Planning for the Worst at the World s Largest Medical Complex

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(1)Planning for the Worst at the World’s Largest Medical Complex. Texas Emergency Management Conference March 26, 2013. Edgar L. Tucker, FACHE Executive Vice President. Angela N. Smith Emergency Management Planner.

(2) Introduction to Texas Medical Center.

(3) A Vision Turned into Reality… the Texas Medical Center Today            . The largest concentration of medical assets in the world 7.1 million Patient visits 54 Member institutions, all “not for profit” 92,500 Employees (largest Houston employer if viewed as single entity) 34,000 Students , including 5,000+ international students 6,900 Hospital beds 350,000 Annual surgeries 16,000+ International patient annual visits $14 billion Total budget (all institutions) 1,300+ Acres of land 280 Buildings 45.5 million Total gross square feet (GSF) for all campuses Updated to include 2010-2011 figures. 3.

(4) Of the 54 Member Institutions         . 22 19 3 3 1 6 2 2 27. Academic institutions Hospitals Medical schools Public health organizations Dental school Nursing schools Schools of pharmacy Mental health organizations Agencies of government. 4.

(5) Serving the Needs of the World’s Largest Medical Center. Parking and Transportation. Security Services. Growth Coordination. Street Maintenance. Wayfinding. Leasing. Landscaping. Emergency Preparedness. Food Operations. 5.

(6) Core Campuses . Main Campus – Historic core of Texas Medical Center. . Main Street Corridor – An important bridge between Texas Medical Center and Rice University. . Mid Campus – Brings together emerging large land development areas South Campus – The University of Texas campus dedicated to patient care, research, education and administration/parking. . . W. Leland Anderson Campus – High school for health professions, psychiatric center, childcare center and school for developmentally delayed children. . Rice University Campus – Unprecedented opportunity to expand teaching and research initiatives. 6.

(7) Other Member Institution Locations  DePelchin Children’s Center  Lyndon B. Johnson General Hospital  Quentin Mease Community Hospital  Shriners Hospitals for Children - Galveston  The Menninger Clinic  The University of Texas Medical Branch at Galveston  University of Houston  University of Houston – Victoria School of Nursing  West Campus (Texas Children’s Hospital and The Methodist Hospital). 7.

(8) 2012 TMC Employee ZIP Code Density Map  Triennial ZIP code survey used for transportation planning with METRO, TxDOT, City of Houston and Harris County  Carpooling, emergency preparedness and evacuation planning facilitate employee access to Texas Medical Center. 8.

(9) Main Campus Area’s Dramatic Growth Number of New, Expanded and Under Construction Buildings and Garages as Shown 1998-2012 42. 9.

(10) Why is Texas Medical Center Vulnerable?.

(11) Vulnerabilities of TMC Campus     . Largest concentration of medical assets in the world Campus is prone to floods, hurricanes and tornadoes Located in the drainage area for the Harris Gully Watershed and in the 100 and 500 year floodplains Most buildings have open access with frequent international and high-profile patients and visitors TMC must shelter in place and is needed to support most disasters. 11.

(12) Vulnerabilities of TMC Campus, Cont.  . All five of the Southeast Texas region’s Level 1 (L1) trauma centers and approximately half of the hospital beds are TMC owned TMC hospitals are highly specialized and include the following: 1. Children’s Memorial Hermann Hospital (L1) 2. Harris Health System – Ben Taub General Hospital (L1) 3. Harris Health System – Lyndon B. Johnson General Hospital 4. Harris Health System – Quentin Mease Community Hospital 5. Memorial Hermann – Texas Medical Center (L1) 6. Methodist West Houston Hospital 7. Michael E. DeBakey VA Medical Center Houston 8. Shriners Hospitals for Children – Galveston 9. Shriners Hospitals for Children – Houston 10. St. Luke’s Episcopal Hospital 11. Texas Children’s Hospital (L1) 12. Texas Children’s Hospital West Campus 13. Texas Children’s Pavilion for Women 14. The Menninger Clinic 15. The Methodist Hospital 16. The University of Texas Health Science Center at Houston Harris County. Psychiatric Center 17. The University of Texas MD Anderson Cancer Center 18. The University of Texas Medical Branch at Galveston (L1) 19. TIRR Memorial Hermann (The Institute for Rehabilitation and Research). 12.

(13) Lessons Learned Tropical Storm Allison and Hurricane Sandy.

(14) Tropical Storm Allison – June 8-9, 2001  The storm dropped 14.7” of rain on Texas Medical Center in 12 hours,    . including 10.3” in just 3 hours $1.5 -2 billion in damages Texas Medical Center was inaccessible for 9 hours 25 years of research, 34,000 animals and 60,000 tumor samples lost With the loss of power to run medical equipment and life support systems, hand ventilation and patient evacuations were necessary:  Memorial Hermann, St. Luke’s Episcopal Hospital and The Methodist Hospital evacuated or transferred hundreds of patients  In a spirit of cooperation, other member institution hospitals accepted the patients  Not a single life was lost at TMC. 14.

