Author(s): Jesse Roman. Published on November 1, 2017.

Hardened Up

How years of investments in safety systems helped Houston’s health care facilities withstand Harvey


Sixteen years ago, Tropical Storm Allison dumped more than 40 inches of rain on parts of Texas. The Houston area sustained about $5 billion in damage, nearly half of which occurred at the Texas Medical Center (TMC), a sprawling campus of hospitals, research institutes, and other health care facilities in central Houston.

But as Hurricane Harvey inundated America’s fourth-most-populous city with even more rain and stronger winds than Allison, inflicting far more damage on the city as a whole, the TMC was left largely unscathed, a trend that held true for most of the 250 or so hospitals and health care facilities in the Houston area.

“When you consider the magnitude of this storm, hospitals prepared really well not only in terms of the management of their staffs and how they moved patients when necessary, but with the investment made by facilities themselves and their emergency preparation over the years,” Lance Lunsford, a Texas Hospital Association executive, told Health Facilities Management magazine. Investments in infrastructure made as a result of Allison and Hurricanes Rita in 2005 and Ike in 2008 were largely responsible for the positive outcomes during Harvey.

Outside of flooded hospital

Localized Flooding Facilities at the Texas Medical Center were largely unscathed by Hurricane Harvey, as were most of the roughly 250 hospitals and health care centers in the Houston area. Photograph: AP/Wide World

For the Memorial Hermann Health System, which operates three hospitals in the TMC and several other hospitals and outpatient facilities in the Houston area, these investments included extensive building “hardening” to prevent intrusion from floodwaters, moving generators to high ground, sealing off underground tunnels, and more, according to Memorial Hermann engineering officials contacted by NFPA Journal. NFPA codes and standards like NFPA 99, Health Care Facilities Code; NFPA 110, Emergency and Standby Power Systems; and NFPA 111, Stored Electrical Energy Emergency and Standby Power Systems, all play integral roles in preparing health care facilities for storms like Harvey.

Learning from the past

Michael Hatton, vice president of facilities engineering for Memorial Hermann, started working for the health system just a month before Allison struck in June 2001. The storm caused flooding in the basements and underground tunnels connecting Memorial Hermann buildings. “One of our campuses alone experienced many, many millions of dollars in damage from Allison,” Hatton said.

The incident triggered sweeping changes that would take place over the next 15 years or so, including sealing off tunnels with concrete and pouring concrete around the bases of buildings, moving electrical systems and generators to upper levels, and investing in the most advanced roofing technologies available. The result, Hatton said, was very minimal damages during Harvey. “The outcome was very good,” he said, “and I think it helps validate our best practices when it comes to our utility systems.”

With patients connected to electrical devices that in some cases are keeping them alive, power is perhaps the most important resource for a hospital building to maintain during an emergency event. This wasn’t lost on Memorial Hermann officials. Hatton said over the years they used NFPA 110 and NFPA 111, which both deal with backup power systems like generators, to make their emergency power distribution as robust as possible. “It wasn’t just moving generators out of the basement—it was also getting redundant generators, paralleling them, focusing on fuel systems, and being more rigorous about testing,” he said.

Nurses evacuate a patient down an escalator due to flooding

Recalling Allison Some Texas Medical Center facilities were forced to evacuate patients due to extreme flooding during Tropical Storm Allison in 2001. Photograph: AP/Wide World

While not specifically mentioned by Memorial Hermann officials, the requirements included in NFPA 99 closely mirror what many Houston hospitals did to prepare for Harvey, said Jon Hart, the NFPA staff liaison for NFPA 99. “The way Houston hospitals developed emergency preparation plans and mitigated some of their risks goes in line really well with what NFPA 99 does,” he said. “The hospitals were self-sufficient, operating like islands.”

Of the 17 hospitals Memorial Hermann runs, only one had to be evacuated in a move that was proactive and precautionary, and its 75 patients were safely transferred to another Memorial Hermann hospital a few miles away. For the most part, hospital staff, visitors, and patients took advantage of the buildings’ safety to ride out the storm. “A lot of people ended up staying in our hospitals,” said Terry Scott, system director of engineering services for Memorial Hermann and past president of the American Society of Healthcare Engineering. “At all of our hospitals we provided free meals to thousands of employees, visitors, and patients every meal for free. We set up dorms where employees could sleep. Lots of people slept on air mattresses. We made it for four to five days before we even walked out the door.”

For all the successes seen in Harvey, Hurricane Irma—the strongest cyclone ever recorded in the Atlantic, which roared through the Caribbean and up the Florida peninsula just a week and a half later—showed what can go wrong for health care facilities during a powerful storm. More than a dozen patients at a nursing home in Hollywood, Florida, reportedly died from excessive heat in the weeks following Irma, after the hurricane knocked out the facility’s air-conditioning system. David Downey, chief of Miami-Dade Fire Rescue, said the threat of power loss for the area’s elderly population is an important and complicated issue that his department will consider in its after-action assessment of Irma.  

While NFPA 99 includes requirements for emergency power, it does not address air-conditioning, Hart said. Like most NFPA codes and standards, though, it tasks those who adopt it with determining the greatest risks to their specific communities. In Florida, for example, one of those risks is heat. The state has already moved in that direction; less than a week after Irma first made landfall, Florida Governor Rick Scott announced new rules requiring nursing homes and assisted-living facilities in the state to have generators capable of keeping air-conditioning on for at least 96 hours.

ANGELO VERZONI is staff writer for NFPA Journal. Top Photograph: Newscom