Dr. Chris Souders, Associate Medical Director for the Houston Fire Department Emergency Medical Services (HFD EMS), and Kevin Schulz, Assistant Medical Director, helped to organize the emergency medical services offered at the George R. Brown Convention Center (GRB) during Hurricane Harvey.
Souders explains that the response to Harvey was based largely on the response to Hurricane Katriana, when a shelter opened in the Astrodome [and GRB]to house displaced residents from New Orleans. Using GRB as a shelter was not in the original plan from the city, but the decision to open it was made after officials realized that the disaster required a more coordinated response. Schulz says that the length of the flooding event, lasting over several days, caused many to reconsider the size and scope of relief efforts and realize the need for long-term medical care for those in shelters. Souders was called to open the GRB shelter and said that evacuees were arriving in dump trucks and buses. The initial response focused mainly on getting people dry, finding them clothes, and feeding them with the initial resources provided by the nearby Hilton hotel. After the first twenty-four hours the challenge became expanding the GRB medical services beyond the simple first aid station originally set up. As more medical volunteers arrived, the medical station became like a small emergency room. HFD EMS medical director, Dr. David Persse, served as the shelter’s chief medical officer. One major task was deciding which patients could be treated at GRB and which needed to go to a hospital. Souders explains that area hospitals were dealing with their own influx of patients and internal disasters, so the doctors at the shelter tried to avoid overwhelming the hospitals by treating as many patients on site as possible. A few days after the shelter opened, assistance from FEMA, with Disaster Medical Assistance Teams and ambulance strike teams, arrived to take over medical care while HFD EMS continued in an oversight role. Schulz describes the conditions that were treated, from injuries to patients with chronic illnesses who had missed treatment or who had been without medication for several days. A pharmacy, stocked with donated medicines, was able to provide medication to those who needed it. Both Schulz and Souders emphasized the generosity of the community, saying the shelter was overwhelmed with donations of food, towels, clothes, and other supplies. Schulz says that the thing that had the biggest impact on him was that the people in the shelter were very appreciative of the help they received, and that there was upbeat atmosphere in the shelter. Both men agree that lessons learned from operating the shelter can apply to future disasters, including that aid can come from many sources inside and outside the community.
Interviewee: Chris Souders and Kevin Schulz
Interview Date: November 12, 2019
Interview Location: Houston Fire Department
Interviewer: Christina Shibu, Debbie Harwell
INTERVIEWER: My name is Christina Shibu. Today is November 12, 2019. We are at the Houston Fire Department, and we’re interviewing Dr. Kevin Schulz and Dr. Chris Souders.
CSh: First, we’ll be taking some personal information. So can you both please state your full names?
KS: Kevin Schulz.
CSo: Chris Souders.
CSh: Please tell us when and where you were born and a little bit about your life growing up.
KS: So I was born in New Jersey in 1983 and grew up in the northeast — came to Houston in summer of 2012 after medical school and residency in emergency medicine to do an EMS fellowship here with the fire department and have stayed on ever since.
CSo: And I was born in Houston, Texas at the now-no-longer-existing Spring Branch Hospital in 1971 and grew up in [0:01:00] Alief and Klein on the north side of town — let for college to Iowa, came back to Baylor here for med school, left for ER training in Rochester, New York, and then came back for EMS fellowship training here in Houston in 2001 and have been here ever since.
CSh: What inspired your interest in medicine?
KS: You can go first sometimes.
CSo: I guess my interest in medicine came from my dad’s dad, my grandfather and his wife, who were both doctors. And so, growing up and visiting my grandparents, I heard, you know, lots of stories and would go to his office. And that was sort of my introduction to medicine. When I was a med student at Baylor, between ’94 and ’98, I actually did a medical student rotation with the fire department here. And so that sort of got me into emergency medicine and EMS as something interesting to do.
KS: And it’s been [0:02:00] kind of — it was kind of a conclusion forever. I don’t have — my grandmother was an ER nurse, but other than that, there weren’t a lot of — there weren’t any physicians in our family. We just got — I got involved a little bit as a lifeguard and first responder and doing first aid. And it just kind of grew on me, and I just kind of escalated it beyond that. I can’t say there’s one particular person or thing that got me into it, but it just kind of kept growing and growing. And then I got involved with an ambulance organization during college, which then took me into the emergency medicine/EMS-kind of direction.
CSh: Did you always want to be involved with the fire department or emergency medical services?
CSo: I sort of decided that, for sure, in ER residencies so a couple of years before I actually started here. You do emergency medicine as a specialty. And then within emergency medicine, there’s other sub-specializations, which EMS is one, toxicology [0:03:00], various sub-specializations. And so I had — for me, I had some experience when I was in med school — more experience in residency, which sort of, you know, cemented my desire to do it.
KS: Pretty much from the time I started doing anything medical, you know, with that lifeguarding, EMT kind of stuff, that was the part that really drew me — was the EMS — the kind of outside the hospital — the first responder kind of role, so everything I did into medicine at that point was largely geared towards getting to something like this. I can’t say it was, “I want to be in the fire department,” but I wanted to do something — not just be in a hospital all the time.
CSh: So what is your current role with HFD and EMS?
CSo: So I’m the associate medical director, which is like the number two on the hierarchy of positions. My more specific responsibilities — the main ones are the medical incident reviews [0:04:00], which is handling any sort of concerns or complaints that come from outside the department or inside the department about the care that we give. I also deal a lot with dispatch, with contracts, with our documentation software. And that keeps me busy.
KS: I work for him. I’m an assistant medical director, and so I’m full time with the fire department was well. And my kind of specific areas of kind of involvement — I’m the lead for a lot of our educational programs, credentialing status of the members of the fire department — as well as I work with one of our other medical directors on a lot of event medicine, large-scale incidents, planning for a disaster. I work with the Houston Police Department SWAT team as a tactical physician. And I also lead the training of our EMS fellows who train here at the fire department. So other doctors [0:05:00] who are training to kind of get into roles like what Chris and I have.
