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Tom Flanagan, administrative director of emergency services, said hospital directors quickly learned that it's a good idea to have call lists with them at all times. Most kept their list of people to call in the event of a disaster in their offices because they expected to be able to get to work when a disaster struck.

But the flooding prevented that in many cases and the carefully compiled call lists were rendered useless. Now, most hospital directors have their call lists on their Palm Pilots, he said, which they carry with them at all times.

Flanagan said the hospital also is in the process of developing an evacuation plan, something it didn't have when it was forced to shut down. "Our safety committee for the hospital is looking at developing a mock disaster drill, where you would have to evacuate the hospital and how would we go about doing that."

Many hospitals in the Texas Medical Center, which sits at the lowest elevation in Houston, quickly learned that placing emergency generators in the basement was a bad idea. The basements flooded immediately and the water shut down the generators. Methodist was one of the few that had emergency generators on risers outside the hospital, Rand said.

Unfortunately, the distribution equipment used to deliver power to the hospital was below the floodplain, making it useless once the water reached it. "That equipment was in the basement, so once that got wet, we were now losing even emergency power even though the generators were running away," Rand said. That equipment has been moved to a level 1 foot above the 500-year floodplain.

Plan of attack

Methodist has always been prepared to handle an external disaster involving a large number of patients, Rand said, but since Sept. 11, it has taken measures to protect against assaults on the hospital itself. Recent measures include fencing to keep people away from loading docks and other areas where they might enter the building, and disguising intakes that provide fresh air to its heating and air conditioning system.

The hospital also has fenced off access in ways that don't attract attention and, twice a day, facilities personnel check the utility systems where they come into the building to make sure they haven't been tampered with.

The events of Sept. 11 have forced hospitals throughout the country to examine their disaster response/emergency preparedness plans. Hospitals that traditionally have focused their response on natural disasters and accidents have been forced to examine more earnestly how they would respond to mass casualties, as well as victims of chemical, radiological and biological attacks.

Marianne Klaas, MN, RN, director of accreditation and safety at Swedish Medical Center in Seattle, said her hospital began gearing up for such eventualities long before Sept. 11. That's because Seattle, which would later be the target of a plot to bomb the Space Needle, hosted the World Trade Summit in 1999 and was warned to be ready to deal with victims of chemical attacks. As it turned out, the protests, although violent, did not involve the use of chemical agents.

Seattle, like cities around the world, also geared up for potential disaster (Y2K) as the year 2000 approached and Feb. 28, 2001, experienced a magnitude-6.8 earthquake.