Iowa hospitals reflect on lessons learned from pandemic, derecho

Emergency preparedness plans take into account unconnected disasters taking place at the same time.

But the confluence of the derecho and pandemic — and the need to follow public health measures that, at times, clashed with typical natural disaster response — placed an additional burden on Cedar Rapids hospitals.

As a result, it highlighted the need for medical centers, running on emergency power, to be able to handle an influx of vulnerable residents.

After more than a year of emergencies, officials in hospitals and other health care agencies that serve as first responders are looking ahead, discussing what improvements can be made to emergency operation plans that serve as a guidebook during unprecedented events — such as a pandemic and hurricane-force winds and civil unrest.

“Experience is the best teacher,” said Mike Hartley, emergency management coordinator at the University of Iowa Hospitals and Clinics.

“A community shelter was something that we needed very badly because we were already taxed as a hospital,” said Casey Greene, chief operating officer at UnityPoint Health-Cedar Rapids.

Thousands of residents were without power following the devastating derecho that swept across parts of seven Midwest states on Aug. 10, 2020. In some cases, power was out for more than two weeks.

For Cedar Rapids residents such as Garret Frey, the lack of electricity was not just a hardship — it was a matter of life and death.

Frey, 39, is a quadriplegic who relies on a ventilator to breathe. After the storm hit, the first priority was to find a way to recharge his wheelchair and the ventilator attached to it, which had about 36 hours’ power remaining.

Even after several phone calls, no aid organization was able to help. A friend brought him a generator that night, but Frey’s family couldn’t find any gas to power it.

After two days, they left Cedar Rapids to stay with family members in Missouri.

“Even when we got back, we heard far worse stories than our own,” said Charlene Frey, Garret’s mother. “We had a safe place to go, but there were some people in far more dire circumstances than we were.”

Those kinds of circumstances forced many to turn to a hospital.

Cedar Rapids hospital officials said dozens of individuals came to their emergency rooms — not because they needed medical care, but because they needed a place to recharge medical devices or to receive oxygen.

“We had to figure out how we could manage those types of community members who aren’t patients and need power sources,” said Chris Williams, safety and emergency management specialist at Mercy Medical Center in Cedar Rapids. “How can we bring them into the organization, especially in a pandemic when we’re trying to social-distance?”

COVID-19 patient volume in early August was at a manageable level, and hospitals were able to find space in conference rooms and other areas to house those non-critical, healthy patients.

“I hope that’s a lesson learned for our community to be prepared for something like that and to stand up those types of community shelters with a greater sense of urgency in the future because it was challenging for us here in the hospital,” Greene said. “We were happy to support these community members, and, of course, we would do it again, but that’s something we could have used a little bit sooner.”

According to state emergency management officials, COVID-19 restrictions presented a challenge for local responders as they worked to establish emergency shelters.

As a result, organizations such as the Red Cross relied on “non-congregate shelters,” such as hotels, to lodge displaced residents. Charging stations and overnight shelters were later established across the county.

Responding to a natural disaster in the middle of a pandemic also showed state and local officials the need to adapt to a hybrid operational environment.

“Historically, the state's emergency operations occur in a face-to-face environment, but with COVID being overlaid on the derecho, a large majority of those operations occurred in a virtual environment,” said John Benson, chief of staff at the Iowa Department of Homeland Security and Emergency Management.

On a local level, the pandemic added complexity in terms of officials’ ability to coordinate response and recovery face to face. They had to balance infection control strategies to ensure their workers stayed healthy — all while grappling with broken communication systems.

“If we had COVID-19 run through the staff, we would not have an (emergency response center) to be able to respond to the derecho,” said Steve O’Konek, coordinator of Linn County Emergency Management. “But we had to come together. We had to respond.”

Hospital challenges

Hospitals have emergency operations plans in place to react to an incident of any scale that may affect a facility’s operations. That includes events like the protests against police brutality that took place over the summer.

At one point, when demonstrators made their way to the University of Iowa Hospitals and Clinics’s campus, officials had to find alternate routes for ambulances and staff, Hartley said.

Though Corridor hospitals were ready to ramp up operations to house large numbers of COVID-19 patients if the need arose, they were unprepared for the challenges in obtaining personal protective gear.

Early on in the pandemic, as the first COVID-19 hospitalizations were reported in Iowa, hospitals faced major gaps in the global supply of masks and gowns and other gear used by health care professionals to reduce the risk of infection. Hospitals in Iowa instructed staff to reuse PPE and relied on handmade masks donated by community members.

That challenge was felt nationwide.

Some researchers argue it's a result of the country’s unprepared emergency management system. An analysis found the United States did not adequately invest in pandemic preparedness efforts — despite years of warnings about the risk of infectious disease outbreaks — which hindered its ability “to prepare for, detect and respond to” the novel coronavirus.

The report was published late last year by the Council on Foreign Relations, a U.S.-based think tank that specializes in foreign policy and international affairs.

“Over the past two decades, federal support for state and local public health emergency preparedness and response has declined by hundreds of millions of dollars,” the report stated.

Looking ahead

Hospital officials agree a more robust stockpile of PPE and other medical supplies is necessary for future emergencies. However, Hartley said that effort should be shouldered by state and federal governments that maintain strategic stockpile programs, such as the national stockpile run by the U.S. Department of Health and Human Services.

Not all hospitals have the funding or capacity to store supplies long-term, he said.

“Shopping lists of things we need to stockpile are going to be growing, and that’s hard for hospitals to do,” Hartley said.

According to hospital officials, this is just one of the topics emergency responders will discuss in the coming months as they review what worked and what didn’t over the course of the pandemic and concurrent events.

“One of the most basic principles of emergency management,” Benson said, “is to take an honest review of any operation and apply those lessons learned into not only the existing plans but also future training and exercise efforts.”

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