CSh: Can you tell us about your training specifically as it relates to preparation for mass casualty events and evacuations?
CSo: So I can’t recall anything at Baylor or even so much any real activity when I was in New York of any mass casualties, so I can’t say I had any real hands-on experience before I came to Houston, which seems more disaster prone than where I came from. In these —
KS: But your fellowship.
CSo: Yeah, in these standard curriculums for emergency medicine, there is time spent that topic. So in an academic — you know, like I’m getting lectured at about how to manage those things. In your EMS fellowship, where you’re working as a part-time medical director for the city in a training role, that is a big part of the curriculum [0:06:00] for EMS doctors, more so than just a general emergency medicine doctor. In terms of — I was here when Katrina, you know, destroyed New Orleans. And when the, you know, hundreds of thousands of people came to Houston on the bus, that was my introduction to sort of disaster medicine. We didn’t have a local disaster other than the rapid influx of all these people who had had no medical care for a long period of time. And we didn’t know where to put them or how to manage them. And so that was my — that was in my — what year was Katrina? 2007?
CSo: That was my first, you know, real big hands-on sort of disaster kind of stuff.
KS: So I had spent almost 10 years in EMS as an EMT by the time I came to Houston — so right at about 10 years, so there was some training there in managing disasters [0:07:00]. But it was generally in small systems that didn’t have big things come up. So there was some training, but it was largely academic. When I came to Houston, it was for my EMS fellowship as well. And at that point, it was in the process of truly being formalized. Actually, during my fellowship, it became a formal accredited subspecialty of emergency medicine. So the curriculum became much more refined, and there was quite a bit of emphasis put on that training piece. And then, you know, working — as a fellow, you work for the two years – at the time, it was two years – here as a medical director. And you know, they’re — as kind of Chris mentioned, there’s — seems to be a lot of stuff going on in terms of mass gathering and what not, so we do a lot — we did a lot of kind of preparation for things that didn’t happen and then preparation for things that happen routinely, like the Chevron Houston Marathon, like Rodeo, like some of the kind of standard things. And then during my first year here, I believe it was, we had the NBA All-Star [0:08:00] Game here in Houston. And you know, in the years since, we’ve had Final Fours, Super Bowls, World Serieses, and plenty of — you know, and a couple of storms as well, so.
CSo: There wasn’t — one thing occurred to me. There wasn’t a lot of mass disaster casualty training. I started work here on September 5, 2001, six days before 9/11. And 9/11 happened within my first week, and though none of that happened here, you know, EMS around the nation suddenly went into this, you know, “What are we going to do if it happens where we are?” And so it really changed the whole topic of being an EMS doctor in the first — you know, that’s not sort of the job I anticipated. Then this big event happens, which changes the nation’s focus. And that became a lot of that in the fire department and in EMS nationwide. So that really drove a lot of the emphasis.
KS: The other thing is with the — kind of my time in EMS as an EMT and then my time here working with the [0:09:00] fellows, 9/11, Katrina, a lot of these major events kind of formed the curriculums — those formalized curriculums on, and they’re almost kind of case studies that we use to talk about it. And so I kind of stepped from the role of EMS fellow to EMS fellowship director almost immediately. And so I had to educate myself quite quickly, because now, I’m the one responsible. I’m the teacher, and so there was a lot of self-teaching, which really has helped set me up in terms of, you know, when we have things to plan for here in town. Because it’s stuff that I had to look up and figure out myself.
CSh: So now, we’ll move on to the formal interview questions. Both of you have previously mentioned other experiences and natural disaster response, so how did your previous experiences prepare you for this event in particular?
KS: Well, I didn’t have anything to this level [0:10:00]. Prior to Harvey, we had had several floods here in Houston in the couple of years leading up to it that I’d been involved with the response to. But those were very limited responses. We didn’t open up the large-scale shelter, which is where I spent a lot of my time with Harvey. That was more of a response in the field — more along the lines of what my normal EMS physician duties would be when responding out to calls. So I didn’t have a ton of experience with natural disasters that really set me up here. It was more of just the generalized principles that I could try and apply to this new situation.
CSo: Yeah, like I said, with Katrina, it was like Harvey but with no flooding. I mean, the infrastructure in Houston was fine. But all of the sudden, a hundred-thousand people, what do we do with them? That’s probably actually a larger number than we ended up having in Harvey generally speaking, but — so that experience of — so originally, we were at the Astrodome and set up shelter at the [0:11:00] Astrodome. Then the Astrodome got full. And then we kicked the quilters out of the George R. Brown, who were having a conference there and then set up a shelter there. So the county then took over running the Astrodome and the city took over running George R. Brown. And it was just a matter of, you know, trying to anticipate medical needs, a lot of just responding to medical needs that weren’t anticipated, and doing that stuff. But that was the only other large-scale thing I’d been involved with.
KS: I took a lot of cues from him early in Harvey, because he did have that experience from Katrina.
CSh: When we spoke with Dr. Persse, I believe he indicated that the city’s plan was not to use GRB as a shelter again. So how did that change impact your planning and provision for care?
CSo: So I — you know, that’s probably a better question for him, because by the time I knew we were sheltering people beyond what the church would do or the school would do [0:12:00], it was a phone call from him, Dr. Persse, saying, “We’re opening George R. Brown. I’m at the command center. You go there and open it.” And so I really wasn’t involved in the — I know there’s a hesitancy for the city after Katrina to do that kind of thing again. And you try to keep the numbers small and diffuse to other small shelters. I’m not sure exactly what prompted them to just give up and say, “Okay, fine, we’ll open it.” I think it’s just when the numbers become so great and the city maybe can’t keep track of where all the shelters are, we can just say, “Look, here’s one big shelter.”
