​Lessons learned from past hurricanes helped Houston-area hospitals prepare for Hurricane Harvey, but “sometimes even the soundest plans have been foiled," according to an August 28, 2017, article in the New York Times. A county official pointed to “dozens of improvements" such as more solidly engineered structures and practiced cooperative disaster planning. But some damage from the hurricane could not be prevented. One major trauma center found its basement flooded, despite spending billions of dollars on prevention­ measures after Hurricane Allison in 2001. The hospital could not be evacuated, because water surrounding the facility made it impossible for rescuers to reach them. At the time of the article's writing, 10 to 15 hospitals were in some stage of evacuation. The article noted that many of the area's hospitals had regularly conducted disaster drills but, but according to an executive at a health system involved in the disaster planning, the training was “honestly, not at this epic level." A hospital in Victoria, Texas, needed to be evacuated after it lost all its power and its water supply was threatened. The hospital had attempted to evacuate before the storm, but because of road conditions, about 80% of its patients were still inside when the storm hit. Submarine doors put in after Hurricane Allison at a Houston medical center kept the hospital running, the article said, but emergency vehicles were often unable to reach them. “We can be dry and open but if you can't deliver patients to the medical center, that's our biggest concern," said the facility's chief executive. “I've never heard so few sirens as I have in the last few days, which is upsetting." Multiple providers interviewed by the Times said that federal regulations created after Hurricane Katrina calling for health providers to establish emergency plans helped with preparation. Nursing homes were also hit hard by the storm. A photo of residents at one facility sitting in lounge chairs and wheelchairs with water up to their waists spread across social media. An August 28, 2017, article on CNN.com said all the residents are now safe.

HRC Recommends: Failure to prepare for a disaster can have lasting negative repercussions for a facility. Healthcare organizations must design, execute, and evaluate emergency management plans and conduct disaster drills that test the facility's ability to activate a command structure and notify staff, manage communication within the hospital as well as with response entities, mobilize responders and allocate equipment and supplies, and provide clinical care and support activities. We recommend that hospitals choose disaster scenarios that test multiple emergencies and challenge staff and equipment resources as well as patient management procedures. After Hurricane Harvey ends, hospitals should critique the facility's response to identify gaps in preparedness and to make improvements to the emergency plan as needed.