Construction Update

The world's largest medical center, the Texas Medical Center, never saw it coming. With more than 40 institutions, 5October 2, 2006 emergency medicine expertise capable of handling crisis on moment's notice, Tropical Storm Allison was the test of a lifetime.

The storm had slipped into town mostly unannounced earlier in the week from the Gulf of Mexico, saturated the ground, and moved north only to turn around and hover over the Texas Medical Center that fateful Friday night, June 8, 2001. The flood of water unleashed was monumental even by the standards of this bayou city, where street flooding is a common sight during heavy rains. An estimated 12 - 15 inches fell over downtown Houston and the Texas Medical Center complex in less than nine hours. Across the city, homes, and neighborhoods went under and murky lakes emerged above the rooftops of vehicles stranded on Houston's once busy freeways.

Without warning, an estimated 10 million gallons poured from surrounding streets into the basement and ground floor of The University of Texas Medical School at Houston shortly after midnight on June 9. At the same time, a river of water swept into the adjacent doors of Memorial Hermann Hospital -- the primary teaching hospital of the UT Medical School. At the UT Medical School, a catastrophe was under way as 5,000 research animals along with gross anatomy labs with cadavers in place met the rising waters. Basement walls were crushed and heavy doors bent backward against their frames in what one construction worker with Vietnam War experience could only describe days later as a war scene involving mortar attack.

All told, $2 billion of damage was estimated by TMC institutions. For the first time in Memorial Hermann Hospital's 76-year history, the hospital closed its doors, necessitating heroic efforts to calm, treat, and transfer 540 patients to other hospitals up to 200 miles away. Fortunately, no patient deaths at Memorial Hermann Hospital were attributed to the event. Across the city, the death toll from storm-related events was placed at 22.

While the damage was great by all measures, the heroics of physicians, nurses, students, and support staff are perhaps the real story. Faculty and staff from the Medical School's Department of Emergency Medicine who provide clinical care at Memorial Hermann Hospital are trained to think on their feet and react swiftly. Their stories from that night and the days that followed are truly inspiring and provide a textbook definition of what being a health-care professional is all about.

Two Department of Emergency Medicine faculty members were on duty that night, Sally Awad, M.D., and Lisa Freeman, M.D.

"It was surreal when we finally had time to look outside and see a lake where streets once existed that brought ambulances to our door. We were focused on our work and had not realized what was going on outside until we heard reports that a river of water was filling the basement and a piano could be seen submerged. The hospital's emergency sirens and strobes were going on and off to add to the scenario. Flashlights materialized out of nowhere and the order to evacuate the Emergency Room meant that we had to start discharging to the waiting area all patients we could and admitting others."

Looking back on the events of the night, Dr. Awad recalled that while the ER was fairly full, the patients were suprisingly calm given the situation. Local media would feature the hospital's plight the following morning in photos, including submerged piano, destined to become part of the city's collective memory.

"It was a mess. By 4 a.m. Memorial Hermann Hospital had lost emergency power and gone dark. Administration declared an internal disaster and the decision to close the hospital and transfer all 540 patients was made. I knew this was not going to be a typical Saturday morning on the job," recalled David Robinson, M.D., who was scheduled to arrive at 8 a.m. and lead the Emergency Medicine Department that historical day. Dr. Robinson, like many other physicians, staff, and volunteers who could make it through high water to the hospital, would work the next 48 hours or more without a break. A number of ICU patients required hand ventilation throughout the early morning hours and into the first day under the watch of Christine Cocanour, M.D., and colleagues took charge under the most difficult circumstances.

Brent King, M.D., chairman of the Emergency Medicine Department at UT, was stranded at a medical meeting in Florida and led his group by phone until he could return to the city. "I received the call in the middle of the night and began immediately working by phone with my faculty to understand the scope of the situation and discuss action steps for evacuating the emergency room. If we learned anything, it would be that the best laid disaster plan is only as good as the resourceful, quick actions of faculty and staff. In our case, we had the best."

"Just getting to the Medical Center via flooded streets was a challenge early that Saturday morning,” Dr. Robinson remembered. “Driving in, I stopped at a larger grocery store to bring in some supplies. Despite lines 40 individuals long, the store manager heard my situation and allowed me up front and on my way. In hindsight, I can think of batteries and a number of items I wish I had purchased more of at that time."

Successfully evacuating 540 patients on backboards down unlit, hot, and humid stairwells by flashlight is a feat that could only be accomplished with teamwork. "My last trip up was to the 9th floor to evacuate dialysis patients and the last patient on a backboard was a gentleman over 6 feet tall and about 300 pounds,” Robinson recalled. “Rank and title issues went out the window as chairmen, senior administrators, students, faculty, staff, and volunteers worked together. What mattered was that we got those patients down to the ground where they could be discharged or transferred by ground or air to another facility." At the same time, recalled Robinson, a temporary emergency room was established by the front window of the emergency center as the growing number of individuals moving down stairwells necessitated a ready facility in the event of an internal accident or patient emergency. An extension cord was snaked in the door from somewhere, and the tiny source of power stood ready for an emergency room that fortunately was never needed.

Outside the hospital, a street had been cleared for LifeFlight, the hospital's air ambulance service, to land. LifeFlight was joined by Army National Guard and Coast Guard helicopters in a joint effort to move patients.

With no power or computer database at hand, personnel had to create a paper trail on each patient and where they were sent. Tom Flanagan, administrative director of Memorial Hermann's LifeFlight air ambulance operations, worked tirelessly with his colleagues to triage and coordinate on the sidewalk and street outside the hospital the transportation needs of all patients evacuated from the hospital.

The entire stroke team, under the direction of James Grotta, M.D., could be seen searching the sidewalk patient-staging area outside the hospital to locate and assure each of their patients while recording destinations for follow-up. "Times like this simply bring out the very best in our profession and remind us what patient/physician relationships are all about," Dr. King said.

Richard Bradley, M.D., a faculty member in Emergency Medicine, proved an important resource given his background in disaster medicine and his role as assistant medical director for the Houston Fire Department. "I was at the City's Emergency Operating Center that night monitoring the situation. We have a flood-control board with electronic sensors located throughout the city along the bayous. The board lit up like a Christmas tree for a three-hour period with everything on the board flashing," he recalled with a bit of amazement still in his voice.

On the phone with Texas Medical Center officials, Dr. Bradley had his eye on a monitor linked to a Web cam showing the flow of runoff from the Harris Gully, which runs under the Medical Center in 15-foot box culverts. "I watched the culverts fill to 13 feet, turned away from the monitor and looked back to see nothing but water. Things were happening just that fast. In fact, for the period of 3 a.m. to 9 a.m. that Saturday, the entire city of Houston had no emergency response capabilities for ambulance or fire. Emergency vehicles out there had to find high ground and sit."

At Memorial Hermann Southwest, located about 12 miles west of the Medical Center, ground was quickly paved to make a LifeFlight helipad, and trauma surgery teams led by the UT Medical School's Dr. Red Duke set up shop and within a matter of days were providing Level I services where none existed.

"Events such as this can bring out the very best in health-care professionals, and I'm convinced that the best disaster plans are only as good as the innovative and resourceful skills of the personnel,” Dr. King said. “We learned many important lessons from this event, including the importance of cell phones and having enough flashlights with batteries when the unthinkable happens and lives are at stake."

-Bryant Boutwell, Dr.P.H.