But I didn’t know we were opening a shelter until that Sunday, you know, late morning, early afternoon when he called me. There was some — it wasn’t — there wasn’t — I don’t recall — feel free to correct me. There wasn’t a lot of back and forth with the medical directors about opening shelters in the days before that [0:13:00]. There was a lot of fire-based stuff about rescuing, rescuing people in floods, calling people in versus not calling people in, the mayor saying we should evacuate the city or we should not evacuate the city. There’s a lot of emergency management kind of discussions happening, but there was not — you know, the amount of flooding was unknown. And therefore, the amount of needing a shelter was not a known idea.
KS: So it was — there were some briefings leading up to it. And there were ones that — I was able to call into several of them. And there was — there was talk going in that, you know, that’s always kind of in the back pocket. But we don’t want to go there. And I think that, from my perspective, kind of always in that planning for the worst kind of mode, I’m like, “Okay.” Well, in a lot of ways, it made it easier when they made that call, because now, we can centralize resources. Now, we can [0:14:00] kind of, you know — now, I have a place to go, right? If I’ve got 200 people here and 70 people there and 40 people there, I’m not sure where to go myself to be useful, right? To be — you know, and it’s more of that kind of abstract piece where now we’re trying to get ambulances through floodwaters to get to shelters. So you know, in some ways, it was helpful.
Now, it certainly presented its own challenges. But I think that from a planning perspective — but it did kind of make me kind of shift gears, because I was — again, I was looking at something similar to the Tax Day flood, the Memorial Day floods from the previous years of kind of separate, isolated areas of operations that, you know, I was going to try to figure out where I could be helpful — where — you know, I tend to be one of the people who — you know, working with Chris and with Dr. Persse, I tend to be one of the people who kind of tries to help coordinate the where do we physically need to be. Where do we need to put people [0:15:00] among our doctors? And so I was kind of in that mode of thinking, “Okay, where can I — where do people need to go?” Well, this answered that question pretty quickly when they said they’re going to open the convention center.
CSo: And the other thing we didn’t know — all these other floods, you know, are one-day or two-day events in terms of — I mean, someone’s house may flood, and that is a long-term event for them. But when the flooding started happening, we didn’t know for sure whether this was a prolonged event or whether this was a one-day, two-day event. So there’s that, you know, unknown as to how big of thing do you start. If we had opened George R. Brown and then shut it the next day, you know, after kicking out the people who were having their conferences there, then — you know, there’s that hesitancy to sort of overreach.
KS: So I think — I think it brought in a lot of — you know, it was one of these things where everyone had a — kind of a specific idea of where things were going. All of the planning, briefings were more on that [0:16:00] kind of smaller regional area command-style events. And so — which was something that we had — again, it was kind of in the pattern of the previous two years of floods. So that was just kind of, “Okay, here we — we’re here again. This one will probably be a little worse, but –” You know, and then this really kind of turned — kind of completely turned a lot of heads and turned everybody’s page to say, “Okay, we need to ramp up for something a little bit different this time.” Because it’s not just the water rescues. It’s not just the pulling people, you know, off roofs and people who drive into water. It’s long-term sheltering. And then for us on the medical side, it’s long-term medical care for these sheltered patients.
CSh: Can you specifically describe your roles at GRB during that time?
CSo: You want me to start since I’m sort of at the beginning?
CSo: I was lucky to not stay there the whole time [0:17:00] in some ways. So I don’t remember. It was Sunday. I was watching the news shows, like Meet the Press or whatever, in bed — just watching TV. And Dr. Persse calls me and says, “We’re opening the shelter.” So I got up, put on my city clothes, went there, met up with a Red Cross guy, and, I think, a city housing guy. And you know, it’s like — well, George R. Brown has like five halls. You know, and the George R. Brown staff is — you can’t just take over the whole thing right at once. So the original plan was limit it to the one hall on the end, right? And so that’s what we started doing. People started coming in by dump trucks. Well, there’s a lot — first, it was a lot of homeless people that reside around there coming in from the rain. Then it was a lot of people being dropped off in busses and trucks. Main issue at that point in time was everyone was just wet. And the George R. Brown was incredibly air conditioned. And everyone was [0:18:00] just freezing and hungry. So it was really drying people off, trying to find clothes, feed them.
We interacted with the Hilton, which is connected. And they brought over big carts of towels and stuff. And then you had been doing some field rescue stuff and then came over that afternoon into the evening — somewhere in that timeframe. And from a medical standpoint, we started with having an EMS unit or two there and then setting up a table just like with a couple nurses and like first aid, Band-Aids, and stuff like that. And that was the first — through the first night into the second day. And then it basically got — they got overwhelmed. And then the requests or the needs from the people were way more than just first aid kind of things. You know, we have people without seizure medicine [0:19:00], dialysis patients missing their dialysis, things that would become emergencies if we didn’t do something about it. Psychiatric patients off their meds.
KS: In those first — that first, you know, 12 to 24 hours, you know, it was a combination of, you know, taking care of people when people presented, because we were certainly overwhelmed in terms of personnel on site, especially through that first night — as well as trying to get a feel for what we needed to do — you know, how — if this thing keeps ramping up the way it eventually did, how are we going to expand this? Because this is not — you know, the initial model was not sustainable with the rate of dump trucks dropping off out front.
KS: So it was kind of trying to do that planning. And it was helpful to have like — to have both of us there pretty early, because we could kind of divide and conquer some of that, right? Start dealing with resources. Start dealing with where are we going to get more [0:20:00] personnel. Where are we going to get more supplies? You know, what services are we going to need to address? Which, every time I thought I knew what services we needed to address, I found new services we needed to address. And so in that first — in the first 24 hours, we went from, you know, a table with some nurses and some Band-Aids — and the first big ramp-up really happened on that next day — on Monday. And that was largely an HFD driven — because that’s the resources that we could bring to bear, right? That’s who we have. That’s who we can get ahold of. That’s who we can talk to — the chiefs. When one of our executive assistant chiefs was there with us and kind of said, “Look. We need more of this thing.” He could see it happening. We could get the initial responders to help. That first surge was actually Houston firefighters, EMTs, and paramedics from the fire department, who are essentially dispatched to the building as if they were on a call. And then, okay, you’re here. That’s — now, you’re going to stay here and keep working with [0:21:00] us.
