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On the morning of September 13, 2008, Hurricane Ike made landfall on the upper Texas Gulf coast at Galveston Island as a category 2 storm, with hurricane force winds extending 125 miles from its center. As the storm continued through nearby Houston and surrounding areas, it caused power blackouts for more than 3 million households. In Houston, city services were disrupted for weeks, officials declared nightly curfews, and supplies of bottled water, ice, electrical generators, and gasoline became scarce. At least five deaths were associated with carbon monoxide asphyxiation from improper use of generators in homes. During September 18-19, 2008, the Houston Department of Health and Human Services conducted a rapid needs assessment to gauge the prevalence of injuries and health complaints, determine immediate needs for health-care and medical supplies, and provide assessment information to those responsible for postdisaster response management and intervention. This report describes the assessment, which found that services to residents were disrupted longer and more extensively than anticipated, and that the greatest need among surveyed households was for assistance obtaining food (26.8%). The results suggest the need to prepare communities at risk for hurricanes for longer than the commonly anticipated 3-5 day recovery period. These findings also highlight the importance of rapid assessments of health and basic needs in such areas, even when communities sustain little structural loss and few injuries. Responders should prepare to support such areas that might experience health-related effects exacerbated by protracted recovery periods.

During power outages after hurricanes, survivors can be at risk for carbon monoxide (CO) poisoning if they use portable generators improperly. On September 13, 2008, Hurricane Ike struck the coast of Texas, leaving approximately 2.3 million households in the southeastern portion of the state without electricity. Six days later, 1.3 million homes were still without electrical power. To assess the impact of storm-related CO exposures and to enhance prevention efforts, CDC analyzed data from five disparate surveillance sources on CO exposures reported during September 13--26 in counties of southeast Texas that were declared disaster areas by the federal government. This report describes the results of that analysis, which indicated that one data source, Texas poison centers, received reports of 54 persons with storm-related CO exposures during the surveillance period. Another data source, the Undersea and Hyperbaric Medical Society (UHMS) hyperbaric oxygen treatment database, reported that 15 persons received hyperbaric oxygen treatment for storm-related CO poisoning. Medical examiners, public health officials, and hospitals in Texas reported that seven persons died from storm-related CO poisoning. Among the data sources, the percentage of reported storm-related CO exposures caused by improper generator use ranged from 82% to 87%. These findings underscore the need for effective prevention messages during storm preparation, warnings, and response periods regarding the correct use of generators and the installation and maintenance of battery-powered CO detectors.

Objective: To increase awareness of specific risks to healthcare systems during a natural or civil disaster. We describe the catastrophic disruption of essential services and the point-by-point response to the crisis in a major medical center., Design: Case report, review of the literature, and discussion., Setting: A 28-bed intensive care unit in a level I trauma center in the largest medical center in the world., Case: In June 2001, tropical storm Allison caused >3 feet of rainfall and catastrophic flooding in Houston, TX. Memorial Hermann Hospital, one of only two level I trauma centers in the community, lost electrical power, communications systems, running water, and internal transportation. All essential hospital services were rendered nonfunctional. Life-saving equipment such as ventilators, infusion pumps, and monitors became useless. Patients were triaged to other medical facilities based on acuity using ground and air ambulances. No patients died as result of the internal disaster., Conclusion: Adequate training, teamwork, communication, coordination with other healthcare professionals, and strong leadership are essential during a crisis. Electricity is vital when delivering care in today's healthcare system, which depends on advanced technology. It is imperative that hospitals take the necessary measures to preserve electrical power at all times. Hospitals should have battery-operated internal and external communication systems readily available in the event of a widespread disaster and communication outage. Critical services such as pharmacy, laboratories, blood bank, and central supply rooms should be located at sites more secure than the ground floors, and these services should be prepared for more extensive performances. Contingency plans to maintain protected water supplies and available emergency kits with batteries, flashlights, two-way radios, and a nonelectronic emergency system for patient identification are also very important. Rapid adaptation to unexpected adverse conditions is critical to the successful implementation of any disaster plan.

Hypothesis: Valuable lessons can be learned from the emergent evacuation of a large urban teaching hospital because of flooding., Design: Case report., Setting: Four hundred fifty-bed adult and 150-bed children's tertiary referral teaching hospital., Case Summary: Massive rainfall from tropical storm Allison caused extensive flooding. Emergency power came on at 1:40 AM. Complete power loss occurred at 3:30 AM. The decision to begin evacuation of patients was made at approximately 10:30 AM. All 575 patients were either discharged from the hospital (169 patients) or evacuated (406 patients) to 29 other facilities by both ambulance and helicopter by 3 PM the next day. Six deaths occurred, none of which could be attributed to the conditions created by the flooding., Conclusions: The lessons learned from this experience included the following: (1) flooding will occur in a flood plain; (2) electrical power outages are not necessarily temporary-begin evacuation; (3) appoint a triage officer from those available; (4) have a reliable in-house communication system not dependent on telephone lines or electricity; (5) have a reliable telephone system for contacting outside facilities; (6) have flashlights available on all units; (7) have battery-operated exit signs and stairway lights; (8) maximize use of volunteers when they are available and fresh; (9) maintain a paper record of all patient transfers; (10) coordinate loading of ambulances and helicopters for patient transfer; and (11) reassign staff as necessary to care for transferred patients. Emergent evacuation of a large, tertiary hospital requires extensive effort from both the hospital staff and the community.

In many areas of the country, tornadoes represent a major concern for hospitals in preparing disaster plans. Like all such plans, the hope is that they will not have to be put to use. But last spring, in areas of Arkansas and Texas, damage and casualties from twisters made national headlines and put the disaster plans of a number of hospitals to the test. For example, as part of the country's worst tornado outbreak since March 1994, twisters that tore through Arkansas from southwest to northeast on the afternoon of Saturday, March 1, killed 25 and injured hundreds. The tornadoes left a path of damaged buildings and downed trees more than 200 miles long. Three persons died in the Little Rock suburb of College Station. Warning sirens and TV and radio broadcasts a few minutes before the tornadoes hit were able to give area residents time to take cover, reducing the number of casualties. On May 27, tornadoes that hit three central Texas counties killed 32 people and left hundreds homeless. The small town of Jarrell was flattened by winds of up to 270 mph. In Cedar Park, about 20 miles south of Jarrell, a grocery store was demolished and a nearby shopping center had roofs torn off. Fortunately, there were relatively few injuries. In the area immediately around Jarrell, hospitals reported 33 casualties treated. The small number of injuries may have been the result of a large number of deaths, one official speculated. In this report, we'll give details on how nine hospitals in the affected areas dealt with tornado emergencies and how their disaster plans were carried out.