20 seconds, wait a little while. It's ready as ever. All right, here we are live. You ready? Yep. Okay. You good? All right, and we're live now? We're ready to go live now? Yeah, in the Zoom room with the wire calculator. Okay, good. So let's go ahead and start. Yes, click over here. Yep, all right. All right. Good morning, I'm Bob Bourgeois, and the talk today is going to be on hurricane preparedness. If you've never had a roof blow off of your hospital, you'll find out today a little bit more about how much fun that is. Our speakers today, I'll be speaking, and Sandy Kimley. Sandy is the assistant medical director of quality at Ochsner, and Ochsner is the biggest hospital system in Louisiana. She's actually boarded in internal medicine and infectious disease. She's actually presented at several of our meetings before about TB and other issues, so she's done a lot of good work for us, and we appreciate it. Sandy and I are also classmates with Pam Heimel and Senator Cassidy, who you saw on the video yesterday. So this is almost like a mini class reunion for us. So I'll go ahead and let Sandy get started, and we'll entertain questions in and out through the session. If you have a question, if you come to the mic, we'd like to make sure everybody online gets to hear it, and the folks online will be entering questions in the chat, and we'll answer those in the chat but also give you the question and answer live here. Sandy. Thanks, Bob, and thank you for having me here to share our story. These meetings are always fun to see old friends. So today I'm going to share with you our experience with hurricane planning and specifically some of the real challenges we faced with Hurricane Ida. So I have nothing to disclose, neither does Dr. Bushbaugh. Can you all flip the presentations? Thanks. Unless you want to go first. Are we switching between two presentations? Or just the next slide? Her slides should have been before mine. I've got some more for you. Redundant processes. Anybody tell jokes? Okay. Okay. All right. Here we go. So these are my slides, so thank you for switching those out. I apologize for the delay. So for the last, you know, 16 years, we've had significant challenges that have faced our institution, and I'm going to start in 2005. We had Hurricanes Katrina and Rita in 2005. And then over the course of the years we've had additional hurricanes, and so that's allowed us to prepare. But in addition, we had the financial crisis, as well as the very large BP oil spill in the Gulf. And then, as everyone is quite well aware, in 2020 we had the global pandemic, which, of course, you know, has affected everybody. Also in 2020 we had Hurricanes Laura and Zeta in our region, and Hurricane Ida in 2021. So we've gotten a lot of practice planning for and drilling for and preparing for hurricanes. And so the preparation is ongoing. We do it all the time. And certainly you have to train all your staff every year. You have to train your new staff. You have to train people that are not from Louisiana. And so it's the constant preparedness and planning that's so important to be able to survive these storms. And so we learned from others. We learned through tabletop exercises. We learned through talking about the emergency operations folks and both our local and state governments. We have developed relationships with our suppliers and our vendors. So we have an order, if you would, for storms. And so we don't have to make it up each time. We just said, you know, we're activating our plan. Please send all of our supplies. And we also have a very strong tie with the Emergency Operations Center. We strive that everybody needs a personal plan for themselves and their families, as well as the hospital. During the disaster, we were able to figure out about what time landfall is going to occur. And so we activate our plan. We use the Team A, B, C concept, where A is the designated essential personnel that are needed in-house for the duration of the event and to which time it's safe to move around the communities. Team B are designated individuals that know in advance that they're going to relieve the Team A people. And so that's important. And then Team C is those who just come back when there's normal operations. Over the years, we have, as we've gotten bigger as a health system, we have put wells in all of our facilities that have hospitals. And that becomes important if you lose city services and are able to at least run the—you can't really drink it, but you can certainly run the toilets and the water and have water. And that was really helpful for us in Katrina. So throughout the storm, it's very regimented. It's very locked in. And then post-disaster, we have a very methodical process by which we look at our utility assessment. Who has lights? Who doesn't have lights? Do a damage assessment. What needs to be repaired and such? And then certainly all the paperwork that comes with accounting and documentation and those types of activities are all, if you would, you know, done the same way each and every time with some modifications. And then after the storm, we have ongoing challenges in the sense that people are displaced. They may have evacuated. They may not be able to get to their homes. And the other piece to this is that our employees work and live in our areas for the most part. I mean, we do have some remote workers, of course, but they're members of our community. And so while they may be working in health care, caring for patients, they are also worried about themselves, their family, their houses, and what's happened to them. And then we retool the disaster plan and wait for the next event. So we've learned a lot, and I think it has served us well despite, you know, some of the things that have happened to us. So I'd imagine most of you have heard about Hurricane Katrina. It was a big event in the New Orleans area in 2005. Hurricane Katrina made landfall as a Category 3 storm, so that's a mid-range storm. However, the levees that surrounded the New Orleans area were breached, and so we had a very big water event where about 80% of the greater New Orleans area was underwater, which is unusual for these types of storms. So not to really belabor the Katrina disaster, because it really was, but we learned some stuff with that. And I show this slide because it demonstrates the federal commodities that were in place before Katrina hit. Now, many of you may have remembered the scenes from the Superdome and the convention center of all the despair and everything that was so horrible. But what you have to keep in mind is that the government pre-places ice, water, MREs in all these areas, but it takes two or three days to get to the places it needs to go. So you really have to be self-sufficient for 48 to 72 hours, if not longer. And so we order supplies ahead of time. We make sure we have enough medicines and water and food and supplies to sustain our little ecosystem, our little cities, for as long as we need to. So I think, you know, importantly, these are learning opportunities, and preparation was key to us succeeding in Katrina. We were one of the only hospitals in the greater New Orleans area that remained open. All the ones surrounding Orleans Parish, we were in Jefferson, all closed for the time being. And that's because we drilled this and were prepared. And that was the first year we utilized the concept of Team A and Team B. And so it was a tabletop exercise for us previously with our local emergency operations people. So we had it written down. We had sort of an idea, but we really weren't sure how it was going to work. But it worked very well because the New Orleans airport was closed for a long period of time. We, at that time, had two hospitals, one in New Orleans, one in Baton Rouge, which is about 90 miles away. And so we had a clinic in Baton Rouge. And so we were able to open, if you would, an operations incident command center in the air-conditioned building in Baton Rouge, I may add, because it was August and September, and then funnel people to wherever they were back to Baton Rouge and shuttle them with the help of state police and such via motor coach down to New Orleans to care for our patients. So it worked. And so we were very grateful. Had we just had all our assets, all our people assets in New Orleans, we wouldn't have been able to do that. Communication was a real problem with Katrina. At that time, I had a Blackberry, but cell phones really weren't working. They wouldn't work because of the cell towers. And so communication