CSo: And it basically expanded from a desk with a couple nurses — because I think this happened when I was finally sleeping, but — to a cordoned off area with cots, so people could, you know, lay there and be monitored or watched. You want to talk about — did we set up the triage that early as well? Or did that come as an add-on?
KS: It came as an add-on.
KS: So the first — I mean, really a lot of what we did — and by we, I can’t take — certainly not just us. We have, you know, several other medical directors. I think you’re going to speak to several of them, including — you know, in addition to Dr. Persse. A lot of what we did was to really just kind of help monitor the flow of resources and of the way things were developing. I mean, at the end of the day, we moved towards almost a very hospital-like set-up of our clinic — whatever you want to call it, with a triage area. And then behind the curtain is the treatment areas [0:22:00]. And there’s a critical care kind of area. There’s some like low acuity kind of area. And it became very — and partially — probably because we’re doctors who work at hospitals, but it kind of became an ER-style. And one of the things we did is transition out of the role of, “I’m the guy sitting here, you know, cleaning your wound or listening to your lungs” to more of that admin and how — okay, what’s the next expansion? Okay, what happens when we find this, right? And that became more of the role in managing people who came in.
CSo: Yeah. Part of that was because medical volunteers starting coming. You know, a lot of people were bringing stuff and donating stuff, but we started getting medical volunteers showing up, saying, “How can I help? I’m a nurse. I’m a doctor. I’m a podiatrist. I’m a whatever.” You know, can I help you with, you know, the medical stuff? And there was some back and forth about, you know, who of what kind can we let work on people or not and coverage concerns and stuff like that. But once that was figured out [0:23:00], it was — yeah, it was essentially the HFD doctors were sort of serving as the ringmaster of all the other healthcare providers in the area.
KS: Yeah, by the end — by Tuesday night into Wednesday, it truly became — the HFD medical director on site, whoever that was, was essentially the overall medical control and chief medical officer of George R. Brown hospital — essentially is the way you can kind of look at it, right? We were — we were really more hands-off the patient care stuff and helping to direct, helping to work, because there was always interactions that — as an EMS doc, we don’t really — we solve problems but things we don’t always necessarily interact with, right? We haven’t run out of — you know, I haven’t had an incident until this that, “Okay, we can’t get our oxygen tanks filled. We’re running out of oxygen. We have patients that need oxygen.” And by the way, where we get our tanks filled is under water [0:24:00] — you know, kind of the problem solving, making phone calls, deal with people who are giving donations, right? Small donations, large — people emptying their medicine cabinets, saying, “Here. I don’t know what you need, but here, you can have this,” to literally pharmaceutical companies and nonprofits bringing truckloads of medications to try and help us out. So it became more of a management kind of role probably that Tuesday when we really started getting a large medical volunteer core that was doing the patient care. And we really stepped back into that manager role on Tuesday, because Monday was still mainly HFD-driven. So we were still kind of in the weeds doing some work.
CSo: And part of the philosophy was — and part of the big thing that we did that was helpful — a lot of times when HFD evaluates a patient, it’s just sort of an assumed, “We’re going to transport you to the hospital.” But one of the philosophies was, you know, if we can treat them and keep them at George R. Brown, let’s just do that [0:25:00]. But for the patients that did need transport, the medical directors, along with usually a captain or a chief within EMS at HFD sort of triaged — this kind of patient is going to go to this hospital or this hospital. Because we had to keep track of hospital capabilities. Were they flooded? Were they not flooded? Were they open? Were they not — in addition to their regular capabilities as to what kind of patients they take. And so, the volunteer doctors don’t know any of that. And this continued on as — when federal resources came, which Kevin knows all about. But yeah, we were sort of the triage officer in a sense to make sure that we didn’t overwhelm — Saint Joe’s was the closest hospital. But we didn’t want to give them every single transport, because then they couldn’t stay open.
KS: And in the first — about 24 hours into it, we had — really had good and consistent ambulance access to two hospitals. HFD transports to 46 different hospitals. We had access to [0:26:00] two of them because of street flooding and hospital flooding and internal disasters and other stuff, because, you know, things were happening all over the city that were making it, “Okay, well, we can’t go here.” So keeping track and kind of ticking off — “Okay, well, oh, they’re open again now. We can get — let’s get some people there. Do we have any ambulances who’ve driven that route? Can we get an ambulance in there?” Right? So that became part of it as well, because I have a patient who’s sick enough to want to send to the hospital. I don’t want to put him in an ambulance and have them go drive around in circles trying to find a way through the water. So there was a good amount of that triage both of who needed to go and who didn’t.
And I think that’s where having the EMS physician kind of level personnel who was that final say on who actually left. And we kept a lot of people there, which probably helped. Because the hospitals had their own influx of patients from several different sources. And so that made — we were trying to do what we could to help and kind of manage that as best we could from system standpoint [0:27:00].
One of the things that we trained our fellows that were training — that we’ve kind of come to look at is — you know, if a doctor at Memorial Hermann or a doctor at Methodist or a doctor at Harris Health — you know, they often times can become — not always, but can become tunnel vision on Memorial Hermann, the system and Harris Health, the system. You know, we look at the entirety of Houston as the system, right? And how are we going to help manage patients within that system and make sure we don’t break part of it. Because if we break this part, this part over here is going to break soon, too, right? So that mentality, I think, probably — I’d like to think helped early on when those hospitals were pretty heavily hit by patient influx.
CSo: And then was it Tuesday when I left?
CSo: Okay, so there — so Tuesday, as I’m working, I suddenly go blind in my left eye. And as it turns out, I had a retinal detachment while I was working the George R. Brown, so I suddenly became [0:28:00] —
KS: He just wanted to go home.
