By Sy Mukherjee
August 28, 2017

Hurricane Harvey has already wreaked havoc on Texas infrastructure, commerce, and human life. Originally a tropical storm, Harvey made landfall as a Category 4 Hurricane in Corpus Christi last Friday and brought with it 130 miles-per-hour winds decimating the storm’s path. As deadly as those gales may be, from a public health perspective, they’re nothing compared to the damage wrought by water—rainfall, high surfs, and related conditions accounted for 88% of all hurricane and tropical storm-related deaths in the U.S from 1963 to 1992.

Harvey has already dumped more than two feet of rain in certain parts of southeast Houston and isolated regions could eventually see totals of 50 inches by later in the week, according to The Weather Channel. At least eight people are estimated to have died so far. So just how do a state’s hospitals prepare for such an enormous, ever-evolving onslaught?

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Preparation is key, according to Dr. Andrew Rhim, a physician and assistant professor at the University of Texas MD Anderson Cancer Center, one of the leading oncology institutes in the world. “MD Anderson was hit really hard in 2001 during Hurricane Allison,” he told Fortune in a phone interview. Rhim wasn’t at the center back then–but he says that administrators took that event as a wakeup call and worked to shore up disaster management in the years since. “The response to Harvey has been a product of those preparations.”

MD Anderson is currently experiencing some flooding, forcing appointment cancellations and closures for outpatient procedures. But there hasn’t been an evacuation, and the facility remains staffed for inpatients who cannot be discharged, according to Rhim. That’s thanks to preventive measures like flood gates which minimize damage and so-called “Ride Out” teams that prepare to, well, ride out the storm. These include nursing and technical support staff, custodial and food management, and extra food, water, and changes of clothes (in addition to a barrage of emails and other communications between administrators and staff).

Despite all that prep, transportation dangers continue to be a challenge, and MD Anderson has been forced to limit the number of family members who can come visit inpatients (while also attempting to discharge as many of them as possible before the worst of the hurricane).

Other facilities have faced greater hurdles. Ben Taub Hospital, an extremely busy Houston-area trauma center, is preparing to evacuate all 350 of its patients amid medicine and food supply disruptions. They will have to be diverted to different hospitals until the flooding and rains subside.

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