became a very, very big problem for post-Katrina times. And so we now have redundant, and we had them at the time, but satellite phones, mobile hotspots, landlines, walkie-talkies, ham radios, whatever you need to communicate needs to happen, but that's during the event. But you also need to communicate with your people when they're displaced. So we utilized certainly the Internet and our internal channels at that point in time, but we've made a lot of improvements since Katrina with the communication piece. Additionally, you have to be decisive. In these sort of very challenging times, the answer may not be clear. You might not know exactly what to do. We're a very deliberate organization, and we tend to mull things over. But during these crisis times, you have to make a decision based on what you have and be agile enough to change and be okay with that. And so that served us well in Katrina, and certainly with COVID, because certainly COVID's been challenging in and of itself. And the most important thing that we have going for us are our people. And so, again, as I mentioned, the people are affected in their communities. They may have had damage. They may have lost their houses. They may have lost the roofs of their houses. And so with Katrina, we stood up markets and donated items, personal needs, cleaning products, anything, so people didn't have to go to the store and didn't have to go scrounging for them like everybody else. So as difficult as Katrina was, it certainly has served us well. In 2020, during the pandemic, we were in eight cones of hurricane prediction, and that's just a lot. You know, one or two are stressful enough, but eight is a whole lot. Five may landfall. Three is hurricanes. The National Weather Service ran out of the pre-named storms, so they had to go to the Greek alphabet, which was really kind of difficult and somewhat of a disaster. They're not doing that anymore. And so in the pandemic, you know, so we had lots of practice, and so that's, you know, given us the ability to continue to modify our plan. So Hurricane Ida popped up pretty quickly as far as hurricanes. It didn't sit out there for two weeks where we could watch it and see what it was going to do. It kind of popped up, and unfortunately, it popped up on the exact same day as Hurricane Katrina, August 29th. And so that evoked a whole bunch of emotion for a lot of people. And by the time from 2005 to 2021, we grew as a health system. So we went from two hospitals in two cities to over 20 hospitals in two states and over 250 clinics. And so that's a lot of preparation. That's a lot of territory to prepare for. And so the storm on the left, the one, I guess, to the west, that was Hurricane Laura in 2020. Zeta is the one to the far right, more east, in 2020. And then you can see Katrina's path and Ida. And I show this because all of our clinical assets, if you would, are different for each storm. And so in the health system where the Lake Charles area got the brunt of Laura and some to the Lafayette area, and the Mississippi coast got really the brunt of Zeta, and the New Orleans area certainly got Katrina, but Ida went through a larger part where we had many, many hospitals and many, many clinics. And this just shows the destruction of Hurricane Ida as it made landfall at Port Fouchon down at the Gulf. It came in as a very, very strong Category 4 storm, maybe even close to a 5, but still categorized by a 4. It went up through the bayou, through Houma and Thibodeau, through Terrebonne Parish. It skirted to the west of Orleans and then went up through Baton Rouge and such, still as a Category 1. The amount of destruction, the wind associated with the storm was tremendous. Cell towers were down. Electrical transmission towers were down. The power was out pretty much everywhere for a very long time. And it became even more difficult during those periods of time. And for some of those very low-lying coastal areas, we had difficulty getting in touch with people for a few days. And if you look, about 20 miles west of that line is Morgan City, where I'm from. And if you remember, the hurricanes spin counterclockwise. And the folks in Fouchon, even though they took that bad a whipping, because they had about a foot, right up the coast, they have levee systems. They had about a foot of cushion from the storm surge because it hit them straight on. If it had come a little bit farther over, because the eye was supposed to go over Morgan City, if it had come over us, we'd have gotten a lot more wind and a lot more damage, but they would have gotten a much higher storm surge. They would have all had flooding events in addition to the wind. And a lot of folks stayed there, which would have been devastating for them. So at the last minute, they kind of tweaked back to the right a little bit and saved them from getting a lot worse damage. These storms, as predictable as they seem to look like on a map, the difference between 20 to 30 miles can make a world of difference to the people affected by these storms. So now just to set the stage, we're in COVID. We're having storm preparations. Our hospitals are full. Vaccines are available, so we had to have different considerations for how we used to sleep people. Back in the day, we would just put people in conference rooms and endoscopy labs and just wherever they could find places to sleep. We used to sleep a lot of people in a hospital to do that. And so here we are. COVID was surging. We were in the fourth surge at that time, and we did not want our people having more than one person in a room. So all of our hospitals were full. They were at capacity, and it was a very, very difficult kind of time. The emotional piece with Hurricane Katrina cannot be understated. So we had to have different considerations for COVID considerations. We re-evaluated the needs to determine whether or not every team member of Team A needed to be in-house, specifically like the corporate divisions that are essential personnel for operations but don't need to be in the hospital. So we had a Team A remote. Team B and C functioned as normal. We slept people and tried to maintain social distancing. It worked pretty well, but it wasn't great. And we decreased the number of people in the building. That was probably the key thing. In the past, we would let dependents come if somebody had their own office. We used to have a pet program where we would let people house their pets in our garage. So we just stopped all that and really kind of reduced the number of people in the building. And at the time, we were still doing the temperature check and the symptom check for COVID. So all that had to continue. And then we moved patients from our orthopedics hospital to our main campus, just because it was a little bit too far away to make sure that it would be safe for patients. And then our supply chain, as I mentioned, gets supplies preordered before all these events so we have enough food, medication, water to be able to be self-sustaining for a number of years. And then we had, each facility had to be able to, you know, care for a COVID patient. So if one of our, I mean, a COVID employee, so if one of our employees became sick, we needed somebody to evaluate that patient, make sure they could be isolated. And so it was a little bit challenging. We stopped visitation and we just asked our employees to take their laptops because if they wound up evacuating, we needed ways to keep in touch with them. So post-item, the Bayou and the River region where Dr. Bush was from had significant damage. Three of our hospitals, two of our hospitals and one of our partner hospitals in the Bayou region lost significant amounts of their roofs and those hospitals had to be evacuated. We did, however, keep our emergency departments open in all the locations because what happens after a storm, people leave, the storm passes, and then they go out and clean up and they fall off ladders and cut themselves. So we maintained ER services in all those areas. And just the St. Mary Morgan City Hospital did not have significant damage. We were able to open a number of new beds that had been unoccupied, just sort of there. So we quickly opened beds and they ran a daily census of about 30 patients pre-storm and overnight they doubled to more than 70. So a lot of work for the people in St. Mary's. Generally speaking, our other campuses did fine. And so there was roof damage, there was all, there was roof damage, ORs had gotten wet at our main campus, but by and large, not like the significant