Hurricanes keep emergency doctors busy

Dolly, Gustav and Ike affected millions of storm evacuees along the
Gulf Coast

By Connie Piloto

When a hurricane begins churning in open waters and threatens the U.S. coastline, emergency medicine experts at UT Southwestern are routinely called upon to provide guidance and respond to the emergency.

The summer of 2008 proved to be very busy for UT Southwestern physicians, who worked closely with local, state and federal officials when hurricanes Dolly, Gustav and Ike targeted Louisiana and Texas. Those doctors cared for patients transferred from hospitals in the path of the hurricanes, coordinated medical evacuation plans and provided direct relief to people in the affected regions.

On just one day — the day before Hurricane Ike made landfall — doctors from
UT Southwestern were already preparing for the aftermath:

Dr. Ray Swienton (right) briefs Dr. Rich Besser on the state's planned medical response to Hurricane Ike the day before the storm made landfall.

Dr. Paul Pepe, chief of emergency medicine, was at the emergency operations command center for the U.S. Department of Health and Human Services in Washington, D.C. He was there to discuss strategies to deal with surge capacity.

Dr. Ray Swienton, associate professor of emergency medicine and co-director of the UT Southwestern Section of EMS, Homeland Security and Disaster Medicine, was in Austin, at the request of Texas Commissioner of Health Dr. David Lakey, helping to lead the state’s medical response.

Dr. Ray Fowler, associate professor of emergency medicine and co-director of the UT Southwestern Section of EMS, Homeland Security and Disaster Medicine, was leading the local preparations for medical evacuees at the Dallas Convention Center along with Dallas County Health Authority Dr. John Carlo and Dallas County Medical Director for Public Health Preparedness Dr. Ira Nemeth. Drs. Carlo and Nemeth are clinical assistant professors of emergency medicine at UT Southwestern.

Dr. Dorothy Lemecha, assistant professor of emergency medicine, provided the medical leadership for the Texas-2 Urban Search and Rescue team that was deployed to disaster sites in the Beaumont-Port Arthur area.

Dr. Jeffery Metzger, assistant professor of emergency medicine, and Dr. A.J. Kirk, a disaster medicine fellow, were deployed to help lead the Texas Department of State Health Services medical assessment and response efforts on Galveston Island. Another senior
UT Southwestern disaster medicine fellow, Dr. Jong Kim, was assigned to Dallas.

To some extent, hurricanes Dolly and Gustav provided emergency response practice for the aftermath of Ike, which devastated the Texas coastline and claimed 96 lives across the country, a figure that might have been much higher had it not been for the organized, prepared response.

“Our team had hands-on involvement across the whole scope and spectrum of the disaster, starting at ground zero, to the command center in Austin, to the receiving centers here in Dallas,” said Dr. Pepe, holder of the Riggs Family Chair in Emergency Medicine. “Moreover, it was a true ongoing learning experience for our specialized EMS and disaster fellowship trainees.”

“Our team had hands-on involvement across the whole scope and spectrum of the disaster, starting at ground zero, to the command center in Austin, to the receiving centers here in Dallas.”
— Dr. Paul Pepe

Drs. Kim and Kirk are currently serving in a unique two-year fellowship training program offered at UT Southwestern that includes disaster preparedness and response. Drs. Metzger, Nemeth and Lemecha previously completed this training, which pairs UT Southwestern emergency medicine doctors with specialized police tactical units, health officials, federal agencies and emergency managers at the highest levels of government.

While the Dallas Convention Center served as Dallas’ primary shelter for storm evacuees, Dr. Fowler also helped coordinate medical operations at several other shelters in the Dallas area. In addition to UT Southwestern physicians, medical and nursing staff from area hospitals, including Parkland Memorial Hospital and Children’s Medical Center Dallas, helped staff the disaster clinic.

“We learned from Hurricane Katrina in 2005 that the convention center operation was a true medical necessity to protect already strained area EMS crews and emergency departments,” said Dr. Fowler. “In the first 24 hours of operation following Katrina, nearly 1,200 patients were seen at the convention center and a total of over 10,000 patients by the time the medical shelter was demobilized several weeks later, providing needed care while avoiding overwhelming local emergency rooms.”

A measure of progress: In 2005, it took the UT Southwestern disaster doctors and their colleagues about 24 hours to set up the medical surge shelter for Hurricane Katrina; this year it took just five hours for Gustav. By the time it was clear that Ike was on its way, setting up the shelter was a turnkey operation.

Mental health services also were a critical component of the medical help provided.
UT Southwestern’s Department of Psychiatry, with the assistance of the city of Dallas Crisis Team, established an acute care, mental-health evaluation and treatment site at the convention center. These efforts were led by Dr. Frank Webster, clinical associate professor of psychiatry, along with Dr. Carol North, professor of both psychiatry and emergency medicine and a published national expert on mental health aspects of disasters and homelessness.

“We provided care for more than 120 patients,” said Dr. North, holder of the Nancy and Ray L. Hunt Chair in Crisis Psychiatry. “We not only provided medication refills to people with serious psychiatric illnesses, but also provided care to those who were in mental health crisis and needed acute care.”

Dr. Swienton, who had previously led an effort to write the state’s medical plan for evacuation, sheltering and repatriation as well as for establishing a medical strike team to deliver rapid assessment and response efforts in the impact areas, also provided input and on-site perspectives to government officials – including Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, during her inspection of Galveston shortly after Hurricane Ike made landfall.

“While it was, at times, a very intimidating challenge to predict accurately and prepare to respond optimally to a monstrous moving target, it was also a privilege to directly impact the outcome for the millions of citizens whom we serve,” said Dr. Swienton. “We couldn’t have done any of it without our highly skilled team of trained disaster docs and the wonderful support provided by our leadership at UT Southwestern in our nationwide efforts to mitigate the impact of disasters.”