(15) Why Was TMC Caught Flat-footed?  Tropical storms given little respect vs. hurricanes  A unified emergency preparedness plan and structure did not exist  Drainage systems and flood protection infrastructure were not. adequate for a 100-year flood event like Allison  Valuable research, diagnostic and electric infrastructure were located below grade in the tunnel system and basements  A formal tunnel protection strategy did not exist  Corporate memory was lost over time since the previous catastrophic flood of 1976 15.

(16) Allison and Sandy Comparisons  Never say never  Below grade equipment. may fail  Electricity may fail.  Hand ventilation and. patient evacuations may be required. NYU Langone Medical Center Hurricane Sandy 2012. Memorial Hermann-Texas Medical Center Tropical Storm Allison 2001. Photo courtesy of NBCNews.com. Photo courtesy of Steve Ueckert. Mitigation Projects Pay Off!. 16.

(17) Hazard Mitigation Planning and Emergency Response.

(18) A 50 Year Master Plan - 1999 . Established a clear framework to guide institutional growth. . Advocated that TMC play a strong role in ensuring that flood control improvements are identified and realized. . Identified regional and city coordination efforts to improve vehicular access and public transit. . Introduced skywalk network connecting multiple institutions. . Recommended flood proofing buildings and locating critical building systems above grade 18.

(19) TMC Specialized Hazard Mitigation Plans.  A Hazard Mitigation Master Plan was published in 2001 to document hazards  The Stormwater Management Design Guidelines were published in 2005  The 1999 Master Plan concept of elevated pedestrian and patient corridors to. connect different buildings was updated in the 2006 Master Plan and further documented in the 2002 and 2005 Pedestrian Circulation Master Plans. 19.

(20) Hazard Mitigation Master Plans. Each TMC institution which sustained damage was required to analyze vulnerabilities and develop its own hazard mitigation plan for submission to FEMA  All Hazards Vulnerability Assessment of Texas Medical Center, September 2004, U. S. Department of Homeland Security  TMC’s hazard mitigation plan for the entire campus, and listing 112 projects, was approved by FEMA in 2005  TMC’s current list of 51 projects is included in the City of Houston and Harris County’s Hazard Mitigation Plans . 20.

(21) Flood Protection Improvements  Since Tropical Storm Allison, the TMC member. institutions have worked diligently to implement the flood mitigation actions recommended by the Texas Medical Center Task Force:    . Install watertight submarine doors in the tunnel system Install floodgates instead of logs and sandbags Construct exterior perimeter floodwalls and berms Relocate electrical equipment, vital hospital functions and medical equipment from the basement to upper floors. Texas Heart Institute Garage #1. 21.

(22) Street Drainage and Access Improvements . Improved storm drainage   Kirby Drive   Hermann Drive   MacGregor Way   Fannin Street  Holcombe Boulevard. Bertner Avenue Main Street Pressler Street Cambridge Street. . Major drainage outflows to Brays Bayou  Hermann Drive  Kirby Drive  Cambridge Street. . Improved access to the Texas Medical Center  Cambridge route over Richard E. Wainerdi Bridge  Reconstruction and elevation of North and South MacGregor at State Highway 288. . Brays Bayou widening from the Texas Medical Center to the Houston Ship Channel  Willow Waterhole. Richard E. Wainerdi Bridge Project Brays Tunneling Machine - Placement of Concrete Segment at Cambridge Street. 22.

(23) Flood Alert System  The TMC/Rice Flood Alert System, developed in 1997 and now in its third upgrade, monitors the Harris Gully Watershed and the Brays Bayou to provide early warning lead time to implement flood protection measures in the TMC campus. Hurricane Ike 9/13/08 4:00 AM10:15 AM. 23.

(24) Flood Management Group  . The TMC Flood Management Group (FMG) was created in 2002 to protect personnel, facilities and equipment TMC members include:     . . . Texas Children’s Hospital The Methodist Hospital St. Luke’s Episcopal Hospital Children’s Nutrition Research Center Texas Medical Center. FMG staff monitor weather conditions and water levels while adhering to the Flood Management Policy Alerts of the benchmark water levels in the Harris Gully box culvert are communicated from the TMC Command Center to the Flood Management Group via radio, e-mail and telephone (or conference call) 24.

(25) January 9, 2012 Close Call Rain Event. TMC received over 5 inches of rain, including 4-1/2 inches in 4 hours, causing closure of State Highway 288 at Holly Hall from late morning to mid afternoon  At its peak, Brays Bayou was channeling more than 25,300 cubic feet of water per second, or 84% of the full capacity peak flow of 30,000 cubic feet of water per second . 25.