amount of damage that happened along the Bayou region with Ida. So we had to move a lot of patients. So we did 814 total transfers out of the Bayou in August and September, 98 transfers in the two days of the, from the storm to September 2nd. 144 total evacuations, 80 different transfer destinations, and 38 patients we had to send out of state. Again, we couldn't send patients, we couldn't send everybody to Baton Rouge or to our usual transfer things because all these hospitals are full with patients, full with COVID patients. There's not, there weren't at the time as many personnel. So they had the nursing staffing shortage. And so it wasn't business as usual. It wasn't in our 700 bed hospital didn't have 700 bed capacity. So it was difficult, but we did a lot of movement in a few days successfully. So this is Shaw Bear. Can you cue the video again? We've got a video just to kind of let you see what this feels like. Here we go. The National Weather Service in New Orleans has issued an extreme wind warning. But we do begin tonight with this category four hurricane slamming into the U.S. and making the landfall. Several people on our staff with us have been nurses or taking care of people in hospitals during Katrina. We would probably have evacuated more patients if we could before a large storm like this came. But again, with COVID and hospitals already at this time, we're not so easy to evacuate. This is an extremely dangerous and life-threatening situation. Take cover now. This is Kendall at X. I'm okay with being on the team Sunday to stay. The staff that was currently working that week was assigned team A, meaning that they would continue their work week. And since the hurricane fell on that week, then we would stay at least for a few days. We knew regardless of how bad it was going to be I was too pregnant to deal with a power outage or anything else hurricane-related. So we packed up that day and evacuated to my parents' house in Shreveport. I was actually up all night before the. So while they're doing that, I'll tell you, the hospital was about 25 minutes from us, lost a big chunk of roof, and then they also lost the backup generator. So all of us, where we were, we were on auxiliary power for a few days, some places a few weeks, and then we were on auxiliary power for a couple of days. So we were on auxiliary power for a couple of days, and then we were on auxiliary power for a couple of days. A few days, some places a few weeks. But we have a 235-kilowatt generator just for the office, and then we have a 60-kilowatt generator between my house and my dad's, and three backups for those because they do go out. But that particular hospital lost one of their backups, and it was the backup generator for the ICU. So in the middle of the storm, they lost power, water's coming in the roof, there's no power for the vents, so they're taking all these intubated COVID patients and bagging them as they carry them down the stairs and over to another wing of the hospital that had power in the middle of the storm. So these aren't always fun, aren't always easy, but like Dr. Cassidy said yesterday, Senator Cassidy said, we're the flex physicians. That's when you have to be flexible and figure it out because everything you do during a hurricane, you have all this pre-planning, and it helps, but something always goes wrong. So that's why you have so many backups and so many redundancies. Right, okay. Those are taking care of people in hospitals during Katrina. We would probably have evacuated more patients if we could before a large storm like this came. But again, with COVID and hospitals already- 16 years to the day since Katrina in Louisiana. This is an extremely dangerous and life-threatening situation. Take cover now. I'm okay with being on the team Sunday to stay. The staff that was currently working that week was assigned a team day, meaning that they would continue their work week. And since the hurricane fell on that week, then we would stay at least for a few days. We knew regardless of how bad it was going to be or not. I was too pregnant to deal with a power outage or anything else hurricane-related. So we packed up that day and evacuated to my parents' house in Shreveport. I was actually up all night before the storm even hit operating. We did have a patient come in with an acute abdomen. I had a cyst on my right ovary that erupted and was filling my stomach with blood. I'm 22 years old and she was coming in saying that I could possibly lose my ovaries and not be able to have kids. Like that was the biggest thing going through my head. Dr. Reynolds really calmed me down. She, you can tell she was, she brought more of just the doctor in her. It was more of the mother in her. I remember telling her boyfriend, I don't think y'all are gonna be able to get out of here in time for the storm. We're gonna be riding out in the storm together. Ida now gaining strength in the warm waters of the Gulf of Mexico, expected to make a landfall as a category four tomorrow, bringing a dangerous storm surge, flooding rain, and powerful winds. Hurricane season for Ochsner is a year-round occurrence. Our preparation for Ochsner facilities is what we call hardening. And that's really focused around the priority of our patients and our staff in terms of safety. Preparing for a category four hurricane is a challenge for any organization. And then the fact that we're a healthcare organization with hundreds and thousands of people and patients makes it even more challenging. Ochsner has prioritized transparency in such a manner that we've developed a patient flow center. An evacuation like St. Charles Parish Hospital, we immediately recognized how many patients there were and how quickly we had to move because the winds were coming in and ambulances are unable to move after or transport after about a 40-mile-per-hour sustained wind. Tiles of the essence, we had to get patients moved. We were able to look across the system and be able to see where we had available resources and utilize those resources appropriately to get these patients out in time for action. I was on COVID psych, so they had split up a portion of the BHU upstairs and turned it for six beds for COVID patients who were psyched. We had to move about 22 patients out, out of all the units. Three of me and my other colleagues drove through Hurricane Corps Twins, around 1030 that day, over the Luling Bridge. If you know where that's at, it's terrifying. It was kind of, it was a little scary. It was like you're not knowing what's going on. You're like, you're on a whole different unit. You're to this hospital, you don't know what to expect. You don't know where to go. So we're all feeling a little lost. The Kenner staff, they were very accommodating. They were awesome. They were immediately like, what can we do? How can we help you get, basically get assimilated into the unit better? Even though they were strangers to us here at Kenner, everybody fit in. We all had a job to do, take care of our patients. And that's our team, that's our team. We had some pretty severe traumas and sick people that we were extremely happy to be able to stay open because they really had nowhere else to go. Well, it was the first time I was in a hospital for a hurricane. I mean, I could hear debris hitting on the side of the window, but I normally sleep on hurricanes anyways. One of the first things we did was we lost the roof on the elevator shaft. And so the entire center of the hospital and the elevator shaft throughout the whole hurricane sounded like a wind tunnel, like truly like what you'd hear a tornado would sound like was in the center of the hospital. It was very eerie. And that was the roof of the elevator shaft blowing off. And it fell onto the lower roofs, punched holes in those. And they were taking on water like crazy. We're down to one elevator in the facility, which was the freight elevator. Our ICU on the fourth floor started taking in water, so we needed to evacuate the ICU patients. We then had 12 patients in the med-surg unit that we had to segregate, five COVID-positive, and then seven non-COVID patients. It felt like we were in a movie, like we were living in a movie, because that would be a scary movie. I believe we were in the eye of the storm at that time. And the hurricane hunters tonight flying inside the eye of the storm, the clearly defined walls of the storm there, 17 miles across. And Ida, at this hour, still a dangerous category for hurricane, winds 130 miles per hour. But they all got a