Hurricane Florence made landfall early in the morning on September 14 as a Category 1 hurricane, wreaking havoc throughout the Carolinas. With six emergency department and four hospital medicine contracts in South Carolina, APP clients were right in the danger zone. Dr. Bill Cauthen, our regional medical director for South Carolina, demonstrated exceptional leadership coordinating APP’s efforts during this crisis and is the first physician we are featuring in our ongoing Leadership in Action series.

How far in advance did you start preparing for Florence?

We were lucky to have good, advanced warnings for this hurricane. There was a very large target zone, so it wasn’t until about five days out that we started making formal, concrete plans.

What are some of the first steps a medical director should take with his or her team?

The very first thing you need to do is secure your own family so that you can focus on the job. That may mean evacuating them or ensuring they’re in a shelter. Then the medical director should contact all providers to ensure their families are taken care of and they have the means to travel to the hospital. Providers should plan on sequestration—having to stay in the hospital overnight—and should pack all provisions necessary, including at least 3-4 days’ worth of clothing, medications, and food—especially if you have special dietary needs.

How did you interact with the hospitals?

As the RMD over several facilities, I chose to base myself at our Carolina Pines facility in Hartsville. It was a little further inland than one of our other facilities, so I felt more secure about communications capabilities there.

Living in South Carolina for years, I’ve been through a number of hurricane scenarios. The plan is a little bit different from facility to facility, so you have to adapt to your hospital. About three days prior, I started having daily meetings with the CEO and the hospital’s Disaster Response Team. As the storm approached, we ensured the hospital had enough bedding, supplies, and food. We also had to ensure that all staff members had available transportation and were able to make it in to work. At our facility, we made sure all specialties—ortho, general surgery, radiology, peds, hospitalists, OR teams—remained in-house so we were ready to treat a variety of injuries.

Another thing you have to be prepared for is to receive patients, sometimes through the ED, who have been evacuated from other facilities. Two of our hospitals took on extra patients. In Hartsville, we were able to coordinate with the CMO to get these patients directly admitted.

What parts of the plan went well and you were glad you thought about ahead of time?

You have to be prepared to be isolated from any outside source of help, so it’s necessary to plan ahead and stock up on equipment and medications, such as thrombolytics for TPAs. And you have to assume that some services, like the cath lab, may not be functioning. We were prepared to lose power, which we did, having several facilities running off generators.

What didn’t you plan for that you wish you had?

I don’t think we anticipated how protracted and long-lasting this storm would be. Even a week later, we were still having to make adjustments to the schedule because some people couldn’t travel to work—roads were still closed due to floods or fallen trees.

As a clinician, what do you need to be prepared to see in terms of volume spikes and acuity?

Unlike a mass casualty event, in the initial phase—the worst of the storm—you’ll see a drop in patient volume as everyone is secured. In the days following the storm, you typically experience volume increases, especially during protracted storms like this one. Presentations usually include injuries and possibly even heart attacks due to people cleaning up from the storm.

What role does a leader play in disaster situations?  

My primary role was to ensure adequate staffing and coverage for all of our facilities. Communication with the teams is also critical. When the power goes out, you can often lose cell coverage, so you need to position yourself where you’ll have the ability to provide continued communication. 

Did APP’s strong presence in SC add value?

Absolutely. Having that extra bench strength in our provider team helped, as many of our physicians are cross credentialed. The key was that we had a number of APP clients in the surrounding area. For example, we relied on providers coming in from Charlotte to cover when more local providers couldn’t even get out of their neighborhoods.

Is there anything you’d like to say to the SC providers?

I was so proud of our teams! Everyone did a great job, everyone showed up to work. They kept positive attitudes. We had providers sleeping on the floors in back offices, and they all came together as a team in support of the patients.  

“Our community was under a great deal of stress leading up to this event. Our ER was extra busy, and Dr. Cauthen demonstrated tremendous leadership during this trying time. He managed the patient flow under a census we had never experienced before and navigated our care teams through being “sheltered in” for several days. While the storm itself wasn’t as bad as we expected, we had immense and long-lasting flooding. Dr. Cauthen’s positive attitude helped to keep spirits up. He is a great medical staff leader, and we consider ourselves fortunate to have him at our hospital.” Bill Little, CEO, Carolina Pines Regional Medical Center, Hartsville, SC