A RESIDENT OF HOUSTON since 1998, Brent Mothner, MD, reels off a list of local disasters he’s lived through: tropical storm Allison, hurricanes Ike and Harvey, and a string of industrial explosions, not to mention the 2014 Ebola scare not far away in Dallas.
During this year’s hurricane season, Dr. Mothner, medical director of pediatric hospital medicine at Texas Children’s Hospital-Medical Center, says that Houstonians need no prompting in personal preparation. Everyone in the greater metropolitan area knows if they live in an area prone to flooding and has an evacuation plan. And he and his colleagues all have their “Carla bags”—named for another hurricane that devastated Texas—packed and ready, filled with what they’ll need if they have to camp out for days at the hospital: extra clothes, food, prescriptions.
But disasters, even in areas prone to them, usually come just one at a time. This year, hospitals in Houston have to prepare for a possible natural disaster at the same time that coronavirus is surging through the county and state, with ICU beds at capacity since early July.
“Our biggest vulnerability is exhaustion.”
~ Brent Mothner, MD
Texas Children’s Hospital-Medical Center
Texas Children’s has long taken care of some adult patients who have had chronic diseases as children and continue to be followed. Now, however, the pediatric center—which has three separate campuses throughout the city—is taking overflow adult patients, both covid and non-covid, from other acute care hospitals within the city. Adult patients are being treated in one area if they are covid-negative and in another dedicated area if they are positive.
Dr. Mothner spoke with Today’s Hospitalist about how he and his group are planning to handle the possibility of two ongoing disasters at the same time.
What is it like to plan for a disaster when your hospital and staff are already stressed?
It’s a great challenge to talk about resource planning in the midst of resource strain.
Here’s what makes planning right now different: Leadership has to understand that people are already coping with threats at home as well as at work. During this pandemic, some colleagues have had child-care issues or are caring for elderly relatives at home. We have people whose spouses have lost their jobs, and others with family members who have perished.
We also have faculty and staff who are being quarantined, so we need to be aware of the toll this current disaster is already taking. You have to be able to reassure people that, if the next one comes, you have the infrastructure and lines of communication to support them.
In thinking about a potential weather-related disaster, do you need to layer other planning resources on top of what you’re doing for the pandemic?
Actually, we can use much of the same infrastructure. In the early days of the pandemic, we realized we’d need to continuously reassess our staffing and resources. To do so, we leaned heavily on our hospital medicine directors of patient care, scheduling, education and administration to coordinate frequently as we reacted to an ever-changing situation.
We have also relied on our director of wellness to support our providers and respond to the challenges that the pandemic has brought to individuals and families.
Together, the directors held virtual meetings three times a week, falling back to twice a week as covid cases waned. Now, we’re back to meeting three times a week again, and we’re also holding 30-minute staff meetings three times a week.
We’ve also expanded back-up during the pandemic. While we typically would schedule one doctor as back-up, we now schedule three or four to accommodate faculty who may be ill or quarantined.
I understand that staffing during a hurricane is very different from a regular schedule.
You need a designated ride-out team who may spend days at the hospital. During two previous hurricanes, for instance, the area around our hospital was flooded and relief staff couldn’t arrive for days.
You also need to schedule that relief staff, and that’s when the hospital really becomes busy: after the disaster passes and patients can once again get to the hospital.
It helps that we have a large group with more than 60 faculty, so that gives us options. Every spring, we survey faculty to see who wants to work on ride-out or relief as part of a disaster coverage team.
This year, we surveyed staff again in light of coronavirus to see if their preferences for working disaster coverage had changed. And we’ve expanded those teams. While we typically assign three or four doctors to work ride-out 24/7 in eight-hour shifts, we’re making that team bigger this year with six or seven per site.
I also understand that as part of disaster planning, you constantly assess your hospital’s areas of vulnerability. In the event of dual disasters, where are you most vulnerable?
Our biggest vulnerability is exhaustion. We have a group of people who have been working really hard, particularly on the adult side, and are coming up against their own physical, mental and emotional limitations.
So we need to reassure them that we have a thoughtful plan that we can implement, that we have all our communication and staffing needs in place, and we have all the supplies in place as well.
We also have this in our favor: As hospitalists, we’re not passive participants waiting on the sidelines to receive directions from the hospital. During any crisis, this pandemic included, if your hospital has a command center or some sort of central crisis support, you should be in that room.
We are, and we’ve helped create algorithms and care guidelines, and we hear all about PPE and supply-chain issues. We’ll be there during any subsequent disaster, and we’ll share what we know with our colleagues.
Phyllis Maguire is Executive Editor of Today’s Hospitalist.Published in the August 2020 issue of Today’s Hospitalist