whole team to drag the bed in the elevator downstairs. Came up with a plan that we put all of our COVID patients in the ER and all of our non-COVID patients in the lobby near the ER, which would give us access to an easy evacuation and keep everybody kind of together. I got a phone call. The search and rescue was responding to a call of a tree that fell onto a trailer. And a gentleman was pinned under a tree. And even though the weather was starting, they felt it was important that they responded. We waited and waited and waited, and it was probably about two and a half hours we waited for this gentleman to come to our ER, and we were ready. And then we got word that search and rescue had to make the very difficult decision to leave him. The storm was really getting bad. And, you know, if anything would have happened to those rescuers, it wouldn't have done anybody any good. And it got to the point where they had to leave him, and they couldn't get him free immediately. The wind just went out of everybody's nails. Because, you know, first priority is your family. You know, having a wife and daughter and two dogs at home. I have the privilege of caring for other people. In New Orleans, the new levees after Katrina did hold. That was reassuring. But the city's reinforced power grid did not. Tonight, more than a million customers across Louisiana are without power. And the utility now warning it could take weeks to restore. No way to charge phones. For many, no way to call for help. Hospitals filled with COVID patients had no choice but to shelter in place. This hospital, the roof torn off, Ochsner Health System transferring about 165 patients after some of their buildings suffered damage. At about 4.30, they came and knocked on my door, telling me that they needed me. And search and rescue was starting to bring people into the hospital. They finally died down enough where they were rescuing people. And shortly after, they brought our tree guy in. I'm gonna get emotional. He was much better than we thought. It turned out that it was only his foot that was severely pinned by the tree. We were just heartbroken for you the entire night. So when you came in looking like you did, we were just ecstatic. It was a huge sigh of relief, you know, because I didn't think... I was thinking I wasn't gonna make it. You know, it was just a whole bunch of stuff going through my mind at the time. But when it got back, I was grateful. Once I got there, man, the Ochsner staff, they was real supportive. They was like... It's like they've been knowing me. Like, oh, man, you're finally here. They was filled with joy. And it kind of surprised me because I didn't expect that. That was the first time where I felt like, okay, everything's gonna be okay. Like, it was just the whole building needed that... that good story, you know, because we really thought he wasn't gonna make it. About 6 in the morning, 5 in the morning, I looked outside along scene end of LA-1 right here. There was, like, 30... 30 ambulances ready to pick up our folks. As soon as ambulances could start running again and the flooding receded, we evacuated multiple facilities. Terrebonne General, St. Anne. We helped with Our Lady of the Sea, River Place. We helped with Our Lady of the Sea, River Place, to name a few. I went and sat on the front curb, and I was just kind of sitting down trying to get service, trying to get service just to text my husband or to call out and give anybody, like, a little update. And all of a sudden, I looked up and my partner, Dr. Goss, was walking up. And I got up and I just ran to her and jumped in her arms and cried. That was the first time that, you know, seeing my partner and I knew what devastation laid ahead for us. Like, I knew our clinic had been destroyed, but when I saw her and we just held each other and cried and I knew, like, we're gonna get through this. We're gonna get through this. The news she gave me of, oh, I saved 70% of your ovaries, of your right ovary. Like, we saved it. You still have it. All of that process was overwhelming, but she was very, like, comforting in it. Like, I want her to be my OBGYN now, because she was amazing. It's nice to know that we can be out of New Orleans and still get access to Ochsner and all that they have to offer. We didn't plan to have a Shreveport baby. A little vacu-baby. Yes, that's right. There were many of our employees and family members who lost everything. Houses were flooded. They immediately started talking about how we can offer housing for these employees that didn't have a house. We actually brought gasoline in almost at every one of our campuses and fueled all our employees' vehicles for many days and maybe even weeks in some areas after the storm. You know, like, you reflect back on it, and you say, man, I worked 18 20-hour days for four or five straight days, but in the end, all of the memories that I have of it have been really positive. Very similar to Katrina. The human mind has an innate ability to be able to block out that and really focus in on the good. I can reflect back and say that my team, our team really worked hard to make sure that every patient was taken care of. The job got done because of good people. All right, so, you know, kudos to our creative media people and all the workers that took videos during the time. I mean, we didn't have a camera crew in all those hospitals, and we're grateful for the patients to share their stories. So that's just a flavor of how it is in the storm, and there's a lot there, so thank you for indulging that. But I think it can tell a story better than the slides I can show and my stories. I was in the Incident Command Center, you know, communicating, helping with, you know, some of these patient transfers and the whole COVID response, and so it was tough going for a few days, but as Dr. Kuo said, you know, the humans have a way to make it all okay. So after the storm, we, we focused on our people, you know, our physicians, our APPs, employees, because everyone had been affected. We were concerned about the burnout and more additional stress on top of stress on top of stress with COVID. And so many of the physicians and employees needed temporary housing, so we arranged all that. And then again, we focused on our patients to make sure that they were cared for. And certainly after a storm, you can have increased heart attacks and strokes and traumas. So we really just focused on our patients. I mentioned that we have learned from all these storms with the flooding of magnitude for Hurricane Katrina and New Orleans being underwater, there was not enough emergency vehicles in the city. And so over the course of the years now, we have acquired high water vehicles, jeeps, boats, so we can really, if we have to evacuate hospitals by water, we can do so if there's water. And then we drill. I mean, the Ochsner Navy goes and drills several times a year along with the state and other emergency preparedness people to make sure that those skills remain. The storm garnered a visit from President Biden. That's Air Force One flying over our hospital and him meeting with our CEO, Warner Thomas. This is the Jefferson Parish where the main hospital is. The water plant did not have electricity. And so as part of our pre-procedures, we have potable water stationed in all our facilities. So we actually had to use it for a couple of days. And so that's just an example of the tanker truck. So a lot of things that you don't think of in medicine that you have to prepare to make sure you keep our patients safe. From an IS perspective, the two data centers had no issues. We had migrated the clinical systems to the North Louisiana Shreveport campus. We had lost over 115 connections that had to be restored. And then we had to outfit the beds at St. Mary with all the electronics and all the IT stuff for the computers and such. And the bayou had no cell towers. And so we were able to arrange with AT&T, two trucks and a blimp to have cell service in the bayou. So that was a big lift for a lot of our people. And then just the support efforts of the organization. We had 14,800 employees that were Team A and Team B members. Our organization employs about 35,000 people. So almost 15,000 were Team A and B. Over 4,000 of our employees reached out for the employee assistance line. And 1,200 required some housing accommodations. And so we were working with hotels and such to have rooms so people could come back to the region that had maybe had either lost their home or had evacuated. We had eight