Houston Academy of Medicine, Texas Medical Center Library

Deborah Halsted, Associate Director, Public Services and Operations, Houston Academy of Medicine, Texas Medical Center Library in Houston, Texas, discusses flooding issues in the academic health sciences library resulting from Tropical Storm Allison in June 2001.

Interview date: June 5th, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

Between June 8th and 9th, 2001, Tropical Storm Allison circled over the Houston metropolitan area for the third time, dumping a lot of rain over already saturated ground. One of the most heavily hit areas of the city was the Texas Medical Center, which is home to over 40 health-related institutions. Hardest hit were Memorial Hermann, Methodist and Ben Taub Hospitals, The University of Texas Medical School and Baylor College of Medicine. The Houston Academy of Medicine-Texas Medical Center (HAM-TMC) Library is situated right in the middle of these institutions. The morning of June 9th the library had 4.5 feet of water in the street level, which meant the one-level parking garage under the library was completely full of water. The street level housed the computer classroom and lab, the offices of the National Network of Libraries of Medicine South Central Region, and the Archives of the John P. McGovern Historical Research Center.

While the flooding in the Library was devastating, the damage in the other institutions was more drastic. Both Hermann and Ben Taub Hospitals (the only Level I trauma hospitals in Houston) had to be evacuated. Yes, even the patients. Hermann was closed for 6 weeks. Methodist lost all their patient records. UT and Baylor lost years and years of research, both in laboratories and laboratory animals. The south side of the TMC campus was saved due to two huge construction sites (pits) which served as retention ponds.

(2.) How did the library respond? How did the librarian respond? Were there non-traditional (unusual) roles that the librarian performed?

The HAM-TMC Library is unique in that it is a private library which rents 72,000 square feet of space from the Houston Academy of Medicine (HAM). Due to this arrangement, HAM was responsible for recovery and restoration of the actual facility and Library staff members were responsible for the contents. Both of us had prior relationships with Munters, a recovery firm, and they were on the scene the morning of June 8th. Library staff could do nothing until the water was pumped out, so our recovery efforts began on Sunday, June 10th.

Did library staff do non-traditional roles? Yes! Digging muck, contaminated with sewer water might be considered “other duties as assigned.” But, loyal library staff arrived on Sunday to do what they could to save anything we could, especially the archives.

The Library was one of the few institutions in the northern part of the TMC with water still running, so we became a popular spot since we had working restrooms. We also had to post a TMC security officer at the front door, since some people displaced from their offices in other building thought they would just come to the library to “photocopy some articles.” The security guard had to explain that the Library, too, had no electricity.

Although the entire TMC was affected, the Library staff were really only responsible for recovery of the Library. Staff members were not called upon to assist other institutions or departments, as was the case after Hurricane Katrina in New Orleans. In our case, local librarians not affected by the flood, as well as some library clients displaced from their offices and unable to work, arrived on our doorstep offering help.

With a lot of work and many thanks to the HAM staff, we had electricity and phone lines (although spotty on both accounts) back on by Wednesday. We opened our doors with limited hours and services on Thursday. Recovery efforts on the building continued until January 2002, when we finally opened totally, with a renovated street level. Over 850 boxes of wet archives were shipped off to freeze-dry facilities, and returned in October 2001. It took many months to process the materials that returned. We have since relocated the archives to a warehouse facility about 3 miles from the TMC campus that is not in a known flood zone.

(3.) How has the library (or the services provided) changed as a result of these events?

The first change would be the location of the archives. Renting the warehouse facility is expensive, but necessary. Now, clients needing access to the archives can go to a lovely facility with free parking. We have also co-located our proxy server to a remote location, so in the event of another storm (we do live on the Gulf Coast), clients will still have access to needed resources. We are in the process of having key staff test working from home to ensure that if needed, we can continue to offer library services remotely.

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

This question can be answered on so many different levels, depending on the type of library. The roles for public libraries after a disaster are obvious, and I am proud to say that the public libraries in Houston and surrounding areas really responded to the needs of the evacuees. What is not so evident is the importance of the medical library. After Katrina, physicians in the Astrodome and George R. Brown found themselves treating patients and cases not in their usual area of expertise. These patients had no medical records with them, were taking medications the physicians were not familiar with, and the doctors found their greatest need was a PDR (Physician’s Desk Reference). For example, pediatricians were treating geriatrics, since they took whatever patient was next in line. For that reason, staff members at the HAM-TMC Library have become totally ingrained into the disaster planning at the TMC as a whole. Librarians have sat on the Inter-institutional Council, Katrina and Rita Lessons Learned Task Force, and disaster planning committees. At first, the TMC staff wondered why we were there, but now has come to conclusion that librarians are integral to the process. I have been invited to participate with TMC staff in NIMS Incident Command System training. These courses, designed by FEMA, offer a standardized command system and terminology to respond to disasters. They will soon be required for any institution to received FEMA funding in the future. The Library has now incorporated the ICS system into the newly named Business Continuation and Recovery Plan formerly known as our Disaster Plan. Our main goal in all this was to been seen as first responders, which we now are. TMC will be issuing key library staff sticker to be among the first responders the next time a major disaster strikes. This designation is a mixed blessing, since this means we now will be expected to be among the first on hand, not part of the general population asked to stay away until the area is safe!

