In June 2001, Tropical Storm Allison devastated the Houston Metro area and surrounding communities. Five days of pounding storms dropped up to 37 inches of rain in the area, and Houston was hit with what was then the worst urban flood in U.S. history. The flood closed down Memorial Hermann & Children's Memorial Hermann hospital in the Texas Medical Center for the first time in its history, leading to a massive effort to evacuate patients and protect medical equipment.
Douglas Dreps, biomedical engineering manager with Memorial Hermann's clinical engineering department, lives 60 miles from Houston and was on his way out of town when he got the news about the flood.
“The funny thing was that I had my bags packed and was ready to attend the AAMI convention when my wife called me over to the TV, because she saw that the hospital was flooded,” says Dreps. “When I saw a grand piano floating in the water, I knew that my trip was cancelled and I needed to try to get to the hospital as soon as possible. The piano that was floating on the television was one floor above the clinical engineering department. I knew that the clinical laboratories, cath labs, and other departments were also submerged.”
During the early hours of the morning, the hospital lost all power when vital electrical components were submerged under water. A decision was made by the CEO to evacuate all patients. Over the next 36 hours, nearly 300 volunteers carried and assisted 540 patients down darkened stairwells and halls to ambulances and Life Flight, Black Hawk, and Coast Guard helicopters. They used flashlights and other portable lights to find their way in the dimly lit hospital. Patients were transferred to several hospitals around and outside the city. And, because those hospitals needed extra equipment to care for those patients, Memorial Hermann's equipment went with them.
When Dreps arrived on the scene early that afternoon, about 22 feet of water stood between the basement and the ground floor of the main hospital building. Four other buildings were also flooded. With many of his staff trapped by the flooding and unable to get to the hospital, Dreps and his team leader, Robert Koehl, were the only medical equipment staff on hand for the first 24 hours of the emergency. Gradually, his full team of 15 was on the job along with imaging and electronic technicians from clinical engineering.
He found his entire clinical engineering department under water. All test and repair equipment in the department was a total loss, along with any other medical equipment there awaiting repair. Fortunately, the medical equipment database was stored on the hospital's IT backbone and the data were safe. The entire clinical laboratory and five cardiac cath labs housed in the hospital's basement were also destroyed.
The hospital administrative team was working out of a command center set up in the emergency room. “It all revolved around patient safety,” says Dreps. Dreps and his team brought their skills as engineers and medical equipment specialists to meet the changing needs of the situation. First, their focus was on helping facility engineering set up temporary generators to provide power to the buildings, and hanging temporary lighting. Next, they helped evacuate patients. Finally, and for the next several weeks, Dreps and his team focused on equipment needs.
“The key in the beginning was to get the equipment to where the patients were going,” he says. “We had to hand-carry ventilators and other patient care equipment down nine flights of dimly lit stairs.” A typical ventilator and its cart can weigh well over 100 pounds.
Keeping track of where equipment was going was a major challenge. “Initially, in the panic of that first 36 hours, the equipment was just going out the door with the patients and nobody was keeping track of it,” Dreps says. Fortunately, all of the equipment was already labeled with the hospital name and a barcode that hooked into the hospital's equipment database, and much of the equipment went to sister hospitals that used the same equipment database.
“Then, we started putting tags on all of the equipment with my name and phone number on it. We kept a paper spreadsheet of where all the equipment was going, and put it all on a computer as soon as one became available.”
Saving the equipment remaining in the building was the next focus. All equipment stored in flooded areas was a total loss. Other equipment was also in danger from exposure to water, heat, and humidity. “There were 42 million gallons of water sitting in the building, and it took several days to pump it all out,” says Dreps. “Any equipment under water was discarded, anything in an area filled with water was questionable.” To protect imaging equipment and other valuable medical devices, Dreps and his team set up air conditioning units and fans to dry and cool the equipment as soon as temporary power became available, within 48 hours of the initial power loss.
Douglas Dreps believes that the medical equipment database was key to his department's ability to manage and recover from the 2001 flood that shut down his hospital for six weeks. He also thinks it is key to his department's ongoing contribution to patient safety in the hospital.
“If you instill in your technicians that they need to document everything properly, you can use these powerful databases to identify trends that affect patient safety,” he says. “We can tell when and where equipment was bought, what was spent on it, what use errors occur with it.”
Clinical engineers and biomedical equipment technicians are patient safety advocates, says Dreps, and need to make nursing, administrators, and IT better understand the importance of that role. “Saying we have value is not good enough. We need to be more aggressive with our presence at nursing, administration, and IT meetings and strategic planning committees.”
Rapidly evolving medical equipment had also changed that role. “Maintenance of equipment was once the main way we affected patient safety,” says Dreps. “As equipment has become more reliable, we can now focus on evaluating and implementing new patient safety technologies.” He points to technology that integrates medical devices into electronic medical records as one that will improve patient safety through reduction in translation errors.
Dreps' technicians take an active role in addressing use errors, educating staff on proper use of equipment, and working with department heads and educators to address use error trends.
His department also holds regular medical equipment subcommittee meetings where nursing, risk management, education, materials management, and administrators are invited to address the medical equipment Environment of Care portion of JCAHO requirements.
Keeping up with new technologies and meeting with others in the engineering and affiliated fields are also key to improving patient safety, Dreps says. “Engineering and IT leadership now meet weekly at my institution to improve our relationship and work together on technologies that improve patient safety,” he says.
As the flood waters subsided and the hospital began the cleanup process, all equipment had to be cleaned, inspected, and recertified. “Our focus became moving the equipment back in, getting it back in place, and getting ready to reopen.”
The hospital reopened six weeks later, on July 17, with limited services. It did not return to full operation for another two months. From the flood to the reopening, Dreps and his staff worked 18-hour days, providing 24-hour-a-day coverage, seven days a week to handle equipment needs.
What have Dreps and his team learned from this disaster? “First, you can't always prepare for a disaster, because you don't know what the disaster will be,” he says. “Having our equipment database on the IT backbone was key. Even though our whole department was under water, we didn't lose any data.”
Now, Dreps has key people assigned to track equipment leaving the building in case of another such emergency. The disaster plan also calls for twice daily conference calls with hospital leadership to discuss clinical engineering issues.
At Memorial Hermann Healthcare System, they have learned to take hurricane preparedness seriously. Before Hurricane Rita hit in September 2005, the system closed two hospitals and evacuated all patients beforehand. Biomed staff moved key equipment away from windows, and helped maintenance board up the windows. While Rita wound up not causing much damage in Houston, an affiliated hospital in Beaumont did suffer water damage. Some of Dreps' staff spent several weeks there helping them recertify equipment.
Biomedical equipment technicians helped to evacuate both patients and equipment in the aftermath of Tropical Storm Allison.
Biomedical equipment technicians helped to evacuate both patients and equipment in the aftermath of Tropical Storm Allison.
Douglas Dreps, biomedical engineering manager with Memorial Hermann's clinical engineering department.
Douglas Dreps, biomedical engineering manager with Memorial Hermann's clinical engineering department.
“Having our equipment database on the IT backbone was key. Even though our whole department was under water, we didn't lose any data.”
“Having our equipment database on the IT backbone was key. Even though our whole department was under water, we didn't lose any data.”