industrial generators used for backup and the backup generators. And I think they mentioned it in the video, the gas thing. The gas problem was real because the gas stations didn't have any gas. The ones that did had long lines, but there wasn't enough electricity to keep refilling them. And so somehow our supply chain people started getting big giant gasoline tanker trucks. We parked them in all of our hospitals so our employees could get gas so they could go to and from work or do what they needed to do because they couldn't otherwise get it. So that was pretty clever. And then certainly the supplies that were donated to our employees for their personal use. So it's been an ordeal. This one was in some respects harder than Katrina because that we've gotten bigger and this was a much stronger storm than Katrina. And so the flooding was minimal for this storm. So by and large, learn from prior storms, prepare, drill, and do it all again and just stay vigilant. So I'll turn it over to Dr. Boosbrough. Thank you very much. So looking at these, you never know what's gonna happen. You always have to kind of be ready for it, but look at the blimps. When they put the blimps up to make temporary cell towers, that helped a ton, but think about it. Everybody has cell phones. The insurance adjusters are taking pictures of damage. People have video in their house trying to, or livestreaming stuff to show family that can't get back in. So the bandwidth is gone in no time. So you'd get cut off over and over. You'd drop calls or you couldn't get anything. So there are a lot of things that even though we're trying to fix everything, it doesn't always come right back up. So the needs, when you think about what happens, the needs that you really have, shelter, but that damages the houses, damages the business, damages the hospitals. So I'm gonna go over some of the clinic side of it and the employer side of it, let you see where those issues come. Power, you almost always lose electricity. If you have backup generators, a lot of those are natural gas. But if the gas gets cut off, you have no backup power then. And propane, if you're gonna run propane generators, you have to have thousand gallon tanks, or thousands of gallons, because it takes a lot to do that. Food, if you lose power, most of your perishables are gonna be gone in about three days max. Canned goods, dry goods, a little longer, as long as they don't get wet. Water, you need water for drinking, basically. You need some for cooking, and then bathing and washing afterwards. Medications, your chronic meds, any acute meds. With all the injuries, the cuts, the lacerations, everything else that you see, crush injuries, do you have enough tetanus available? So again, getting all that stuff stocked up front is a good idea. So for shelter, the damage is usually from wind for us. And in the hurricanes, it's not always just the hurricane wind, a lot of times there are tornadoes. When Hurricane Andrew hit Morgan City dead on, remember it hit Homestead, Florida back in 92, it hit Morgan City afterwards, and the eye wall, it stalled, and the eye wall was on Morgan City for six hours. So one-sixth of our building was torn down to the slab. And it shifted the whole roof over six inches. That was just a tornado off the storm. The flood damage is way worse, because it takes you a while to recover from that, because you've got to redo everything that's wet and in some. And if you have any significant structural damage, trying to get all that stuff fixed when everybody else has issues is a problem. Wind damage. If during the storm you have some leaks, sometimes you can isolate them or fix them or whatever, but a lot of times it'll make the whole, that part of the hospital, that part of your clinic or whatever, unusable. Water damages, when you get that much mud and everything else in there, it's months before you can access your building or use it again. And afterwards, trying to find repairs, and all the shyster contractors that come in, everybody's a contractor, as soon as a hurricane or a tornado comes through, and they want to, if you give me some money up front, I'll go buy the stuff, come back, fix it, and bye. So it's really difficult to find good people to do things. This is the kind of stuff you see, wind and sometimes the water damage, and this is both. So power. Electricity, you need that, really, food preservation and lighting and cooking. You don't have to have air condition, but in South Louisiana, it sure is nice. Communications, the difference between now and Andrew is Andrew, you know, 92, a lot of folks had cell phones, but not a ton of them, and almost everybody still had a landline at home, and most businesses still had regular landlines. Now, almost everybody has cell phones. Not many people have landlines at home, and in most businesses have internet phones. So if your cell service goes out, how do you get in touch with your folks, your people, anybody else? How do you let them know you're open or you need help or whatever? It's really, you know, you can't do it. And when you don't have internet service, if you lose power, you don't have it, but if you do have a backup generator and you have power, but your internet service provider doesn't have backup power, you don't have internet, so you can't even do Wi-Fi calls. Radios, not many people do a lot of radio work anymore, because cell phones are so convenient. Ham radio operators, used to be a ton of them, but not as many as they used to be. And again, landlines, it's really, they're kind of almost forcing you away from the landlines now, but in this particular storm, where normally our landlines never go down, they went down. So at the clinic, we had to do Wi-Fi calls over the cell service, and our internet provider actually has a backup, has backup to all the generators, and we had backup power, so that's how we functioned. The hospital, Oshkosh St. Mary, which is across the street from us, internet was down, cell service was down, so when helicopters were coming in, they had somebody sitting on the roof with a walkie-talkie, radio down to the E on the first floor that there was another helicopter coming in. And anything you had to do in the hospital, you had to do on walkie-talkies, because until everything came back up, that's all you could do. Again, backup power. Most of us have, a lot of us have generators. Some are natural gas, some are diesel, some are gasoline. There's some folks with propane, but again, you have to have a tank buried in the ground to have that much propane to stay on power. Diesel, you gotta have somebody come back and keep refueling it. If the natural gas gets cut off, for Katrina, that was cut off for months and months in New Orleans, so if you had a generator, you couldn't do anything. If you look at Texas, when they had the freeze a year ago, two years ago, when the natural gas, the ability to push it out to the consumer was cut off because there was no electricity to run them, nobody with a natural gas generator had power either. Solar panels. In Louisiana, we call that flaps, because during a hurricane, that helps to rip your roof off that much faster. Wind turbines, we don't have a lot of them down there, because when you get to 150, 160, 170 mile an hour winds, when you see those wind vanes just come flying off and you don't want to have anything close to your house that does that, so those don't work down there. And then for vehicles, if you have an electric vehicle, you can use it to go outside, plug in your cell phone and charge it. If it's cold, like when Texas had the freeze, you can go outside and warm up, but if you can't recharge it, it's a big paperweight. So the best thing for us is either, still the gas vehicles or a hybrid, because a hybrid you can still get around. But like Dr. Kimberly was saying with the gas stations, we were the first people to get power after the storm. And the gas stations, most of them had power within a week and a half or two weeks where we are. But imagine folks coming all the way from New Orleans and everything down the bayou coming to our little town to get gas and they couldn't bring gas in fast enough. And initially the stations were on generator if they had it. And when they got opened, half the awnings, everything at the tops were all blown off of them. So they were trying to make sure everything was structurally intact. But one month after the hurricane, we were trying to go out of town. So my wife says, I'll get up and go get gas at six in the morning when the line's