Houston Academy of Medicine, Texas Medical Center Library

Dr. Elizabeth Eaton, Director of the Houston Academy of Medicine, Texas Medical Center Library in Houston, Texas discusses the effects of Hurricane Katrina and flooding at the academic health sciences library in 2005.

Interview date:

June 5th, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency) and how did your library respond?

Between August 31st and September 4th, 2005, Hurricane Katrina devastated the Gulf Coast including New Orleans. Many thousands of the evacuees were brought to the two large conventions center in Houston: the George R. Brown (5,000) and the Reliant Center (11,000). The evacuees arrived several days after the levies broke. They came with the clothes on their backs, sans prescriptions, no medical records, no schools records. The convention center grouped the arrivals by families, single male, single female. The facility was clean, accommodated all for sleeping, eating, medical, computer stations, clothing selection, and school study areas for the students. The two medical schools opened medical centers to treat the evacuees. Baylor College of Medicine (BCM) ran the Reliant medical center; The University of Texas Health Sciences Center-Houston, the George R. Brown Medical Center. The UT Dental School moved their mobile van into the GR Brown Convention Center. We heard about this arrangement and immediately found the UTH organizer. The Library supplied needed information to the George R. Brown medical triage area. It took several visits, the first to inquire about their information needs. The physicians were volunteers and worked shifts. They saw a random assortment of patients. One Internal Medicine physician said he wanted infectious disease texts, another said he wanted the PDR, another wanted access to the library’s online journals. We engaged our serials librarian and the IT Systems person. The Convention Center had an IP address, all we had to do was locate the person who knew it and receive permission to give it to vendors to allow access from the convention center. In all cases, the vendors gave us 30-60 days permission from machines we identified at the convention center.

September, 2005: Hurricane Rita, the second Class 5 Hurricane in the Gulf heading toward Houston resulted in mass evacuation of Houston and the surrounding communities. The Library battened down the hatches and evacuated the premise from Wednesday to the following Monday. Fortunately no damage was inflicted upon Houston.

(2.) How did the library support the regional community of health information professionals?

2005 August 31-Sept 4 Hurricane Katrina

Houston watched as Hurricane Katrina wrecked havoc with New Orleans. LA is in our NNLM (National Network of the Libraries of Medicine) SCR (South Central Region), the academic health sciences libraries and the hospital libraries in New Orleans were flooded; Oschner Hospital was surrounded by water but remained open, with a helicopter pad on the roof. The worse part for all of us was not knowing where the LSU and Tulane staff had gone. The NNLM SCR staff within 60 days had contacted all affected libraries and determined their needs and what the costs would be. Contacting persons and confirming that they were OK was a lengthy and arduous procedure. Home phones were down, work phones down and many cell towers inoperable. We contacted friends of friends and NNLM SCR set up a blog which was a great way to deliver and receive information. We were on the phone to the SER (South Eastern Region) as well, trying to assess damage in Alabama and Mississippi.

Within a week of the flood, the entire Tulane Medical School, including faculty, staff, residents and medical students were relocated to BCM, one of the two medical schools which we serve. So while the NNLM SCR stayed with the project of polling all members, assessing damage and prioritizing services needed, the Library staff was welcoming yet another medical school to its services. We phoned vendors trying to include the Tulane medical students as our students for assessing resources. The Tulane students had dual resources, those already paid for by Tulane and also this Library’s online resources. The vendors agreed to allow Tulane students, staff, residents and faculty access from our IP addresses. The Tulane Medical School Library Director and a librarian who had relocated to Houston were given desks and became members of our Library staff while helping their students. Although the move of Tulane to Houston was not prearranged, the BCM faculty and staff accommodated them and made the transition smooth. Medical School classes began 3 weeks after the storm; Tulane faculty taught their medical school classes; residents were placed in appropriate units.

(3.) How has the library (or the services provided) changed as a result of these events?