(26) TMC’s Annual Process for Hazard Mitigation Plan Review .   . Purpose - Collaboration of Texas Medical Center member institutions and vulnerability partners to review current hazard mitigation projects and identify new ones Updates on ongoing institutional and campus-wide hazard mitigation projects are shared Current city, county, state and federal processes are reviewed Members of TMC Hazard Mitigation Advisory Group             . AT&T CenterPoint Energy City of Houston Public Works City of Houston Office of Emergency Management Department of Homeland Security Federal Bureau of Investigation Harris County Flood Control District Harris County Office of Homeland Security and Emergency Management Houston Police Department Houston Regional Intelligence Service Center (Fusion Center) METRO Texas Department of Transportation TMC Member Institutions. 26.

(27) TMC Staff Participation in Regional Hazard Mitigation Planning            . Catastrophic Medical Operations Center (CMOC) Cities of Harris County Greater Houston Partnership Harris County Citizen Corps Council Harris County Flood Control Task Force Houston Galveston Area Council (HGAC) Mass Fatality Planning Joint Information Center (JIC) and Public Information Officer (PIO) Networks Regional Catastrophic Preparedness Initiative (RCPI) Concept of Operations Planning for Multiple Incident Sites Regional Healthcare Preparedness Coalition (RHPC) Regional Pandemic Influenza Steering Committee (RPISC) TMC Spring Break Coordination with City of Houston, Hermann Park, Houston Zoo, Museum District, etc. Urban Area Security Initiative (UASI) Critical Infrastructure and Key Resources Committee. 27.

(28) TMC Communications, Operations and Mobility Center  Centralized communications  Mobility management  Law enforcement alerts  Disaster management  Brays Bayou and Harris Gully alerts  Impact Weather red and orange severe weather alerts  Hurricane and tropical storm warnings  City of Houston video sharing partner  Recently upgraded radio system with. 20 TMC institution users and 3 daily radio checks. . Radio channels to member institutions, city/county offices of emergency management, CMOC, TranStar, METRO Police and Harris County Precinct 1.  Staffed 24/7  State-of-the-art facility 28.

(29) Governmental Partnerships.

(30) U. S. Department of Homeland Security Projects . Department of Homeland Security (DHS) Joint Site Vulnerability Assessments.  During 2010-2012, 12 TMC institutions were selected for DHS sponsored assessments to identify critical infrastructure/resource vulnerabilities and protective measures; seven assessments are complete and five are ongoing. . Resilient Constellation Exercise Series (RCES).  DHS RCES tabletop held in December 2012 to focus on information-sharing activities before, during and after an emergency incident and evaluate internal security measures  In addition to TMC member institutions, participants included critical infrastructure owners and governmental agencies. . Homeland Security Regional Resiliency Assessment Program (RRAP).  Facilitated discussions held in February 2013 in preparation for upcoming RRAP functional exercise and continued site assistance visits to identify buffer zone plans, analyze systems recovery, assess emergency services capability and multi-jurisdiction security plans 30.

(31) FEMA/ASPR Think Tank Conference Call June 28, 2012.  Hosted in TMC Campus at The University of Texas Medical School at Houston’s state-of-the-art facility  Moderators – Richard Serino and Tony Robinson (FEMA-Federal Emergency Management Agency) and Dr. Nicole Lurie (ASPR-Health and Human Services, Assistant Secretary for Preparedness and Response)  Panel – state, regional and local emergency management officials  500 participants on conference call  7th Twitter trending event. 31.

(32) Hurricane Workshops. Lessons Learned Hurricane Panel held May 4, 2012  Sponsored by Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR), Dr. Nicole Lurie . 7th Annual TMC/COH Healthcare Hurricane Preparedness Workshop held June 29, 2012  Special speaker, Chief Nim Kidd, Texas Division of Emergency Management . Both events held at the University of Texas Medical School at Houston’s auditorium with panels of local and regional health authorities. 32.

(33) TMC Hazard Mitigation Grant Projects.  TMC Pandemic Flu Response Guide  DHS - $100K  60 members  Completed November 2011.  Retrofit roof windows with hurricane glass at John P. McGovern Campus  FEMA - $1.8 million  Installation due by May 2013.  St. Dominic Village Emergency Generator  FEMA - $244K  Installation completed July 2012. 33.

(34) Continuous Hazard Mitigation Planning  Never become. complacent or stop planning and preparing for another disaster  Mother Nature and Human Nature cannot be second guessed!. 34.

(35) Questions? Edgar L. Tucker, FACHE Executive Vice President Texas Medical Center 713.791.8806 etucker@texasmedicalcenter.org Angela N. Smith Emergency Management Planner Texas Medical Center 713.791.6172 asmith@texasmedicalcenter.org. Please visit us at: www.tmc.edu.

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