COMMENTARY

What Have We Learned From Hurricane Harvey? One Year Later

Robert Glatter, MD; Neil A. Gandhi, MD

Disclosures

November 01, 2018

Robert Glatter, MD: Welcome, and thank you for joining us. Hurricane Harvey [hit Texas] over a year ago. Today I'd like to go back and revisit the situation with Dr Neil Gandhi, who is the regional medical director for Houston Methodist Hospital System.

He joined me a year ago and we had an in-depth discussion about how he managed all of the effects immediately. Today let's discuss what is happening a year later.

Thanks again for joining us, Dr Gandhi.

Neil A. Gandhi, MD: Thanks, Dr Glatter. It's a pleasure to be here.

Glatter: At the point we spoke, you were at NRG Stadium triaging patients. The floodwaters had receded a little bit. I wanted to hear the follow-up story to our interview from a year ago.

Gandhi: You're absolutely right, Rob. As one could imagine, we had touched base last year about 4 days into the incident. We were providing care at that point at the NRG Center, where we took care of many victims of the flood and families who had been displaced from their homes.

Fast-forward to about a year later. At this point, we've been able to take a detailed look back and pick up and understand lessons learned from the unfortunate incident of Hurricane Harvey.

Glatter: Can you tell me how the hurricane has affected the management of future mass-casualty events?

Gandhi: In regard to these types of events, we've seen a bit of a paradigm shift. Also, we have been able to draw a lot from what exactly happened to us last year.

In regard to staffing, we have a better idea of how to deploy providers—physicians, nurses, and all the other individuals who are very important to keep a hospital up and running. We also understand the importance of rest, break times, and building a schedule. We've re-used a lot of that as our foundation for what we're going to do for any type of these incidents moving forward.

The flood was unique in that many other types of mass-casualty or large disaster events are typically episodic. There's a start point and usually an endpoint, and then there are victims or patients afterwards. With this flood, we saw that it lasted several days, so that put some additional stress on the system, both from a provider-physician perspective and on our additional resources.

Glatter: In light of the hurricane, a year later, patients still don't have adequate housing, they have illnesses related to that, and they lack access to medications. Have you seen patients who are suffering the ill effects of all of these processes?

Gandhi: We're seeing a lot of folks who were displaced throughout the city. With displacement or any type of movement come a lot of the things that you mentioned. It's difficult for some patients who've moved from one side of town to the other to re-establish care with a primary care physician. This has led to patients potentially not taking their medications and some who've not been able to obtain insurance if they've lost jobs due to relocation.

Glatter: Are you still seeing lingering effects, such as PTSD or other mental health effects, from the hurricane?

Gandhi: Sure. In the emergency department, we're obviously on the front lines for a much larger mental health crisis within this country. Any type of event, especially one as devastating as Hurricane Harvey, has the effect to cause symptoms and potentially even unmask some underlying illnesses for these patients. This type of catastrophe has really led to a bit of disequilibrium. There are cases of PTSD, but we've also seen problems due to other issues. With lack of access to care or reduced access, patients have been off their medications and the situation has not improved or gotten better as quickly as we would like.

Recommendations for Future Mass-Casualty Incidents

Glatter: In light of the hurricane, is there anything else in your toolkit now that you would recommend to other hospital systems to deal with such a mass-casualty incident in the future?

Gandhi: There are multiple lessons learned from this event. First and foremost, as we've discussed previously, always keep a very close eye on your provider and ancillary staffing levels. With an event such as the hurricane, which went on for multiple days, it's integral for us to have the right people in place and also the right people to relieve those persons who were there for the initial incident. That's number one.

Number two is to develop a comprehensive system of communication. These days, that's a combination of text messaging, phone calls, and some Web-based and cloud-based platforms as well.

One thing, which was very important to us, is that our cell phone system was still operational throughout the storm. Traditional news media and other outlets did not have the most up-to-date information regarding which roads were passable, which hospitals were still open, and things of that nature. Person-to-person trusted communication became extremely important at that time.

The third biggest takeaway is to never underestimate the human spirit. What we saw during this unfortunate tragedy in this event is that there are a lot of gifted people who work within our system and who work with us on a daily basis. These individuals were able to really make a lot of smart decisions under pressure, and that led to some great outcomes for our patients and our community.

Glatter: Do you think climate change is having an effect on mass-casualty management overall, especially in light of floods and rising seas after such events?

Gandhi: As we think about care throughout this country and, even more broadly, care throughout this world, these are fantastic questions that you're bringing up, both from a climate-change perspective and from a government and regulatory perspective. In Houston, we recently passed a large bond referendum to help build flood mitigation and some different drainage systems throughout the city. It is important for us to be forward-thinking on all of these fronts, whether it is the climate or anything else that we can do collectively as a society to make things better for us.

Glatter: What we saw with Hurricane Florence recently in the Carolinas was contamination with fecal and animal waste. There was also the possibility of radioactive contamination. Certainly, all of this contamination when floods occur is of utmost concern from a public health perspective. That is something I would imagine certainly came up in your case during Harvey.

Gandhi: Absolutely. At least with Harvey, we were able to maintain a safe water supply for our population. The Department of Public Health, working closely with state and local governments—that's really under their purview to help ensure that we have safe quality standards because these are necessities for our daily life.

Glatter: In terms of mental health effects, have you seen any of these impact children or parents?

Gandhi: Some subtle changes that we've noticed include a palpable sense of anxiety each time we have serious rainfall in our Houston region. We hear from children and sometimes other younger patients when they're with their families. They ask, "It's raining outside. Is it going to flood again?" We've also seen some patients ask, "It's raining outside. Are we going to have to move out of our house again?" Those after-effects are definitely real and present.

Glatter: I want to thank you for your time. This has been so informative to me, and to our audience, to hear about how things are going in Houston after the disaster a year ago, and to see what has happened and transpired since then. Thanks again, Dr Gandhi.

Gandhi: Thank you.

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