In recent years, the United States and particularly the Midwest and Northeast have seen a handful of record breaking winter storms. From extreme snow in 2009/2010 to the Polar Vortex in 2013/2014 to 2015’s unrelenting snow in New England, extreme winter weather has slammed major cities with disaster-like conditions.

Functioning health care systems are critical to their communities during such times. As illness and traumas persist, some even caused by the hazardous conditions, patients continue to require treatment. However, as cities shut down and ice, wind, and snow persevere, how do hospitals maintain their standard of care and continue to provide regular service?

Both Henry Ford Health System in Detroit and the MetroHealth System in Cleveland were at the heart of the 2013/2014 Polar Vortex. They shared with us how they prepared for and responded to record breaking snowfalls, wind chills, and consecutive days spent below zero to keep patients and staff safe.

Fighting the cold

Situated around Lake Erie, neither hospital is a stranger to harsh winters and lake effect snow, but this particular winter did bring some unique challenges. Cleveland accumulated roughly 60 inches of snow, while Detroit got a record breaking 94 inches. Additionally, temperatures dipped down into the negative teens with wind chills in the negative 30s and 40s.

The freezing temperatures coupled with piercing winds made it difficult for MetroHealth to retain heat in certain areas of the hospital. “In an effort to retain heat, we went into controlled access, so we closed the amount of doors that were opening up to the environment,” said Marek Owca, RN, BSN, MPA, director of emergency management. Other protective measures included applying plastic sheeting to some of the external vulnerable glass and evacuating patients to warmer rooms.

Partial evacuations were also necessary in both hospitals due to the effect of the wind and cold on aging water pipes. Temperatures below freezing, and especially below zero, increase the risk of burst water pipes and unsafe conditions for patients.

Outside, keeping hospital grounds safe and accessible for patients and staff also proved to be a serious challenge during the extremely cold conditions. Henry Ford’s Emergency Preparedness Coordinator John Snider, RN, said, “Snow abatement here on campus is a concern. We have 13 acres to plow, shovel, and salt. The slip and falls did go up, that was a real issue over the winter.” Similarly, MetroHealth struggled to keep rock salt supplies in stock for de-icing and snow melting. However, the hospital was able to reach out to the local Emergency Management Agency (EMA) for additional vendors.

Despite these challenges, both hospital teams were able to tackle every issue that came their way and continue to provide high-quality care. Snider and Owca noted that their well-established preparedness and response strategies made all the difference.

Don’t go it alone

Such preparations start weeks, months, and even years in advance. For example, both hospitals have worked to build partnerships with local services and emergency preparedness teams. In Detroit, Snider works with local city authorities to make sure ambulance lanes are clear and plowed for emergencies. In addition, Snider and staff communicate with the power authorities to ensure patients with a ventricular assist device – which requires a power supply – are first on the list to receive power when outages occur.

Similarly, Owca works with the Office of the Assistant Secretary for Preparedness and Response, the local EMA, and the Ohio Department of Transportation. He says, “I think it’s meeting directly, investing time, and being transparent. It’s actually more than email, it’s developing those relationships for the longer term. We leveraged all of those relationships and appreciate their support.”

Hospitals also rely heavily on numerous vendors to bring in supplies. And because the hospitals can’t shut down when winter weather interferes, their vendors must be equally as prepared. Snider and Owca recommend ensuring hospital vendors also have thorough emergency preparedness plans and always keeping back-ups on hand.

“We’re not telling them how to prepare, but we are asking that they have addressed it,” Snider says. “And if they can address that to our satisfaction, then we give them a go. If not, we look for different vendors.” Owca recommends keeping your vendor list three deep just in case.

Practice, practice, practice

Testing and running drills are critical aspects of emergency response. When it comes to vendors and supplies, Owca says, “Validate your supplies and run some scenario numbers. If you have 22 tons of salt, what does that get you through? What’s your experience been? Having a monitoring system and a report system is helpful to know what your consumption rates are.”

Infrastructure testing is also extremely important. “Our facility does a depreciation schedule where they look at improving infrastructure, so we always have improvements going on,” Snider says. “There’s actually a process to test water flow at certain temperatures to see if a pipe is at risk of bursting. There are mitigation strategies to better insulate pipes that we’ve identified as risk. The power supply is always being upgraded.”

Caring for staff

In addition to taking care of patients and supplies, hospitals dealing with any kind of dangerous weather – winter or otherwise – must ensure staff members are safe. Transportation can be a major issue for hospital staff in snowy or icy conditions. MetroHealth and Henry Ford both have strategies for assisting staff as they travel to work. They employ large charter buses or vans to pick up staff at specific checkpoints, private transportation vendors for individual pickups, or 4×4 vehicles to pick up staff within a certain radius.

Communication is key

Communication – internal and external – is key during a weather emergency. MetroHealth activated its Incident Command System during the worst of the Polar Vortex in January 2014. As part of this system, the hospital incorporated team huddles with key staff and leadership to discuss the status of current issues, update on weather conditions, and align communication strategies. In addition, the MetroHealth team operated a fully staffed command center for dealing with weather-related issues. These adjustments enabled the hospital to strategically and methodically tackle problems while maintaining standard operating procedures.

Communicating with patients is also part of the response. Both hospitals worked hard to keep patients informed about the weather and hospital status. As Owca explains, “Patients and visitors were more concerned about the staff – how are they doing – than they were about themselves. So I took that as a great message that we were doing a great job of patient care and informing them about what was going on.”

The same is true beyond the hospital walls. Owca and his communications team work together to maintain consistent messaging and leverage social media to keep the public informed. Similarly, Snider and his team work with local entities in community outreach to keep vulnerable patients, such as the homeless, informed on where to go when winter storms hit.

Take the time to prepare

Winter storms and their impacts can be nearly impossible to predict. Regardless, communities rely on hospitals to stay intact during such times. Preparation and response strategies are key for doing so.

Snider says, “In 2013/2014 I don’t think we had the disaster that some facilities had because we do have the planning that goes with it, the resilience.” The time set aside to prepare is always greater than the risk of being unprepared. “Identify your team, identify your triggers and, even if it’s a short meeting and you think you don’t have time for it, have that short meeting,” Owca says.

For more information, please contact:

Marek Owca, BSN, MPA, RN, EMT
Director of Emergency Management and Preparedness
The MetroHealth System
mowca@metrohealth.org
(216) 778-3540

John Snider, RN
Emergency Preparedness Coordinator
Henry Ford Health System
disaster@hfhs.org
(313) 916-9373