Evacuating hospitals an especially tricky task with COVID-19

Preparing to evacuate a hospital when a hurricane’s headed toward Galveston County is a daunting task — potentially amplified this hurricane season by the presence of COVID-19.

Mike Mastrangelo, director of institutional preparedness at the University of Texas Medical Branch, has been working since January with the COVID-19 Command Team at the medical branch and, in recent weeks, has been training his team on dealing with a complex disaster like a major hurricane during a COVID-19 flare up.

But Mastrangelo was no stranger to a scenario like this.

“For the past two years in our hurricane evacuation exercises, we’ve stipulated that while the hurricane evacuation is going on there’s a coincident disease outbreak,” Mastrangelo said. “We did that to stress the system.”

Normal procedure is to take a given day, look at the patient census at the medical branch and calculate how many patients need to be moved to a medical center elsewhere in the state.

For the medical branch, normally there have been enough beds available in 11 hospitals in Central Texas. But stipulating the possibility of a disease outbreak changed the normal picture.

“We work with the Regional Trauma Advisory Council of southeast Texas and do exercises and planning with them and the council in the capitol area,” Mastrangelo said.

“Stipulating that Central Texas couldn’t provide enough beds because of the outbreak, a message would go out to the southeast council with the number and general type of patients to find the remaining beds.”

Summer of 2020 marks the third year the team at the medical branch will have planned and exercised under the concept of a complex incident like a hurricane and a COVID-19-like flare up.

When Hurricane Ike hit in 2008, flooding the entire medical branch campus and causing emergency power outages, most patients were transferred to other hospitals by ground ambulance, some helicopters and some fixed-wing aircraft, Mastrangelo said.

In addition to new buildings designed to better withstand major storms, the medical branch now has several ambulance buses equipped to evacuate more patients in a single vehicle. With COVID-19 patients, the buses would isolate infected patients and medical personnel would use protective equipment, Mastrangelo said.

“I think we’ve got some good plans in place,” Mastangelo said.

Early predictions are for an above average storm season, so an evacuation could be in the picture, he said. The worst-case scenario for this year’s exercises, based on flood modeling and modeling of the medical branch campuses, will be a Category 4 storm with a 17-foot storm surge and wind-driven debris damage. Planning helps the team plan pre-landfall evacuations, post-landfall evacuations and scenarios to implement emergency protective measures in place.

“In terms of personal protective equipment needed and transporting patients, we would follow Centers for Disease Control and Prevention guidance and our own infection control protocol,” Mastrangelo said.

And although the medical branch communicates and coordinates with local authorities on the general population evacuation and evacuation of any medical, special or functional needs populations, Mastrnagelo’s team would defer to the local health authority, Dr. Philip Keiser, the local ambulance authority, and the Texas Division of Emergency Management Regional Coordinator on specific plans regarding social distancing and use of personal protective equipment on evacuation buses or other vehicles, Mastangelo said.

“We will do a variety of exercises on a hurricane with COVID-19 thrown on top, and maybe even some more complicating factors,” he said.