Cath Lab Stories and Feature

Mercy Cath Lab’s Flood Recovery: One year later

Shirley C. Bata, BS, RT(R)(CV) Director, Invasive Cardiovascular Services Katz Cardiovascular Center, Mercy Medical Center Cedar Rapids, Iowa
Shirley C. Bata, BS, RT(R)(CV) Director, Invasive Cardiovascular Services Katz Cardiovascular Center, Mercy Medical Center Cedar Rapids, Iowa
One year after the June 2008 epic flood that overwhelmed Cedar Rapids, Iowa and forcd the evacuation of Mercy Medical Center, our hospital is back. But all employees, including our cath lab crew, carry vivid memories of our long, difficult recovery. The Cedar River was rising the morning of Thursday, June 12, but we weren’t expecting it to reach Mercy, sitting 10 blocks away. After all, Mercy stands outside the 500-year flood zone in Cedar Rapids. But all bridges in town had already been closed, making it nearly impossible to travel, because the river bisects the city. Eventually, the river would crest on June 13 at 31.1 feet — 19.1 feet above flood stage. Our staff had all made it in to work. We kept in touch with the hospital’s incident command center, established a couple of days earlier, as flood concerns increased. Although we hadn’t been taking it very seriously up to that point, conditions deteriorated quickly. Downtown Cedar Rapids lost power early that morning. Hospital power went out at 7:40 am, but Mercy’s emergency power was activated, keeping our labs operational. We cancelled elective cases, but continued care for emergency and in-patient cases. For the next several hours, some staff helped with sandbagging at nearby physician offices. But soon it became apparent that the flood waters would reach Mercy. By afternoon, Mercy’s parking ramp was getting water. The south side entrances of Mercy — including the parking ramp, emergency department entrance, Lundy Pavilion entrance and our lab area — sit lower than the rest of the hospital, so they were at highest risk for flooding. By mid-afternoon, all available hospital personnel were sandbagging outside Lundy Pavilion. Citizens began arriving in pick-ups and SUVs with sandbags, joining staff to help with sandbagging to protect Mercy from further damage. Other hospital employees were deployed to evacuate the departments located in the basement, including the pharmacy, central sterile and storeroom. When it became clear that the ground floor would get water, we began evacuating cath lab inventory. We prioritized what inventory we would try to move and what would remain. Working quickly, we used anything with wheels, including patient carts, to relocate inventory. Carts with fitted sheets were filled with as much inventory as possible. Each load was taken to a conference room one floor up and dumped in piles. This went on continuously into the evening, but in typical cath lab style, plenty of snacks were available for staff. We had no water. Plumbers had been called in to help remove sinks and toilets so they could plug lines to prevent sewer backups. Portable toilets were already in place on the high side of the hospital, thanks to Bob Olberding, Director of Plant Operations at Mercy, whose amazing foresight anticipated this and every other potential concern throughout our flood recovery. He was later recognized by the Iowa Hospital Association for his heroic efforts. By dark, the water outside Lundy Pavilion entrance was hip high, ultimately reaching four feet. Due to sandbagging and pumping efforts, only three inches of water seeped into the ground-level Lundy Pavilion lobby. Until then, one lab had been kept operational for emergencies. But at that point, a decision was made that safe patient care in the lab was no longer possible. Now it became necessary to sandbag within the cath lab, in case the worst happened. Cath lab staff all pitched in. Everyone made extraordinary efforts to work as a team. After moving our equipment and furniture up as high as we could, we began sandbagging entrances into our lab. Although the water in the labs was never even an inch high, a slick sheen of water filled our hallways. The water was filthy and considered “black water.” Wet vacs were used in the labs to try to keep the water at bay. In Lundy, sandbagging was still ongoing, outside and in. The greatest fear was that Lundy’s floor-to-ceiling windows would break, but they held. By this time, rising flood water had started to seep through the walls of our emergency department as well and the ambulance bay was inaccessible due to standing water. Our lab staff continued hauling equipment out as fast as we could. We filled large recycling bags with thousands of CDs holding patient records, using rolling chairs to haul them upstairs to our education center, the largest conference room available. This would become our second home for the next few weeks. Throughout the day and night, people brought food and water to sustain staff. The community response was incredible. Citizens and physicians worked shoulder-to-shoulder with Mercy staff late into the night, continuing to build a protective barrier of 50,000 sandbags around the Lundy entrance. The decision to evacuate the hospital’s inpatients came about midnight, shortly after word came that we could possibly lose light and power to the elevators. Inside the elevators, you could hear water dripping. Because of the flood, all patient support services were affected (cath lab, pharmacy, dietary, radiology, emergency, lab, maintenance, storeroom and housekeeping), so we couldn’t provide adequate care. The city’s steam supply was destroyed, disabling our ability to autoclave or provide hot water. Some images are still etched in our minds, like the scene of anxious patients in beds, wheelchairs and carts in a hallway, waiting for ambulances. Patient placement was well-coordinated by local, state and disaster officials. Mercy staff tracked where each patient would be transferred. Thanks to a well-organized communications system, our disaster response was phenomenal. When the request for help was issued, 27 ambulances from 15 services arrived to help with patients, as well as vans and local transport services. By 6 am Friday, June 13, all 183 patients were safely transferred. In all, 30 hospitals and nursing