on as long. So she waited one hour in line to get gas and you could get 10 gallons. I said, well, where are we going up into the middle of Mississippi? We ought to be able to get gas along the way. But when you got past the top of the, you know, the front of the boot in Louisiana, when you get past there into Mississippi, you saw these massive 200-year oak trees that were all uprooted. It had survived every storm for the last 200 years. But this one took out everything. So we were on fumes when we got to the middle of Mississippi and got in line to get gas. That's how hard it was. And that was a month later. Down the bayou, they didn't even have power for about three months after the storm. Dr. Boke, who a lot of y'all know works with us, he lives 20 minutes from me. And he had power two weeks later, but on and off. And he didn't have internet for almost two months. So 20 miles makes a big difference, but it sure changes how everything works in your house and in your practice and in your business. So this is a strong tree, but a lot of weak houses. But that's kind of what you see sometimes. And when you go home and see that, that's devastating. And a lot of the same stuff looked like that for Katrina. So imagine the same day, this many years later, that happens again. So there are a lot of folks that don't wanna move back now because you'd get tired of rebuilding. So food, if you flood and your kitchen's on the first floor, you're done. If it's not flooded, but you lost power again, folks, we tell everybody, don't open your freezers unless you need to. Don't open the refrigerator unless you need to. And everybody keeps opening to check to see if the light's back on, or whatever. I don't know why they do it, but your stuff's gonna go bad sooner. If you need ice or power to keep your stuff safe, I mean, we were doing all kinds of things. We brought generators to people. We store, for us, I put up about 200 or 200-something gallons of gas ahead of time, and about 1,000 gallons of diesel. And we have natural gas generators for the house. We have a 60 kW, we have a backup 40 kW diesel generator, a backup seven kW portable diesel generator, and a backup five kW gasoline generator. Because you can't have enough redundant systems. But you also have to maintain them, make sure they work. But if you get down to where you only have smaller generators, you can actually rotate power to things that you need to run, and cool down your refrigerators and freezers and all. Your canned goods are usually always okay. If it floods, though, and there are no labels on it, it's kind of like a potluck kind of thing. Figure out what you're opening and what you're gonna eat. And that almost makes it comical, because you need something to laugh at when this is going on. So this is between us and New Orleans. And boats are blown all over the place. Everything's blown down. Most of the billboards, the best thing is, and I'll show you another one in a minute, but most of the ones that say, if you've been in an auto accident, call this number. Those all got blown down. That was really kind of nice. So water, if the water's shut off, that's an issue. But also, a lot of times, it's contaminated. So you can't always drink the water, so you have to be ready to do other things. So before storms, we clean all the bathtubs up and fill them up with water. We fill a bunch of tanks up with water. Ice chests, that sort of thing. You need at least a liter of water per person per day. But in South Louisiana, especially if you're doing hurricane cleanup, you better have a lot more than that. Cooking, you need water to cook. My son is a petroleum engineer, and he was shuttling hundreds of gallons of gas and generators and food and ice on trucks and trailers down the bayou every day for a few weeks. And what we actually figured out, one of his good friends has a family of five, and they had one bathtub that they left filled up with water for the kitchen, one bathtub to bathe in. And so five days later, they were all still bathing in the same tub while they're working with no electricity, no air conditioning, and cleaning up. So when they don't throw the baby out with the bath water, that's about how it was in the old days. I guess they kind of felt that it was that way for them. So you can bring things in portable tanks, the potable water in tanks, but what we started doing too is we'd take gallon Ziploc bags and fill them with ice, freeze them, and then send all that down there to them. They could use that in the ice chest for the food. And when it melted, they'd take those bags and dump them and use them again, either to drink, because it was clean water, or they could use it to cook or bathe with. So it was kind of a dual purpose thing for them. So that worked out real well, helping them out. Medications, again, the pharmacies will actually probably triple their volume for a day a few days before a storm, because most of us know go get your medicines filled because you don't know how long everything's going to be closed. So a minimum one month supply. Post-storm, even if you get your mail-order meds, because it's cheaper, the mail doesn't deliver after a storm. It takes a long time before they start coming. UPS, FedEx, and all too, after Katrina, it was six weeks after Katrina before they would acknowledge that they could get to us to deliver things. And we were 70 miles from where Katrina hit. But if they don't think you have power, they just don't come, so you can't order anything. So the chronic meds, there are a lot of folks too taking blood pressure medicine in Louisiana and taking diuretics. But when you're drinking a couple liters of water a day and sweating working outside, hadn't done in a while, diuretics are an issue, so you almost have to start talking to some of your patients ahead of time. And then you need antibiotics, ointments, and all the lacerations, abrasions. Some people actually come in and get a tetanus shot before the storm because they know they're going to get something. So the clinic issues, if you have power. If you don't, are you on backup power? Staff may not have a house, may not have any power. Our staff, almost everybody lost power for I guess a week or two. But we all have generators and we rotate generators to other folks too because once we get power back, we spread them out. And in gas, like Dr. Cameron was saying, the hospital across the street, one of the big bulk tank companies in town brought a tank truck over there and they just, everybody come out one at a time and filled up all the hospital employees' tanks. And we did the same stuff at the office. Cell service, you can't get most folks. Sometimes you can text when they have the temporary towers up because that'll go through a whole lot faster than trying to make a call. But how do you call them? How do they contact you? A lot of times it's good to have something set up ahead of time that this is a number you can use to call us. But if it's anything internet-based, it's probably not going to work. So make sure you have a couple of different ways of doing it. If your staff doesn't have power, at our place, since the clinic has power, we can actually have them come sleep in the clinic and stay there if they need to. And the other thing, too, is we have gas and electric methods of cooking. So if gas goes out and we have power, we can still do that or vice versa. Do you have portable fuel tanks? When are you going to ever get supplies again? So if you don't have it pre-ordered, you're probably not going to get it. If we're doing drug screens, because some company has a job that somebody needs a bunch of folks to go into some place, they need a drug screen to hire them, we can collect them. But you may not be able to ship them out. We may have to drive them 50 miles or so to get them picked up. That's one of those did you get hurt in a car wreck billboards. Look how pretty that is. So for next time, we try to minimize things that are going to fly around and go through your windows or your walls, protect your windows, the entrances, the ventilation system. The hospital across the street years ago for Hurricane Gustav, the intake for the generator room had this big ventilator, a big vent, and the hurricane blew the rainwater right through that onto the main power grid. Brought everything up, shorted it out, so they couldn't do anything. When they brought in another generator to run it, and this is probably 10 years before y'all got it, so now it's fixed. But before that, you hook a generator up, but