Now, we have much better emergency numbers sharing. All cell phone numbers are shared with key people and departments. Email accounts with a national carrier (Yahoo!, Google, AOL, etc…) are encouraged for all staff, as one can usually use the national email if local and home computers are unable to function.

To ensure continuing online access, we have co-located our authentication server and have encouraged the region’s libraries to do the same.

We updated and reviewed the disaster plan, re-stocked emergency supplies and prepared vendors’ contact information. Those details will be available and we will contact them ASAP. We have agreed ahead of time on the process for accessing information during such emergencies.

We worked with community libraries, the city, and TMC (Texas Medical Center) to be better integrated into the emergency response teams.

What became crystal clear after Katrina and Rita is that it is most important to evacuate. Leaving early is the priority – in front of moving furniture, computers or even putting plastic sheeting on books, stacks, etc…

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

Librarians’ roles are to be absolutely in charge of the library. Do not even dream that you will have help. ‘All we have is ourselves.’ Some staff members do not want to participate in recovery and that has to be known in advance.

Librarians must be integrated into the local and regional disaster preparedness and recovery operations. We have knowledge, space and can help in many non traditional ways.

Librarians’ roles are also to collect contact information. Keep all home email address in your emergency manuals. Try and have as many regional and national numbers as possible. Librarians should also keep records of everything before, during and after the flood. FEMA demand receipts.

The role of National programs, such as GoLocal, should be emphasized. The sister-system of RMLs (Regional Medical Libraries) is absolutely vital. In the SCR (South Central Region), the network sponsored a disaster seminar that raised awareness. We encouraged more seminars on regional levels. The NNLM played a key role in promoting awareness at the regional and national levels. The network and the National Library of Medicine need to continue their leadership in promoting preparedness.

In every disaster, the needs are different. But, money will always be needed by the institutions affected. The willingness of vendors to allow for permissions will always be needed. National and regional efforts are required to enable quick response on behalf of the vendor community. Access should be available to wherever the point of care happens to be. Librarians can aid in the provision of these service.

Since Katrina, TMC Inc. (Texas Medical Center, Incorporated) forged a relationship between the medical library and disaster agencies. Now, the agencies will think of the library. The next step will be to get ingrained with the city planning force. The library is much more visible now and they expect to be called. Staying connected with the city is critical. Librarians should be out of the library, making contacts and connections.

Southern Louisiana Area Health Education Center

Helen Caruso, a hospital librarian at the Southern Louisiana Area Health Education Center (AHEC) in Covington, Louisiana, discusses her Hurricane Katrina experience during August 2005.

Interview date: Friday June 1st, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

On August 26, 2005, I was in New Orleans, manning the National Library of Medicine exhibit at a medical job fair. The television in my room didn’t work, so I had gone to bed Friday evening without hearing the weather report. The following morning I was blissfully unaware of the approaching hurricane. After a leisurely breakfast, I arrived at the exhibit hall to find exhibitors frantically dismantling their booths. Everyone was talking about the hurricane.

I wasn’t too worried. Frankly, I thought people were over-reacting. Hurricane warnings are summer constants in southern Louisiana; most of the time they don’t become serious. Since all the exhibitors and attendees were leaving, I decided to take the exhibit materials back to Louisiana State University Health Sciences Center (LSU-HSC) before driving home across the Lake Pontchartrain Causeway. When I got to the LSU-HSC library building, the doors were locked, and I had to bang on the doors for Security to let me in. They told me that the building was closed because of the storm. It took a good deal of persuasion for me to convince Security that the exhibit belonged to LSU-HSC. Finally I was escorted upstairs and allowed to deposit the exhibit in the library.

Meanwhile, it was becoming increasingly clear that many people were taking the situation very seriously. Someone had arrived to remove laboratory animals, and a policeman informed Security that the New Orleans Police Department was taking over the parking garage. As I began driving home, the Mayor was on the radio, telling everyone to “get out” of New Orleans. I realized I was only moments ahead of a mass exodus.

I live in a rural area, and my family decided to wait out the storm there. On Sunday, the hurricane winds and rain pounded the area for hours. (1) The electricity went out and the skies darkened. It became very scary when the tall pine trees started snapping. Over 100 pine trees blocked our road. It was several days before we could leave the property. Phone lines were down, and cell phones stopped working. Electricity was not restored for three and a half weeks!

After enough of the trees were removed from the road, we managed to drive to Baton Rouge for supplies-no stores in our area were open. Cell phones worked in Baton Rouge, but there was no news about St. Tammany Parish. No one knew how far the devastation went. On our way back from Baton Rouge, we drove past Lakeview Hospital (one of the sites where I work). There were a significant number of trees down, along with signs of wind damage, but there was no evidence of flooding. I couldn’t get into the institution however as security wouldn’t let us inside.

