days, certainly when the rains start to abate, we'll realize that this has been an incredible and very difficult time, but we've all been able to come together to make things work.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: