Clinicians Advised to Prep for 'Huge Challenge' From Hurricane Florence

Alicia Ault

September 12, 2018

Healthcare providers and health agencies in the mid-Atlantic and Southeastern states are mobilizing to prepare for what could be the biggest storm to ever make landfall in the Carolinas — Florence — aided in part by the federal government's declaring states of emergency in North Carolina, South Carolina, and Virginia.

In addition, Georgia, Maryland, and Washington, DC, have all declared statewide emergencies.

"My message is clear: Disaster is at the doorstep and is coming in," said North Carolina Governor Roy Cooper (D) during a press conference on September 12. "This may be a marathon, not a sprint," he said, according to The News & Observer.

The US Department of Health and Human Services (HHS) has declared public health emergencies in North Carolina, South Carolina, and Virginia.

And the American Red Cross said it is preparing to help as many as 100,000 people in the affected areas, sending along more than 700 disaster workers who will deploy vehicles, equipment, and relief supplies.

It is still unclear exactly when or where  the hurricane, a category 2 storm with 110-mile-per-hour winds as of early Thursday morning, would make landfall, but North Carolina and South Carolina appear to be the most likely spots. And heavy rains — upward of 20 inches in some places — massive storm surges, and lengthy flooding are predicted in the storm's wake.

South Carolina Governor Henry McMaster (R) initially issued a mandatory evacuation order for all coastal counties, but then later reversed it for three counties in the area: Beaufort, Colleton, and Jasper counties, with the exception of Edisto Beach.  North Carolina's Cooper issued an evacuation order for the state's coastal areas, including the barrier islands of the Outer Banks.

Hospitals Scrambling

The evacuation orders — and the storm threat — leave hospitals to decide whether they will stay open or shut down partially or fully. As of Tuesday, September 11, some 132 patients had been transferred out of South Carolina hospitals in some coastal zones to other hospitals in the state, according to the South Carolina Hospital Association.

Vidant Health, a nonprofit system that serves 1.4 million people across 29 counties, primarily in Eastern North Carolina, has a hospital and multiple physician offices and outpatient clinics in the Outer Banks. It has not yet evacuated the hospital, but all of Vidant's physician offices — including those not in the Outer Banks — will be closed on Thursday and Friday, Brian Floyd, chief operating officer of Vidant Health hospitals, told Medscape Medical News.

Vidant's hospitals, including its main Greenville facility, will also cancel all elective surgeries for Thursday and Friday, he said. "That lowers the demand a bit as the storm approaches," said Floyd, who is also president of the Greenville medical center.

Early on September 11, only a handful of patients were in the Outer Banks hospital, Floyd said. "Our goal is not to ever have to evacuate," he said, adding, "that is a risky thing to do." Vidant has been making contingency plans that would include coordinating with the National Guard if a last-minute evacuation was necessary, said Floyd.

A key issue for the system — and patients — will be coping with potential power outages and anticipated flooding, Floyd said. Normally, Vidant hospitals would have 3 days of supplies on-hand. That has been extended to 10 days, along with 2 weeks' worth of food, he said.

Flooding has the potential to isolate patients for long periods, which means physicians and patients both need to be assessing critical needs — for instance, stocking up as much as possible on needed medications, said Floyd.

After the storm passes, the hospital system is readying for an influx of potential emergencies, including treating people who have wandered into flood waters tainted by toxic chemicals or individuals who have been overcome by carbon monoxide poisoning from improperly placed generators, he said.

Helping the Most Vulnerable

Having continuous access to medications and healthcare is crucial for many individuals, especially those with diabetes requiring insulin and other chronic conditions, those with mental illnesses, or those who are about to give birth, said E. Anne Peterson, MD, MPH, from Americares, a Stamford, Connecticut-based nonprofit that responds to disasters around the world.

As the commissioner of health for Virginia, Peterson went through Hurricane Floyd in 1999. "That was just a category 2 storm," she told Medscape Medical News, adding that even then, "restoring care was a huge challenge." Florence is much bigger, and if it stalls and flooding is anything like that seen in Harvey, it will be a larger response challenge, said Peterson.

Her organization has sent an emergency response team to North Carolina to help assess needs for the safety-net clinics it already serves on an ongoing basis, providing assistance and medications. Americares is already in touch with 90 clinics in the Carolinas-Virginia region, Peterson said, adding, "I anticipate the need will be broad."

During disasters, Americares brings in medical supplies and pharmaceuticals (mostly donated by 200 companies that support the organization) and also provides hygiene and first aid kits to its clinics and shelters. Its workers usually stay long after a storm.

For Hurricane Harvey in the fall of 2017, 75 Americares relief workers spent more than a combined 2500 days in the field. During that storm, workers even picked up patients isolated by flood and brought them to dialysis clinics, said Peterson.

But Americares' main goal is to get its partner clinics up and running as soon as possible, Peterson told Medscape Medical News. That provides "the best and most sustainable response."

She urged Medscape Medical News readers to "be thinking about who their patients are who have the greatest need and seeing if they can help prepare them." And they should also "remember to take care of themselves" because healthcare providers often have what Peterson calls a double whammy: "They feel the hurt of the people they are serving, but they are also going through it themselves."

Help and Tips

The federal government, through the public health emergency, has positioned 230 medical personnel from the National Disaster Medical System and caches of medical equipment in North Carolina and Maryland, with the goal of making them readily available, according to HHS.

It also has activated the US Public Health Commissioned Corps' Rapid Deployment Force to assist if needed. The public health emergency means that the Centers for Medicare & Medicaid Services will be more flexible with beneficiaries and healthcare providers.

HHS is directing both individuals and health care providers to its Hurricane Preparedness website, which provides reference materials and direct links to state, territorial, and local officials.

Peterson recommends that healthcare providers take a look at its WeHateHurricanes website for information that includes five key tips for hurricane preparedness, which, notably, suggests keeping at least a 7-day supply of medication on hand.

Theoretically, clinicians and patients can determine what pharmacies are open for business both before and after the storm by consulting Rx Open, a nonprofit supported by the pharmaceutical industry and pharmacies. At press time, the service has been activated in Maryland, North Carolina, South Carolina, Virginia, and West Virginia. Rx Open displays the precise location on Google Maps of open pharmacies, closed pharmacies, and those whose status is unknown.

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