About ten days later, I was able to go to my other site, Slidell Memorial Hospital. The storm surge had brought the lake water up to less than half a mile from the hospital. The neighborhood suffered severe wind and water damage. Huge trees lay on crushed homes and flood soaked furniture was everywhere. The hospital had remained open through the hurricane, and was accepting emergency patients. More than half of the hospital employees lost their homes or could not live in them. Those who had livable homes shared them with other staff and family. Some staff and many rescue personnel ended up staying at the hospital.

My first day back at Slidell Memorial, I couldn’t go into the library at all. I was asked to assist in setting up day care services in the hospital so employees could return to work. But I didn’t mind in the least being at work (because the hospital, unlike my home, had electricity and running water). The library is located on the first floor next to medical records and rehab. Luckily, someone from rehab had thought to put plastic on the collection before the storm hit. It was a good thing, since the roof had leaked. There were trash cans and hastily gathered containers full of water standing on the library counters and desk. A restoration company arrived to remove the humidity from the air and prevent mold from growing. They dried out the whole hospital. I was surprised at the large containers of water that was “de-humidified’ from the library.

I was allowed back at Lakeview Regional Medical Center after about two weeks. During this time I hadn’t heard from other SEL-AHEC (Southeast Louisiana Area Health Education Center) co-workers, or even my library assistant. I tried to call other library contacts, but couldn’t reach anyone. One of the first calls I received was from Greg Bodin from the National Network of Libraries of Medicine/South Central Region (NN/LM SCR) in Houston. Ethel Madden from Oschsner called the following week and related all the New Orleans news. The pair of us concluded that as far as medical library services in Southeast Louisiana-we were “it.”

Ethel and I began to coordinate our efforts toward recovery. Neither of us lost our homes (although we did host displaced family members). Since our energies weren’t consumed with simply trying to survive, we were able to work and try to help.

The harrowing after-affects of Hurricane Katrina are far from over. I recently traveled through Gulfport, Mississippi, where the Highway 90 Bay Bridge at Bay St. Louis had only just re- opened. (2) What I saw along the highway was truly devastating. It will take a long time for the gulf coast to recover. No one knows the full health effects from the aftermath. Respiratory illness and unusual rashes are common, even though epidemiologists found no lasting effect on the air quality. (3)

(1) For a chilling official report on Hurricane Katrina, see: Knabb, R.D., J.R. Rhome, and D.P. Brown. 2005. Tropical Cyclone Report: Hurricane Katrina, 23-30 August 2005. Miami: National Hurricane Center. http://www.nhc.noaa.gov/pdf/TCR-AL122005_Katrina.pdf accessed 7/6/2007.

(2) For more about the bridge, see: Nossiter, A. May 29, 2007. A Bridge Restores a Lifeline to a Battered Town. New York Times. http://www.nytimes.com/2007/05/29/us/nationalspecial/29bridge.html?ex=1338091200&en=24a98c1c1216af01&ei=5088&partner=rssnyt&emc=rss accessed 7/17/2007.

(3) This article seems to convey the ambiguity of the health situation: Wilson, Jennifer F..Health and the Environment after Hurricane Katrina. Annals of Internal Medicine 17 Jan 2006; 144(2):153-156. http://www.annals.org/cgi/content/full/144/2/153 accessed 7/6/07.

(2.) How did the library respond? How did the librarian respond? Were there non-traditional (unusual) roles that the librarian performed?

The first real day back at work (once the library was accessible again), I helped set up a daycare for the hospital employees’ children. It wasn’t a traditional library job, but it was something I could do to help the hospital The daycare was in operation until the schools started up again in October.

I worked with Ethel Madden. We talked about what was needed for the area and what we could do. We identified information access as the biggest need. Perhaps even more than health concerns, people needed telephones and an internet connection to begin reconnecting their families and restoring their homes. We appealed for assistance from the outside once people were allowed into the area to help. The South Central Region (SCR) of the NN/LM started to send out information about disaster recovery, health vulnerabilities, food storage, etc. which was then dispersed through the hospital library. I don’t know if the information was used, but it was gladly accepted by areas like the infection control, emergency room and the immunization center.

By the third week, the hospital internet was operational. I started to send hospital staff links to useful items. I also printed them out and distributed the articles. The library began offering computer access to displaced health providers and the public. Most of my actions were self-initiated or agreed upon with Ethel Madden. At first, the two of us were out of contact with the professional community. So we made the decision to go it alone. The situation was totally outside of anything that we had ever experienced, so we ended up doing many things that were out of the ordinary.