nothing works because you fried your whole electrical system. So what we do is we pick everything up and put it at least four or five feet higher just to make sure everything's up in case it floods and hope it doesn't get higher than that. We run the generator a minimum of every week, about 20 minutes. We make sure that the fuel's all good. We top everything off before the hurricane. If you don't run them and don't test them, it's a mess because a lot of times when you need it, it's not going to be there, and that's what happened. A lot of folks bought some of the cheaper generator systems. They make you change the oil in the filter every 100 hours. If you're without power for two weeks, you better have a bunch of filters and a bunch of oil, but nobody did, and once the hurricane hit, you can't get it. So a bunch of these generators are burning up and throwing pistons through the top of the cylinders. And in emergency communications, you have to have some kind of redundancy because if you lose landlines, which we did this time, and you lose cell service, if we had not had the internet service, we wouldn't have been able to do anything. So a bunch of us, like Bill Greaves, a whole bunch of us all have operators from way back, so those still work, and then even the walkie-talkies, it's good to have a bunch of them because if it gets bad, that's all you're going to have. So maintain and run a backup power, pre-stage fuel, have an alternate, you've got to have some backups, the gas and oil filters, spark plugs. I have a bunch of those small solar backups that I can charge cell phones and smaller batteries and all, and that works because you can deploy that after the storm. Emergency radios, the ham network, if you know any folks, whether it's in your clinic or in your business, that are ham operators, it's nice to know them ahead of time so if something happens, you can have, and they love this, they live for it, they have all these parties to prepare for this kind of thing, so they like to help you out with that. And then water storage, emergency filtration, we live on a lake, and I have a 40,000-gallon pool in the backyard, so I think I have enough water, and make sure I have enough means to filter it or distill it, whatever I need to do. And then additional fuel for your vehicles because a lot of folks that tried to evacuate New Orleans during Katrina got stuck on the road because they tried to leave with a quarter tank of fuel thinking they could go 100 miles, and they got 20 into traffic and ran out of gas. Now what, you know? And then if you really want to be ready for flooding, you can put a boat up on your house like that, and it does make the folks come take a picture of your house pretty quick, which is kind of funny. So any questions for either of us about preparedness of hurricanes or anything? That was great. Yep. So I noticed the blimp that helped call out Sandy, is that FirstNet on the side? Did you notice that? Yep, yep. How many people here have signed up for FirstNet AT&T? One person. So FirstNet got created after 9-11, it's a federal AT&T partnership to have a better, faster, more reliable backup cell service for first responders, including physicians. And for anybody that's got AT&T service, you can sign up for it, and I did a few months ago, and it's 5G, it works great, and it's less expensive than, I don't work for AT&T or anything, but it's pretty cool. That was just a comment. My question, one of my brothers lived on the coast of the Carolinas for many years, and after hurricane after hurricane, and he was living in 95 degrees and 95% humidity, and no power, he decided he would move inland. But before that, when the storms would hit, he would have to wait in his 95 degree house for a while until the water level went down, because he was always afraid to go out and hook up the generator in the backyard, because a lot of people get electrocuted doing that. Any comments on that specific issue? That was one of the issues during Katrina in New Orleans, is that a lot of the backup generators were first floor or basement in some of the big buildings. Right now, a lot of the hospitals have the generators up on the roof, or way much higher. Where we are, my house is, that's it. Between my house and my dad's, it's the second highest point in the city. We're at 7.2 feet above sea level. The lake behind us is at 4.1 feet above sea level. That's why when you come up the driveway, your ears pop from the altitude change. But for us, the generator's up on a pad a few feet up, and if that floods where we are, and that's why we had it raised, if it floods where we are, everything's flooded all the way to New Orleans. That's how low and low-lying that whole area is, but ours is up on a pad, and all the connections are up on a pad, just because of that, and that is a great point. And the other thing is, there's so many people that buy these small generators, and they're worried about somebody taking them, or worried about whatever, and they put them in a garage and crank it up. So we have a lot of carbon monoxide poisoning, a lot of issues after hurricanes, and you warn them and warn them and warn them, but they still do it. So that's always been an issue. Brett? Really great talk, enjoyed it. So I live in Houston, and when Hurricane Katrina hit, we set up a lot of places, we set up a clinic, we set up places for people who evacuated to the Astrodome, and it was a pretty amazing experience. But I noticed in your presentation, you know, Ochsner's developed a pretty nice, sort of within Ochsner, healthcare system for transportation, and that's one of the things that occurs to me, is if the Gulf Coast cities should maybe more formalize, do what we did during Katrina, and if, I don't know, if you all have made any steps towards that, or if you see a need for it, or a use for it. I mean, I certainly believe there's a need for it. And so I will say that, you know, prior to Katrina, we had like one or two little boats and didn't have the high water vehicles, and had some bigger trucks and such. And as you recall, you know, the flooding around the hospitals in New Orleans around, you know, Baptist, Tulane, Charity, they couldn't get the people out. And so as we've grown as a system, and, you know, some of those, at least the Baptist campuses now, Tenet left the marketplace after Katrina. And so we felt the need, again, to get the vehicles and the equipment that would allow us to do it on our own, because you can't wait for the sheriff or whatever, because it just doesn't, it's not reliable. We do have a good relationship with the State Office of Emergency Preparedness and the Jefferson Parish, you know, where the main hospital is, and we train with them, you know. So the people in the emergency side of the house, they have routine trainings with all the emergency forces or emergency groups throughout the state. So I think, to your point, there needs to be more of that, I think, at the individual kind of level, because, you know, you just can't mobilize enough resources, because everybody's in need, and the whole thing shut down. So yeah, I think that's a great idea. Thanks. And what we did during Katrina, New Orleans had a bunch of buses that were going all over the place, and mostly towards Houston. So we arranged with the folks loading the buses in New Orleans to flag buses with medical needs. So any bus that was flagged medical needs was all folks that either had some chronic medical issue and no medicine, or had something that needed medicine. So my wife and one of her friends opened up a civic center and lined it up where we had doctors, nurses, and we had faxed straight to the pharmacies. So we'd see them, assess them, figure out what medicines they needed, write the prescription fax at the pharmacy, and then they would have people shuttling the meds back and forth. And the next morning, because we'd house them there, the next morning they'd load them back on the buses with all the medicines, and a bunch of the folks in the area donated money to pay for all the meds. And so they did that. So they got back on the bus with medicine, got to Houston with at least a 30-day supply. And that was really, really helpful, because a lot of folks with chronic stuff, you don't want to wait a week to put them back on something. And so that was good. But that was on a fly. And I think, to your point, it'd be great if we had something like that set up ahead of time, because that was really kind of nice. Yeah. It's nice to hear your perspective on the incoming