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Still, there's nothing like a real-life experience to highlight problems with your disaster plan. Salmon said the experience helped them to identify ways to improve the plan for the next time a hurricane or other disaster strikes.

Their food, for instance, was kept in the command center instead of the cafeteria and having all that traffic in the command center made it more difficult to communicate with people on the outside. Salmon also said next time she'll make sure to have a medical/surgical unit nurse on hand to help out.

"We had (emergency department) nurses and a labor-and-delivery nurse, but a (medical/surgical unit) nurse would have served us well in getting the unit back up where it was ready to accept patients again," Salmon said.

Those who stayed-about 40 in all-included the emergency room staff, nurses, registration secretaries, physicians, a radiologist, a radiologist technician, an operating room team and staff members from administrative, clinical and facilities services.

The hospital switched to generator power during the afternoon of the storm because facilities staff worried that power fluctuations would harm their equipment. The hospital lost telephones and air conditioning during the storm and discovered that cell phones and pagers were of no use to them either.

"Many of our physicians were tied to pager systems … and we would be paging physicians and not getting a response," Salmon said. "We found out later that the towers themselves were down and the messages were not getting to physicians."

During one urgent situation, the hospital tried to page a physician and received no response. They then tried calling his office-the phones had begun to work again-and when they received no answer, Salmon took matters into her own hands. "I went to his office and beat on his windows until I got his attention," she said.

Salmon said some employees had a difficult time getting to work after the storm because of flooding and debris blocking roads, but she said no one refused to work before, during or after the storm.

"Because we are a small hospital, everybody knows everybody, so you wanted to come and help your friend," she said. "We've worked very hard to get this hospital running and they were not going to let something like a hurricane keep us from operating."

On the run

The staff at Sentara Nursing Center-Currituck in Currituck, N.C., had no choice in the matter. Currituck County ordered a mandatory evacuation and that meant evacuating 95 elderly residents to three different facilities, said Ruth Vinson, RN, director of nursing at the center.

The nursing home is on the mainland in the northernmost county in North Carolina. It overlooks scenic Currituck Sound and eventually would find itself in the path of Hurricane Isabel.

"We didn't have any prior knowledge that it was going to be a mandatory evacuation," Vinson said. "We had to go into crisis mode and hurry up and get everybody together."

Although the staff practices fire drills on a regular basis, it had never practiced evacuating the facility, Vinson said. With Hurricane Isabel only 24 hours from landfall, the center called on vans and ambulances to transport residents. Eighty-three were taken to Sentara facilities in Norfolk and Virginia Beach, while 12 medically acute patients were taken to Albemarle Hospital in Elizabeth City, N.C.

"We took an enormous amount of supplies and equipment," Vinson said.

Those supplies included oxygen concentrators, pumps for those who needed tube feeding, bulky medicine carts for dispensing medicine and supplies, toiletries, clothes to last several days and enough medicine to last a week.

"Sometimes, we'd have to put one medicine cart in one van and one in another because they are big pieces of equipment," Vinson said.

Those transferred to the hospital in Elizabeth City continued to be hooked up to oxygen and feeding tubes. "The ambulance people are used to that sort of thing, so that wasn't any problem," she said.

Vinson, who went to the Norfolk facility, said they kept their patients separate from those at the Norfolk center and the staffs didn't intermingle except at mealtimes. The center had several empty beds available because it's in the process of reducing its licensed beds and they had not been removed yet.