Even though the immediate financial future was uncertain, SEL-AHEC asked me to go to the SCC/MLA conference. There, I talked to other librarians and learned what they were doing. I came away with these pieces of advice for professionals in a disaster situation:

Ø Go in person to the areas where help is needed

Ø Talk to people

Ø Don’t wait for an invitation

The Medical Library Recovery Project was inspired by Ethel with input from Jenny Dagate and me, and funded by NLM and the SCR. We determined what was needed: computers, internet access and training. While we were working on the proposal, Hurricane Rita hit the region. Luckily, it didn’t affect us like Katrina did. We kept working. The proposal went to Renee Bougard and by January we were visiting the sites. We finalized the contact people and made agreements very quickly. By February, we started getting the computers. We hired a soon-to-graduate library school student to teach the classes and began the project. It continued until March 2007.

The Medical Library Recovery Project was so well received that we were invited to organize more classes. After The Medical Library Recovery Project funded a full year of high speed internet access and provided two MedlinePlus classes for The Community Resource Center at Miller Memorial Library in Hammond, they asked for more classes during 2007.

I served the North Shore and Ethel and the Ochsner staff covered the South Shore. They opened two libraries – one in the former Memorial Hospital, newly acquired by Ochsner, and one in Raceland at St. Anne’s. Some of our outreach efforts changed as we determined different needs along the way. Luckily, NN/LM SCR and NLM were very flexible, allowing leeway to revise the plans when needed.

(3.) How has the library (or the services provided) changed as a result of these events?

In general, I am more proactive. The Medical Library Recovery Project was a foot in the door for the library. It opened many places to library services that had never worked with a librarian before. The work enabled me to be more willing to approach hospital/clinic administration. And I was able to include patients and their families more in library services.

I am still working to make contacts with emergency responders. Individuals that worked for emergency agencies and groups passed through the hospital quickly. The relief workers used the computers, but that was about all the contact they had with the library. I later attended a community outreach exhibit in Hammond that included representatives from Red Cross and FEMA. I went to talk to them and handed out brochures with information about NLM’s environmental resources, MedlinePlus, and WISER.

I recently wrote another proposal (which was funded) to conduct outreach to emergency responders.

I received help from other library professionals, including my EBSCO agent Pat Pauletti. Pat provided essential aid by helping us stay connected, find missing issues (mail service was particularly bad during the aftermath). Because of Pat, my libraries are missing only a few issues.

I also received help from several libraries, including the medical library at Harvard Medical School. They had sent new, useful books for use in the emergency shelters. The leftover books made it into hospital libraries that didn’t have much funding for collections.

A hospital in Cambridge, Maryland (part of the Shore Health System) adopted Slidell Memorial Hospital. They sent truckloads of household and personal supplies and even sent people down to help out. The two institutions continue to maintain a relationship.

I spent a lot of time helping displaced health providers. Both hospitals had lots of extra people. Many displaced doctors, medical students, and nursing students needed library reference, computer access and help continuing their studies. Through The Medical Library Recovery Project, I helped put a workstation in the library as a convenient location for these individuals.

I remember a fire in 2000 at the SEL-AHEC headquarters. The library lost everything but the card catalog. At the time, it was the worst thing that could have happened to them us. Katrina was a different kind of loss entirely. The library gained much more in the long run and became more effective. It certainly doesn’t mean that Katrina was a good thing – the entire area still has devastation two years later – but I was able to help in a positive way and to increase the reach of the library. It made a difference to the kinds of services that I could provide and doors opened as a result.

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

There are three major roles that librarians can take: conducting outreach, training, and proposal writing. They can appeal for needed help through their networks and professional connections. I knows from experience that the outreach grants from NLM have made a significant difference, especially by providing opportunities to network with local health providers, hospitals and clinics, By getting to know them, I was better able to predict their needs following this disaster .

Librarians also know which information resources have accurate and reliable sources. And they know the community. As a result, they can accurately decide what is needed and provide it quickly.

In thinking ahead for another hurricane season, I advise other professionals to make sure they have accurate contact information – “real” contact information, which includes relatives and friends and cell phone numbers. The contacts should also include hospital administrators and staff. I also think it is a good idea for hospitals and organizations to set up websites hosted from an outside location and toll-free numbers to provide up to date information for employees.

Here are some pictures submitted by Helen Caruso and Kathy Duplechien, SWLAHEC Librarian, that illustrate the extent of the destruction in Slidell, Louisiana.

Destruction in Slidell, Louisiana

Destruction in Slidell, Louisiana