CSo: I suddenly became more interested in my vision saving than working at the George R. Brown, so I skedaddled out of there and made my way to the hospital myself. And then basically, Dr. Schulz and our other HFD docs took over. But it might be good if you want to talk about how Feds got involved.
KS: Yeah, so —
CSo: Because that occurred after I left.
KS: So as — what we’d kind of fallen into — like I said, by Tuesday, we had kind of fallen into this more of the management kind of oversight role, both lending our kind of pre-hospital spin on the provision of medicine to — because a lot of the people who were volunteering, you know, came from all kinds of specialties, all kinds of backgrounds, all kinds of experiences. But you know, the answer — if you were a doctor of any kind almost, except for kind of pre-hospital or emergency medicine, and — the answer to a lot of things they need a chest x-ray or they need — “Oh, well, let’s watch them overnight,” or whatever else. And those all mean hospital, right, in this setting [0:29:00]. And so we were able to say, “Well, what if we look at it this way and kind of deal with that.” So we were able to do a lot of that.
On Tuesday — so on Monday, as we’re ramping this up and we’ve got HFD resources, we kind of had been communicating with Dr. Persse, who was still primarily over at the command center. And he’s been to George R. Brown. I think he’d gone back to the command center to kind of, you know, help liaise with this stuff. And this is going to — A, it’s going to be — it looks like it’s going to be a long-term — this is going to be bigger than we can easily handle with kind of local resources. You know, we talked about the federal assets. We talked about some of these other resources. And he said that they had been talking about it. And so they activated the Disaster Medical Assistance Teams, who came in — and if I remember correctly, they showed up on Tuesday night initially. And so they showed up Tuesday night, kind of got set up, and they kind of commented [0:30:00] to me on Wednesday — so Wednesday morning, they opened for business, but they kind of took some patients and let us keep seeing some to kind of refine their processes and get themselves kind of up and running to full speed, which they commented later — they were like, “Usually, we’re just dropped in here and say, ‘Figure it out.’ And we’ve got to kind of take care of people while we set up. This was great to be able to kind of bring it up.” And by Wednesday night, the DMATs had taken over the patient care aspect of taking care of the people.
CSo: You want to explain who they are.
KS: So yeah — so Disaster Medical Assistance Teams, they’re a FEMA team — a Federal Emergency Management team activatable kind of on a natural disaster — or a disaster. And they’re called up to government service essentially. And they’re from all over the country. I think our first two teams were Minnesota and North Carolina. We ended up with at least portions of six different DMAT teams at the GRB [0:31:00] throughout the course of the time that they were there. And it’s generally a couple of doctors, some nurses, some techs, some medical personnel as well as a pretty robust logistics staff that helps keep them operational.
And they come with some advanced capabilities than what we kind of had initially from the fire department’s standpoint in terms of equipment and things like that. So as they set up, you know, we’re — my first thought, “Oh, good, the Feds are — oh, good, they’re here. Yes. Set your tents up, and we can go home and sleep.” The problem was, similar to those local doctors that were mentioned earlier, they don’t know the hospitals. They don’t know the — you know, who’s available, who’s open. And at the same time, they have their designated — their kind of design is to take care of that minor stuff. And then the rest of it, a lot of times had a very similar trajectory of, “Well, we stabilized it. Now, let’s get it to a hospital.” And so what we kind of [0:32:00] pretty rapidly realized is that we still needed to maintain that medical oversight role for the shelter in general, including kind of with these DMAT teams.
The other thing is that they weren’t going to leave really. They weren’t going on from their tents, so if something happened — by this point, we had, you know, thousands and thousands of people — well over — it ended up being well over double what the initial rating on the shelter was in the building. And we all five of the main halls of George R. Brown plus some office space and stuff upstairs. And so we’d get a call through the Red Cross network of, “Hey, there’s someone down in Hall A.” Well, the DMAT doctor wasn’t going to run over there. So we had to kind of coordinate, you know, having someone available who could go and get the patient on a stretcher, bring them back.
At this point, we also had federal FEMA ambulance strike teams, so groups of ambulances that were pretty much — the crews were flown in from all over the country to come down [0:33:00] and essentially be the ambulances so that the Houston Fire Department ambulances could go back to taking care of the 911 calls. So there are people who don’t know where the hospitals are, don’t know the capabilities of the hospital, and the DMAT guys — you know, not to say they couldn’t coordinate with the ambulance strike team guys, it just — somebody with kind of that over our chain — you know, EMS management kind of role had to fill that kind of gap. And so what we decided is even though we were kind of demobilizing the volunteer setting set-up that we had put together, we decided that the HFD medical director staff would need to kind of maintain that overarching control throughout the — pretty much as long as we were running medical operations in the shelter, which has really turned into a longer-term incident on our end.
Meanwhile, the city’s starting to ramp back up. Things are starting to open up. Floodwaters are starting to recede some places. We’re getting back to semi-normalish [0:34:00] out in the city. So we’re trying to kind of manage that. Now, at this point, it’s kind of — to note, so we have — at the time, we had eight medical directors total, but two of them were flooded in. One was in Las Vegas at a review course, and Chris was going to get operated on for his eye. So it became difficult. You know, we ended up staffing this 24/7. And then they all kind of got back into play when they could. And everybody pitched in. Everybody did a great job, but really what turned into — in terms of our roles — so Dr. Persse at this point was primarily based out of the shelter as opposed to based out of the command center. He could still — he called into briefings and what not, but he was there.
Because so were 10,000 Houstonians. And so we pretty much — he and I pretty much turned into a — he was the day shift. I was [0:35:00] the night shift. And we had a couple hours of overlap on each end. And so we — even when our other docs came back in, we kind of pulled them in. But we kind of maintained a continuity of somebody who’d been here from pretty much the beginning, knows what’s going on, kind of maintaining those roles. And we had other docs plug in. That was spectacular, and they did a great — they were hugely helpful, because when you are the only doc in the building, it was — from the Houston Fire Department standpoint, it was daunting and kind of overwhelming. There was a lot going on.
