​Dozens of hospitals and nursing homes in the Carolinas evacuated ahead of Hurricane Florence last week, according to a September 12, 2018, article from CNN.com. Some hospitals kept their emergency departments open but canceled elective surgeries. Others opened with emergency teams in place. Some hospitals closed but kept skeleton crews to care for patients who were too sick to be safely evacuated, CNN reported. Evacuating nursing home residents to other facilities presented difficulties, because facilities in South Carolina were at 90% occupancy. Residents thus had to sleep on mattresses on the floor in the facility to which they were transferred. Moving residents to storm shelters was not feasible because the shelters were not equipped to handle this population. "This is a great strain on our residents," said the president of the South Carolina Health Care Association, in the article. "But our No. 1 concern is their safety and we know they are in good hands." One of the most difficult parts of the evacuation was finding transportation for patients, according to a September 13, 2018, article in the Post and Courier (Charleston, South Carolina). Hospitals are anticipating a surge of patients in the coming days. "We learned through Hurricanes Floyd and Matthew that some of the most devastating impact comes after the storm," said the president of the North Carolina Healthcare Association, in a news release. "Our association and its members across the state are standing by to help their peers wherever needed." In related news, the U.S. Department of Health and Human Services (HHS) declared public health emergencies in Virginia and in North Carolina and South Carolina. These rulings waive or modify certain Medicare, Medicaid, and Children's Health Insurance Program requirements to give providers flexibility in meeting emergency health needs. HHS has sent 400 workers, 300 ambulances, and two 250-bed medical stations to assist with emergency needs in the area. The Medical Professional Liability Association released a checklist for Hurricane Florence medical volunteers. It includes four suggestions: contact your medical professional liability insurance carrier; review the liability laws and protections with the jurisdiction; check with your state licensure board; and consider registering as a volunteer, for instance with the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). The Centers for Disease Control and Prevention (CDC) issued an advisory for clinicians in the impacted areas to be on the alert for carbon monoxide (CO) poisoning. People who live in areas with power outages are particularly at risk for CO poisoning, CDC said. A tension-type headache is the most common symptom of mild CO poisoning. The National Institute for Occupational Safety and Health released guidance on how to work safely and avoid hazards related to hurricanes. Included are resources to keep first responders safe and tips for helping workers avoid CO poisoning.

HRC Recommends: Healthcare facilities must have robust emergency management plans in place for weather-related and other natural disasters. Planning, training, and identifying resources for disaster management are critical to a healthcare facility's preparedness, mitigation, response, and recovery efforts. Efforts should be made to incorporate community-wide emergency plans into the organization's emergency management plan to prepare for regional disasters such as hurricanes. Risk managers should heed lessons learned from successful emergency management programs in facilities affected by hurricanes and other natural disasters and remain aware of available resources and assets, including resources from federal, state, and local governments.