homes accepted Mercy patients. Some cath lab staff members remained at the hospital all night. By about 1 am, we had done all that was possible, so staff took time to retrieve personal belongings from our lab lockers. We took patient carts up to another department to lie down and rest. Sleep never came, despite our exhaustion. By 5 am, I was up and walking through the hallways of our department. The floor still gleamed with water. A flashing strobe from the fire alarm’s emergency light made the scene that much more surreal and heart-wrenching. That morning — Friday the 13th —all Mercy employees still at the hospital gathered for a meeting in our cafeteria, where CEO Tim Charles told everyone they had to evacuate for their own safety. Despite this, Dan Nace, our in-house Service Engineer, stayed on for several hours, doing all he could to minimize damage. After I left the hospital late that morning, I stood staring at the floodwaters surrounding the south end of Mercy. I had no comprehension of the challenges ahead. The clean-up begins Decontaminating an entire hospital is hard to imagine. Over the weekend, volunteers joined Mercy staff as the clean-up began. Disaster recovery crews arrived on site. By Monday morning, we were reporting for regular work shifts, starting to plan where to relocate departments. All cabinetry and flooring was removed and destroyed. All drywall was being removed, four feet up from the floor. At one point, if you bent down, you could see the entire ground floor of the hospital. For that first week to 10 days, hospital access was restricted, for safety reasons. National Guard personnel were stationed at all entrances. All employees signed in as they reported for their labor pool assignments. Cath lab staff met each morning to decide the day’s priorities. Organizing of remaining supplies was the first order of business. Supply vendors helped us organize by providing carts. We began assessing inventory and calling to order new products. Any stock remaining in the labs had to be inventoried and discarded, even though contamination was not apparent. With all our cabinets and storage areas gone, we organized products in labeled boxes according to procedure and placed them on rolling racks stored on the first floor. All the imaging equipment had to be de-installed, including tables and electronics cabinets. All cables were pulled and discarded and cable runs had to be decontaminated. The ground floor of the parking ramp was enclosed to house a temporary decontamination center, where supplies from all affected services were taken. Throughout the recovery, Mercy’s leadership, addressing problems proactively, was impressive. The hospital had set a goal of being up and running in two weeks. It would be nearly three months before we were back in our old quarters, so we all had to think outside the box. We decided that our only option for the interim was to get a mobile cath lab. Our pre- and post-procedure bays were relocated to Mercy’s Intensive Care Center (ICC). The mobile unit was set up to house cath lab services, with a sheltered, air-conditioned ramp to ensure patient comfort. Other services, including radiology, also relied on mobile units. The city power was unpredictable in those first two months and the emergency power built into the mobile unit was unreliable. Rather than endanger patients, Mercy spent an additional $10,000 to hardwire our mobile cath unit into the hospital’s emergency power supply. Electricians worked overnight to complete this project. Cell phones were secured for all staff so we could communicate directly. We were no longer centralized; our inventory and procedure areas were split up and relocated, complicating operations. In addition to the mobile unit, a C-arm and electrophysiology lab were used for less complex procedures. We wouldn’t have been able to get through this situation if we didn’t work together. Our staff took accountability upon themselves as we worked to rebuild and re-open. That was critical as we discovered how our plans and procedures had to be adapted to our new circumstances. What had been standard, automatic routine now took extra planning, steps and time. For each patient procedure, for example, staff had to carry the necessary boxes of supplies to the trailer. One staff person was designated as the runner to retrieve any additional supplies that might be required for procedures. Managing inventory was complicated. It took a lot more coordination and communication from all of us. Re-ordering supplies — from procedure trays to tubing — was up to staff members. The central store room had been flooded, so essential stocked items weren’t available. We had no catalogues, so we couldn’t refer to item numbers to re-order. Even IV fluids had to be reordered manually. Boy, did the Internet come in handy then! We did a lot of online shopping during this period. When we first returned to the lab, many weeks later, we worked on cement floor, with no cabinets, using folding tables with boxes of supplies for procedures. It wasn’t until after the first of the year that it began to feel like home again. We were putting the experience behind us; it wasn’t the topic of conversation every day anymore. Even now, however, we find that we run across things that we forgot to replace. Mercy’s leadership was sensitive to the fact that everyone had experienced a traumatic event. Administration made sure that all employees were checked regularly for signs of mental, emotional or physical stress. Tetanus shots were provided. Mercy also provided $750 gift cards to 141 employees affected by the flood to help with critical needs. Long-term needs continue to be addressed as employees rebuild and recover. In all, 221 Mercy employees have been significantly impacted by the flood. I feel blessed to live in a place like Iowa where, when faced with adversity, we just hunker down and get to it. Throughout this ordeal, Mercy’s motto was “rising above the flood” and our cath lab crew took that to heart. Hospitals do emergency disaster drills on a routine basis, always assuming the disaster is coming from an outside source. We learned you need to have a plan for when you are the disaster. Shirley Bata can be contacted at