Labor and delivery in the eye of the storm

There were many, many acts of selflessness during Hurricane Harvey -- acts of small kindness, acts of great courage. But certainly, some of these were extraordinary acts by clinicians.

As local residents headed to George R. Brown Convention Center, which served as an emergency shelter, they were met and aided by doctors, nurses and pharmacists. Clinicians rushed to hospitals and pulled long, multi-day shifts, instead of heading to a highway to safety. And one of my colleagues, Dr. Michelle Mulder of Ob Hospitalist Group (OBHG), delivered a baby by emergency C-section in the eye of the storm, only minutes before the power went out at CHRISTUS Spohn Hospital – all while her own granddaughter, born prematurely at 28 weeks, was evacuated by helicopter from the NICU down the hall to a hospital in San Antonio.

I’ve spend the better part of the last two weeks assisting with OBHG’s teamwork at five hospitals in Houston. We (and countless other clinicians) staffed hospitals 24/7 during and after Hurricane Harvey. At Memorial Hermann Hospital in North Texas, one of our OB hospitalists worked for three straight days in L&D, with support from community physicians. At two other local hospitals, two of our clinicians rotated onsite for four days to cover for physicians who couldn’t physically get to the facility.

In the face of catastrophe, a plan is only as good as its implementation. Each and every department must be prepared for all contingencies. Based on what I’ve learned across several emergencies – including two hurricanes and several floods – some key learnings may be helpful for Labor & Delivery departments:

Have an administrative team lead - in a remote location if possible. Many states of emergency threaten modes of communication. When feasible, move central communications out of the potentially affected area. We based our communications from our OB hospitalists out of Austin, TX and Greenville, SC. We also texted contact information to all of our team members before Harvey hit, including our physicians who weren’t scheduled for shifts. That coordination extends to all clinical departments: in Victoria, TX during Hurricane Ike, my team set up L&D in operating room suites (and delivered six or seven babies there). That was a plan we’d come up with pre-hurricane, simply by asking the OB staff: Do you know the preparation plans? What can we do to ensure continuity of care during the storm?

Have a Plan B in case clinicians can’t make it to the hospital. Babies wait for no one, and definitely not for an epic storm. Consider having two OBs physically in the building, not just nearby. In many cases, our physicians were covering most of the unit, including handling unassigned patients who could not make it to their own doctor’s hospital (or in some cases, their own doctor’s hospital was closed). Two OBs are better than one, so they can assist in high-risk procedures, trade off L&D and post-partem rounds, and cover shifts for each other in the event that backup is further delayed.

Be prepared to hunker down for the long haul. Our OBs never once complained about the work or the circumstances, but they certainly missed clean clothes. Provide a change of scrubs and enough personal items for several days; even if you have a scrub machine, supplies run out, and no one wants to sit in scrubs covered with amniotic fluid. Similarly, supply bath towels, sheets for the bed, and pillows – all a commodity when everyone is stuck in the hospital; call rooms with water and juice, snacks, paper plates, plastic utensils, cups, nonperishable foods that can tide tired workers over for a few days; and especially phone power packs and flashlights.

Collaborate early, during the crisis, and for the handoff. Communicate early with the local hospitals to get a head start on which hospitals might need to close and where would be the best place to transfer pregnant patients, and urge community OB/GYNs to communicate with patients. Pregnant women who are close to giving birth and are facing a storm are already under tremendous stress. Prepping them with information and assurances of consistency in care may help alleviate some of that pressure.

As doctors, we’re used to putting our patients first. Last week’s storm reminded me how so many others at the hospitals do to the same, from the cleaning crew to the nurses to the physicians. I’m grateful that so many of us served as “First Responders” during Hurricane Harvey, and by following aligned preparation and contingency plans, I’m confident we’ll perform similarly during the next storm -- and the ones that follow.

Dr. Charles Jaynes works for Ob Hospitalist Group as Senior Director of Medical Operations. Based in Austin, TX, he served 34 years in private practice.

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