When Hurricane Florence bore down on the Carolinas last fall, forecasters predicted this Category 4 storm would cause catastrophic damage and life-threatening flooding. Our hospital, New Hanover Regional Medical Center (NHRMC) in Wilmington, N.C., was right in its path.
This “storm of a lifetime” left more than 340,000 North Carolinians without power and caused 43 storm-related deaths. During all this time, our NHRMC teams came together to serve our community with courage, compassion and tireless dedication. Communication planning was critically important in enabling us to continuously and effectively care for our patients. According to the Centers for Medicare & Medicaid Services (CMS), developing and executing a communication plan is one of the four core elements of its Emergency Preparedness Rule to participate in the Medicare or Medicaid program.
Despite the loss of traditional communication methods, our physicians, nurses, staff and other personnel were able to connect and collaborate for the duration of the hurricane and the devastating flooding in its aftermath. NHRMC cared for more than 500 patients during the storm and our labor-and-delivery teams helped bring 42 babies into the world.
Going all-in on patient care
By Sept. 11, 2018, government officials, aware of Hurricane Florence’s imminent dangers, had ordered mandatory evacuations in three states for more than one million people. But while most Wilmington area residents were making plans to leave, we were preparing to care for those less fortunate.
Since we knew that one of our facilities, Pender Memorial Hospital, would not be safe or accessible, we transferred its patients to a mobile hospital unit several days before the storm hit. Food was stocked and ready to be prepared for more than 150,000 meals.
Not surprisingly, the challenges intensified as the days passed and the water rose. Highway flooding quickly cut off our access to Wilmington, our roof had to be repaired, and we needed to set up a medical shelter at an elementary school for people forced to leave their homes who required more care than a typical shelter could provide. Our emergency room remained open, and more than 120 children sheltered at the hospital as their parents worked.
Communication command center
Communication was vital to respond to constant emergencies, coordinate care for patients 24 hours a day and ensure the safety of more than 2,500 people in the hospital, mobile unit and medical shelter. Multiple studies have confirmed that when communications are disrupted in a disaster, managers in healthcare settings may be unable to request help and resources, maintain situational awareness, coordinate assistance, or gather information to make decisions.
To avoid such disruptions, NHRMC set up a communication command center featuring our Voalte smartphone platform and Wi-Fi phones, which proved invaluable when we temporarily lost services from both landlines and cellular towers. We also moved a charging cabinet from a floor not in use to the command center to store phones, chargers and other equipment. We made certain that all phone bank cabinets throughout the hospital plugged into red outlets (which indicate emergency backup power) to ensure that they would remain functional throughout the storm.
We also created a set of “command center” extensions in our directory and assigned temporary user numbers for people using Voalte smartphones over the Wi-Fi network. We cataloged each smartphone serial number, labeled each smartphone and case with the generic login and password, and had a sign-in/out sheet. Our goal was to have everyone using these phones or the Voalte Me apps on their personal smartphones to communicate internally. Fortunately, our internal servers never went down and we never lost Internet connections.
What we learned
As the days passed in a blur of technology challenges and mini-crises of all varieties, the communication support team stayed focused by reminding themselves that their top priority was to always do whatever was needed to help those who care for patients. Following are some key takeaways from our experiences and thoughts on how hospitals can better prepare for and facilitate timely, effective communication when a disaster strikes.
• Smartphones are often more effective, informative and efficient than email and overhead paging. Although our command center sent many emails, we could have improved response times by using our smartphone platform for more urgent messages to clinical staff.
• Two things we found extremely helpful were having extra phones on hand and being able to add generic users to our command center directory.
• We did not realize how critical the use of Wi-Fi calling and texting would become until we lost all internal and external calling capabilities. Recognizing this was a telling reminder of the need to 1) have standard work in place for storm preparedness, and 2) build redundancies into core on-premise Wi-Fi networks, including back-up generators and perhaps locating core switches on higher floors in case of flooding.
• During communication planning, it’s important to consider how a hospital’s different systems and endpoints are integrated and used. Remember, nurses and staff could be working anywhere and may not be able to access their desk phones or computers.
• In the future, we will place a Voalte system administrator/informaticist to be onsite in the command center and make certain everyone there has been trained in the use of Voalte smartphones.