So we became that role, and one of the big things I remember doing was — probably Wednesday night was the first night that the DMATs were fully operational. And we — and taking all the patients. By Thursday morning, we stopped and said, “Okay, we need to come up with some protocols on how we all work together here,” because they were running their way. And the strike teams were running their way. And the HFD units that were around were running their way. And HPD kind of had their own kind of protocol and how they were going to do things [0:36:00], you know, in terms of the security side and medical patients they encountered.
So I spent Thursday night, when I came back for the night shift, pretty much creating — it was like a five-page document that was just, “These are the protocols we’re going to use to work with each other.” Right? Sent them to Dr. Persse — said, “What do you think, boss?” He signed off on it, and the DMAT guys signed off on it. And we’re like, “Okay, this is great.” So really just trying to help put out fires and figure out ways we could all work together to make this run smoothly is really what all of us did after those first couple of days of running around maybe a little like chickens with the heads cut off — long answer to your simple question.
CSh: That’s okay. During Harvey, did you respond to serious injuries? And if so, could you please describe them?
KS: So we had —
CSo: Injuries or illnesses?
KS: More illnesses than injuries, yeah. So we had some injuries come in. We had a broken arm that I recall [0:37:00]. We had — we had one head injury from somebody who fell in the shelter that I recall. The bigger deal was largely the illnesses. So one of the things that was a little bit unique about Harvey compare to most of what we do with EMS and even the in mass gathering world of EMS, right? We just did the Super Bowl — I’m sorry, the World Series. We — just recently, we did the World Series. We’ve done a bunch of mass gatherings — is the thing that we ran into most were chronic illnesses. Usually when you’re dealing with EMS, you’re dealing with acute injuries, acute illnesses, right? Things — people having a heart attack, people having a stroke, people having, you know, acute trauma or injuries. This — the problem we ran into was — really came in at like Day Two, Three, Four. And they were the chronic illnesses. They were the people who left home without their medications, right — or left home with a small supply and didn’t have enough [0:38:00]. And it was people who needed dialysis, right? They’re on a schedule where they need dialysis every two days. And it’s been three days. And people like that are literally dependent on that treatment to live. People who didn’t have their home oxygen. They came with a small portable cylinder that would last them a couple hours. And now, it’s running out. Those were the kind of things that we really ran into.
And several of them were — and dialysis was probably the biggest immediate kind of life-threat problem we ran into. And if I remember — if I recall correctly, we ended up with actively managing 62 dialysis patients out of the shelter by the time we were at our full capacity. And that was a series of people and organizations coming together to help with dialysis centers that weren’t flooded that were saying, “We’re open. Send us people. We’ll get them — you know, I don’t care if they’re our people. Just send us people. We’ll get them dialyzed. We’ll get them taken care of.” The Houston Health Department [0:39:00] members from their staff stepped up and really kind of managed the — “Okay, I know you’re normally, you know, Monday, Wednesday, Friday dialysis. You’re on the Tuesday, Thursday, Saturday schedule now, right? And come check in tomorrow, and we’ll get you off to dialysis.” METROLift provided transportation. I mean, everyone came together to fix that one problem that would have been catastrophic if we hadn’t found a way to take care of those people.
Another big problem we ran into a lot was behavioral health emergencies. There were a good number of patients with behavioral health problems in the — within the shelter. And add to that the trauma of what was going on and potentially being off their meds and not having their medications. And those were some things that had very serious potential consequences, both for the patient and, theoretically, for others around them. And we had some amazing help from — the Houston Police Department has their behavioral [0:40:00] response team members who were largely involved in it — as well as Baylor College of Medicine had several of their behavioral health professionals who came down and helped kind of create almost a separate behavioral health ER station area — kind of separate but connected to our area to kind of funnel those patients to deal with that there.
The other big thing that we had was a lot of just people out of their meds, right? I think — in one 24-hour period, I think about two or three days in, I think, we had something like 40 seizures, because those people were right at that point where their seizure meds wore off. And they don’t have any more. And so medication refills became a big problem. And we were lucky to have multiple large corporations trying to get involved to help and having the pharmacy truck that did eventually get there that was able to essentially — but really, all the major pharmacies were — had a [0:41:00] — by a couple of days in, had a footprint in the shelter, where you could walk in and say, “I’m a Kroger patient,” or, “I’m a CVS patient. I don’t have my ID. I don’t have my — here’s my name. Here’s my birthday. Here’s my Social Security number.” They’d look you up in the computer. They’d say, “Absolutely no problem.” And if it wasn’t — if it wasn’t something they had on site, they’d send a runner. They’d be back — you know, “Come back at 1 o’clock. It’ll be here.” And they’d give you a 30-day supply. It was — I mean, those kind of things really were the things that addressed the serious — a lot of these chronic conditions can become extremely serious if left untreated, right? And it’s not something we tend to see in — even in the EMS pre-hospital world, right? People — we see, “Oh, they fell yesterday and couldn’t get up, so they haven’t had their medicine in a day,” not in a week. So that stuff became a very big part of what we dealt with. So it was more serious than chronic illnesses and injuries [0:42:00]. But we did have — anytime you put 10,000 people in one place, I mean, that’s a small — that’s a small — that’s a town, right? And you get injuries. You get people falling and getting hurt and those kinds of things, too.
CSo: Early on, when there wasn’t a big police presence, we had people using drugs. And so there was the occasional unconscious person or seizure reported to us. And that was pretty dramatic in the first couple days. And then police department beefed up their patrolling around, because they would go outside. They would get their drugs somehow, smoke it, seize or just fall over. People would see that, freak out, and call 911. So that was very dramatic in the first couple days. But that mostly resolved once police started patrolling.
