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Feigin: I
could not be more proud of the Texas Children's Hospital
staff. |
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From
the physician-in-chief
Hurricanes Katrina and Rita and the response of Texas Children’s Hospital
By Ralph D. Feigin, M.D.
As all of you know, the last several weeks have been very hectic
as a result of Hurricane Katrina. At Texas Children’s Hospital,
we followed the news carefully and were immediately engaged in
helping to assure appropriate health care for children,
particularly in New Orleans. On Aug. 29, we were contacted by
Tulane University Hospital requesting our assistance in transporting
children requiring intensive care from their rooftop helipad to
Texas Children’s Hospital. At the time, Tulane University Hospital was
surrounded by water and looting was prevalent. Over the course
of the next two days, many individual transports were carried
out, generally using helicopters to move the children to either
Houma or Baton Rouge, from which they were picked up by our
fixed-wing aircraft transport teams and moved to Texas
Children’s Hospital.
On Aug. 30, we contacted the
Children’s Hospital, New Orleans, which also indicated a need to
move all patients. At that time, we initiated a similar program
to move children requiring intensive care from New Orleans
Children’s to Texas Children’s. The situation in New Orleans had
deteriorated from a security perspective and these transports
were even more difficult with helicopters being vectored into
coordinates (there was no air traffic control and flood waters
were everywhere) and with the transport crews coming under
attack almost immediately by individuals in search of food,
water or medication.
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Photo
by Paul Kuntz
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Several medical staff members
participated in this transport effort, which was coordinated by
many of the senior administrative members of the Texas
Children’s Hospital staff, including Susie Distefano, Randall
Wright, Cheryl Stavins, Susan MacDonald and Garry Sitler.
Medical staff members who should be specifically cited and
thanked for their intense involvement during this early phase
were Drs. Fernando Stein, Jeanine Graf, Joan Shook and Paul
Sirbaugh.
Almost immediately after this phase
ended, during which time we transported 31 children to our
intensive care units from New Orleans, we were informed that
lines of buses were headed from New Orleans to the Houston area
toward the Astrodome and Reliant Park complex.
A model for
future disasters
The Harris County authorities, utilizing the Harris County
Hospital District medical system, were charged with setting up
the Astrodome/Reliant Arena/Reliant Center area for receipt of
these evacuees. Medical personnel from Baylor College of
Medicine were asked to provide medical support. The pediatric
support was placed in the hands of the Department of Pediatrics,
Baylor College of Medicine and the physicians and support staff
at Texas Children’s Hospital.
There are no words for me to portray
adequately the superb quality of the medical effort and the
innovative and creative offsite clinic/emergency room that was
established in the Reliant Arena by the Texas Children’s
Hospital group. We will have a future Grand Rounds where you
will be provided with more detail and a pictorial demonstration
of this effort, which has now already been deemed by national
authorities to be a model for future disasters.
In particular, Dr. Paul Sirbaugh,
who led the medical staff effort in this area, deserves special
commendation. He was ably assisted by Drs. Joan Shook, Jeff
Starke, Mark Ward and more than 135 full-time faculty of the
Department of Pediatrics and community-based pediatricians.
These individuals were supplemented by volunteers who streamed
in from all over the country, including many former trainees who
had graduated from the Baylor Pediatric Residency Program and
simply arrived on the scene to help. There is no way I can
express my gratitude adequately for the efforts of all these
individuals.
Briefly, a medical clinic was
established where none existed. It had the full support of our
pediatric emergency room faculty, other subspecialists and
primary care pediatricians. More than 300 children in a 24-hour
period on a consistent basis were screened, examined, and
appropriately managed. Many of the children who came to the
clinic had gastroenteritis. These individuals were identified
quickly, appropriately cohorted, and investigative studies were
undertaken. Within a 36-hour period of time, all pathogens that
have been associated with diarrheal disease were excluded with
the exception of the Norwalk virus, which were identified as the sole
agents in the stools of many. The virus was sequenced and the
gene sequence of the virus was identified, helping to facilitate
the implementation of appropriate methods for epidemic control.
At the same time, thousands of
people from New Orleans who came to Houston and were not in the
Reliant Arena began to experience a need for medical care. These
individuals were located in apartment complexes, hotels and
private homes in the greater Houston metropolitan area. As of
Sept. 16, we had 114 discrete patients from Louisiana who
had been or who are inpatients at Texas Children’s Hospital;
most of these individuals were very ill, many requiring complex
subspecialty care for cancer, heart disease, rheumatologic
problems, significant invasive bacterial infections, and the
like.
Many reasons to be proud
I could not be more proud of every member of the Texas
Children’s Hospital staff for the way in which they addressed a
unique disaster, the magnitude of which had not been seen
previously in the United States.
The medical staff owes a debt of
gratitude to Texas Children’s Hospital administration and
support staff. The Reliant Arena clinic was provided with
fabulous pharmacy support, with Karen Gurwitch, our director of
Pharmacy, being physically present in the Reliant Arena for
almost 16 hours per day. Exceptional support also was provided
by materials management, respiratory therapy and environmental
services, who worked so hard to keep our clinic area clean under
adverse conditions.
I think that you will find that the
Grand Rounds that we will have subsequently to provide you with
more detail will be one of great interest.
Hurricane
Rita
As conditions were stabilizing following Hurricane Katrina, a
new hurricane named Rita appeared on the horizon. The hospital
immediately shifted into emergency mode to prepare for this
hurricane. Once again, the response of the hospital team was
fabulous. Administrative staff, physicians, nurses and all of
the hospital employees and our resident staff willingly gave of
their time and effort to secure the hospital and to make certain
that we had adequate personnel in the hospital during the
hurricane period.
In the early morning hours when the hurricane thankfully paid
Houston a glancing blow, we had two complete shifts of pediatric
residents, 45 fellows in training and 130 full-time faculty
representing every single specialty and subspecialty service in
the hospital. This cadre of personnel, coupled with the two
nurses per patient who had been assigned to every ventilated
patient in the hospital, would have been sufficient to see us
through most any scenario that might have emerged. Fortunately,
this crisis passed with relatively limited damage. At this time,
the hospital is returning to full function.
We cannot thank all of the medical staff and others associated
with Texas Children’s Hospital sufficiently for their
extraordinarily unselfish efforts to make certain that our
patients were secure and always receiving the best possible
medical care. There has been no time in the more than 28 years
that I have personally served this hospital that I have ever
been more proud of the entire staff.
Ralph D. Feigin, M.D., is physician-in-chief at Texas
Children’s Hospital and professor and chairman of the Department
of Pediatrics at Baylor College of Medicine.
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