when we were on the other side. I'm telling you, every one of them was grateful. They were very, very appreciative. So that was nice. So thanks. Any questions for Janet? No, no. Janet? Hi. Stella Hines from the University of Maryland. Thank you so much for sharing your experiences and for being so responsive and prepared. Prepared first. I mean, it's fantastic. In the last two years, particularly in dealing with COVID, just kind of participating in and observing our incident command kind of response on this, I've been struck by how much I feel like there could be considerable expertise learned on the civilian side from the military experience and kind of responding to kind of emergency and disaster situations and kind of the logistics of how you set up your kind of your structures and your command. Is that a component of what the experience has been in Louisiana? Is that kind of how you've learned or it's just so much you do, you experience this so many times that you don't, the individual civilian world is very kind of familiar with it. I'll take it from the hospital side, you can take it from the clinic side. So I think you're right. Prior to, I think, Katrina galvanizing the fact that you need to be prepared on the front and you need to have processes that are reliable that you do each and every time. So the supply chain people having their pre-order packets and so they just, you know, I guess send an email to send the stuff. So it's not, you're not making it up. And I think prior to Katrina, we just, I mean, we were one hospital, generally speaking, it was a physician led organization and physician leaders were involved. I mean, we've certainly become far more sophisticated from emergency preparedness. And so we have now a giant, you know, because we have so many hospitals, but the emergency preparedness now is doing all the hurricane prep where the physician practice doesn't do it anymore. And somehow, you know, somebody was on vacation once. And so I got in charge of assigning the rooms, you know, for the physicians and it's COVID, hurricanes, they continue to follow me. So I think we formalize the processes, there's methods to it. And so some things you have to adjust on the fly, like the gasoline trucks, you know, we, I mean, we pre, you know, we pre purchased diesel for the generators, but we haven't really bought gasoline trucks for our employees. So that was, you know, in the blimp, you know, so those are things that we normally don't do. And, and we generally don't, depending on the storm, don't pre evacuate hospitals. But we did so in this area with the St. Charles Parish, because we made that decision the night before, because it was, it's in a very low lying areas, like one or two story building. And so we made the decision to pre evacuate that building as well as orthopedic hospital. So yeah, so I think we've mechanized many of our processes. And in the south to, I mean, a whole ton of folks in the South Ex military, and have done a lot of stuff. And they tend to gravitate towards some of the police roles and Homeland Security roles. And so we work really closely with them, but like even for Katrina, as far back as Katrina, three of us, three of the doctors from Morgan City, went with the SWAT teams into New Orleans and Orleans Parish and Jefferson Parish to go help pick people up. And there were folks that we knew had some medical issues. So that's why they asked us to go with them on those particular runs. So we did that. But as far as us being ready for things ahead of time, we actually have meetings in the city. And, you know, really our parish was like a county, 10 minutes, either side of Morgan City is only about 40 some thousand people. But we have a lot of folks at work in shipyards, in fabrication yards, in the oil field, all that stuff, construction down there. And so some of them are temporary residents or some of them, you know, work, you know, months at a time and don't go home till later. So we kind of end up responsible for them too. But we have meetings at least twice a year on hurricane preparedness and other issues with Civil Defense, with Homeland Security, with all the utility people and everybody else. And they include us, which is nice. So that works out. But incident command, we do real well. I mean, a bunch of hot docs have done it for corporations and other things too. So we do incident command real well. And I think when you offer to do stuff in your area, a lot of times they didn't know a doctor knew how to do that. So it is kind of cool. And then they keep inviting you back for more. So that's a really good thing to do. I feel like a lot of U.S. hospitals can learn from the Louisiana experience. So thank you for sharing. We've had a few rodeos. Tony. So, Bob, I'm kind of bringing up the Navy. The Cajun Navy is an informal group of civilians in Louisiana that goes out on these floods during hurricanes and other events, sometimes just heavy brains, and will rescue these people. And I'm surprised you didn't mention that in your talk. The Oshkosh Navy and the Cajun Navy are really almost the same. But it's true. And where we are, you know, you don't see a lot of press and you don't see a lot of folks fussing and saying, where's the government? Somebody come get us or whatever, because everybody just helps each other out. So if you have a bunch of plywood, somebody else has a bunch of blue tarps, we all go help each other, climb on the roof, fix their roofs until you get them fixed. And, you know, we have the generators, and I have probably, I don't know, 12 propane tanks to barbecue or grill or whatever else in case we need to do something else. So we'll have everybody around come over and shower at the house, and we cook for everybody, whatever. But that's not the kind of stuff you see on TV, but that's what this house is about. That's what we do. Very well. So on the hospital network side, since we're completely reliant on electronic medical records now and the infrastructure that goes with that network, and particularly as you described your system, what were the measures taken to harden the network system for your EMRs, and also if that system completely fails in a hospital, what are your backup measures? That's a great question. So we have, and during Katrina, well, let me just take you during a step back. During Katrina, we had a partial electronic record. And so we had paper charts in the hospital, and we had electronic homegrown ambulatory record, which actually served us quite well because we were able to, people that were displaced, we could refill their medicines because we knew what their medicines were. So that helped us. For purposes of this storm, we have redundant, we migrated all the clinical decision makings of the EPIC software to the Shreveport Data Center. And so that information stayed intact. We had used remote servers previously, like I think in Tennessee and somewhere else. And so we've always had an alternative site and not relied solely on keeping the whole enterprise in the New Orleans area. So they, in advance, migrated it all to Shreveport. The electronic medical records worked. But the backup plan is the downtime processes. And so, knock on wood, that all went well. And then we still have, the hospital still has landlines, but they're internet phones. So some of that was kind of wonky this time around. But the data worked, and I think it's because we moved it to the north part of the state. So Shreveport's way, you know, almost to Arkansas. In our area, because, you know, we keep getting pressure to go to the cloud for our occupational medicine software. But I have it housed on a server in the office because we have that one internet service provider. And while I may have backup power, if they lose something, I can't get to the cloud. So we have ours resident in the office, but we do backup. We do three different backups. I bring one set in and out every day. We back up to the cloud and we back up to some backups that are permanently, you know, in the server room. So we have three different backups every day because I'm too OCD to do one. And we print paper records ahead of time in case that goes down for a storm, too. So we have all of our charts that we would normally be able to use, we do that up front. So we're about out of time. Any more questions? All good? All right. Thank you very much. Thank you.

Hurricane Ida

Louisiana

Ochsner Health System

challenges

preparations

COVID-19

hospital capacity

evacuation plans

teamwork

gas shortage

power

coordination