KS: It was brought up — so they had large — they had command briefings of all the involved agencies twice a day. And once it became a problem on the medical side and it was brought up — Dr. Persse and I generally brought them up in the command briefings [0:43:00]. They pretty quickly ramped up their presence and took care of that problem. It didn’t last very long once they got on it.
CSh: You already mentioned medications brought by pharmacies, but were there any other immediate resources or facilities that were available to you to work with in GRB?
CSo: Well, provided by GRB? Cots and food. Towels by Hilton. Non-medical — you know, sort of non-medical stuff, blankets. The medical stuff, there was oxygen.
KS: Well, from the GRB, we kind of made stuff up as we went along, right? GRB had tables. Tables were great. We needed tables. We needed chairs, right? Those were awesome. One thing that we didn’t realize we needed until we needed them were those kind of big, hanging draped curtains. And we essentially — by the end — by the end of it, we had essentially built walls all the way around our little area to — for patient [0:44:00] privacy and to — also, the kind of metal barricades like you would find at a — you know, at a parade or whatever else.”
CSo: Where you line up for something.
KS: We lined them up. We used quite a few of those both to kind of cordon off our area and create, essentially, kind of a cue to get into triage and that kind of piece. So there were — there were several things that they, you know, kind of came up with. And they were great about, “Hey, I need this,” and they’d be like, “Huh?” I said, “What about that?” “Oh, that we can do.” Right? Garbage cans, power, power strips, right? There’s plugs around the building, but getting power to where you need the power — there was a lot of good — a lot of good stuff that they were able to help with. And if they weren’t, their facilities guys were great about talking to the Hilton and talking to some other — I don’t know where they got some of the stuff they come up with. I’ll be perfectly honest.
CSo: And the other good stuff — the good thing about the GRB is they can drive a semi-truck in it, right”? So they have big garage doors. And they can drive in, so like, you know, the pharmacy [0:45:00] trucks and then the DMAT stuff. You know, these are like semis that drive in, park. That’s where that service is, so at a church, that would have all had to stay outside or — you know, at a school or something, it would be a little more logistically challenging.
KS: And then, you know, the next phase of stuff was the medical stuff. And the initial medical stuff was largely the HFD, because that’s where, two o’clock in the afternoon or two o’clock in the morning, I can say, “I need more oxygen tanks. Somebody go over to the closest station and get more oxygen tanks,” right? That became the initial role, but the community came together and did so much that they kind of brought to light that one of the things — people who showed up initially and said, “I want to help.” We had a couple of pharmacists. And my first thought is, “What? Okay. We’ll find something for you to do.” Next thing you know, we had a table, probably this long, full of pharmaceuticals that people had donated. They — literally, people just emptied their medicine cabinets and brought drugs. And half of them, I’m like, “I don’t even know [0:46:00] what I’m going to do with this, but okay.” We gave them all to the pharmacists. I said, “Catalog them. Figure them out. And we’ll send people to you if they need X, Y, or Z,” right? And that was our first batch of medications to take care of people until the pharmacies were able to mobilize and get involved. The UT School of Dentistry has a mobile van where they do dental check-ups and minor procedures. By the — kind of the end of the second week, they were pulling up outside. They were doing stuff there. Somebody — I don’t remember what group it was, but they were making glasses, right, for people who needed — doing eye exams and making glasses for people who needed glasses right there on the spot. You know, these came a little bit later, but you know, I would never have thought to call somebody and say, “Hey, we need someone here to make glasses for all those people, like me, who, you know, might have left my glasses on the bedside table when I evacuated out of my house.”
One of the other big components that we ran into that was interesting from a medical standpoint to a degree was [0:47:00] pets. So we had a lot of people show up with pets, and initially, the first night, they had to stay outside. That was the rule. There was no provision to bring people in.
CSo: Yeah, there was a lot of drama about that. I don’t know if you’ve talked to any of the pet community or this would cover in your area, but yeah, that first night, the police were not letting — so people would come in eventually and sort of be searched by the police before they were allowed in the shelter. And if someone came in with a pet, they said, “Basically, this is a city building. You’re not allowed in.” So we were putting these people in the position of abandoning their pets to stay out of the rain or stay out in the rain with their pets around. And so some people were doing both. They’d tie — you know, I went outside. There’s dogs tied up on the poles and stuff outside.
KS: So they came in, and luckily, BARC was able to set up — we ended up turning one of the — one of the five kind of main halls of the [0:48:00] — of the GRB to essentially a pet-friendly area. And they came in with pet food — the whole nine yards.
CSo: It really wasn’t BARC yet.
KS: Well, it wasn’t BARC yet initially. Initially, it was just like everything else. It was donations and —
CSo: It was — there’s a — if this is something you’re interested in, I can refer you to the right people. But I’m on the — totally unrelated but related to this topic — I’m on the city’s animal advisory committee, run through BARC. And we have a committee that meets, and it’s really made up of rescue organizations, veterinarians, and then me for some unclear reason. And I’m the secretary, so it has to be a city employee. So I put out an email to that committee saying, “We need help.” First, we convinced the police that if we kept the pets with their owners in a separate spot, they could tolerate that. And then we put out a plea. And a lady named Salice with — Friends for Life is her rescue organization — was available and like ran with it. And [0:49:00] so starting that night, they started — and they — they basically did on the veterinarian side what we did on the medical side. They had a full vet clinic. They had food — pet food donations, pet crates, and so Hall E, right?
CSo: Hall E on the far end —
KS: A. We were in E.
CSo: We were in E, okay. Hall A in the far end — the far end from the medical side was the pet place, so if you came in, you were separated — if you were a family, there was a hall for you. If you were a single man, there was a hall for you. I think the single women went in the family. And then if you had a pet, you went the pet area. And that was a huge, incredible undertaking in and of itself. And according to — you know, I’ve dealt with some of that after the fact. Sheltering with — cohabitation shelters with pets has never really been done before to that extent. And they got a lot of publicity in their world [0:50:00] — even wrote a book about it. And it was a big deal for them.
KS: But one of the reasons I bring it up within this setting is we had a couple of people who needed to go to the hospital and had their dog. And they were the only — you know, and there’s rules. There’s rules about that — putting the dog in the ambulance — not a service animal, just their pet dog. Put the dog in the ambulance. The ambulance is going to a hospital — taking the dog to the hospital. And so we had a couple of — you know, we had — we had a gentleman having a heart attack who didn’t want to leave his dog. And he wasn’t going to go until we found — actually, one of the people working in the animal control — animal area, they were — said, “Look, here’s my cell phone number. Here’s my everything. I will take care of it. I will not leave this shelter until you’re back. You know, we’ve got two people who are going to deal with this.” And people were just trying to step up and help with that, but it became a — it became actually a little bit of a medical complication [0:51:00] to deal with some of these — some of these situations. We didn’t —
CSo: It was the same thing in the field actually. I heard stories from the people rescuing in boats that people would refuse to leave their house if they couldn’t bring their pet with them. And so we had to make it — you know, we spread word that pets are welcome at the shelter. So that wasn’t an impediment to people, you know, evacuating.
KS: We had — we had — we had lots of interesting — kind of figure out how to fix it kind of solutions. And the pets were a big part of it. I remember I had a family of a mom — a mom with six or seven kids. And the kid needed to go to the hospital. Kid had an asthma exacerbation — one of the youngest kids. And we needed to get this kid — and the kid needed to go to the hospital, and so we go to load the kid up. But mom’s like, “Well, I’ve got to go with my kid, but I’ve got five more under the age of, you know, 10.” I think — I think the oldest was 13 or something like that. And so me and another volunteer actually called two Ubers and put the other five kids in Ubers and sent them to the [0:52:00] hospital to meet mom. Mom went in the ambulance. But we’re just trying to come up with ways to figure out how to do stuff. And it just became a problem-solving thing. [Unclear, 0:52:10] putting out fires — not because I’m in the fire department, but it just became a lot of that. Like, okay, this is — here’s a problem. They would look for the HFD doctor and be like, “Here’s the problem we have,” and expect an instant solution. So we just started coming up with them, because I had to — I can’t say they were all perfect, but they worked. We all got through, so.
CSh: What would you say was rewarding about working at a shelter like GRB? Did anything surprise you about the impacts you made on patients there?
CSo: Well, I mean, you know — I mean, part of the — we go — we got into EMS to take care of, you know, all patients, not — we don’t care about their insurance or who they are or where [0:53:00] they are or anything. So, I mean, this is really just an extension of that in my mind. And you know, these are people having a horrible day — maybe the worst day of their life, depending, right? And so, you know, part of your responsibility is to be there and let them know you’re there, you know, for them in any issues they have. You know, there were Red Cross volunteers to help with this kind of stuff. There’s all sorts of volunteers, but we’re the — on the medical side to make sure that if they have any medical concerns or issues that we’re there. So I don’t really have any particular individual story but just the provision — you know, we all work for the city to provide care for the citizens, right? And so these were all, you know, people we consider citizens who deserve the same level of care. And so we didn’t really care who came in. Once you were here, we were going to help take care of you, so.
KS: I mean, it was — there was — the biggest thing — one of the biggest things to me that impacted me [0:54:00] was the — you know, I mean, the people who came in generally were super appreciative, right? I didn’t know — you know, somebody who just lost their home or just lost everything — you know, I didn’t know how they were going to react, right, especially when you start imposing rules, right? “Well, you can’t sleep here. This is the families, right? And you go in the single male,” — you know, it just — and they were super appreciative. They were — you know, people really weren’t — like I thought the place was going to be glum and just gloomy, right? I really did. I thought it was going to be just like everyone’s depressed. It really — people had pretty high spirits.
And I think part of it was the volunteers, right? The Red Cross volunteers, the medical volunteers, people who just showed up to help — you know, there were two medical volunteers that I have to — you know, and they got actually quite a bit of press after the fact, but Megan [Jennifer, 0:54:57] McQuade and Regina Troxell, who both [0:55:00] did — they did a lot of the recruiting for our getting our initial providers there. They also did a lot of work with some large organizations, getting us supplies we needed. One big one was insulin for diabetic patients. Getting our hands on some insulin, they were instrumental in that. And they’ve kind of — they were spectacular, but I mean, people showing up — just regular Houstonians showing up to do what they could do to help, right?
And there was a lot of official stuff. I mean, the mayor came down. Congresswoman Sheila Jackson Lee came. The Rockets came at one point. I mean, there was that kind of stuff, but I was — I was — I came in one night, and there’s a guy out in the main foyer giving haircuts. He had set up a folding chair and put up a sign that said, “Free haircuts,” and he was sitting there. And he had a line down the hall, right? And walking through about 2 o’clock in the morning, and I look over. And there’s this guy who had brought a — you know, one of those kind of speakers with a microphone that you plug in. And there were like 15 or 20 people having a little karaoke [0:56:00] party at 2 o’clock in the morning. Like that kind of thing was just really cool, right? To see all these people coming together and doing what they could. Whatever it was, it didn’t have to be something, you know, like, you know, “We’re going to medically take care of all these people,” right? It was just, “Do something. Do anything,” right?
And then city employees who were involved — I mean, the guy who was pretty much driving — you know, running the shelter for a good chunk of it was the Director of, I guess, Housing and Urban Development, right? Which is, I guess, kind of in his wheelhouse but not really. He’s never run a 10,000-person shelter before — just people coming together and figuring it out and working together. And rather than — you know, sometimes when you get into — especially into government and bureaucracy, there’s a lot of bureaucracy, right? “And we need to do X. We need to find a solution to X.” And there’s always, “Well, we have to go through this process and that channel.” And I think one of the cool things for me was largely a, “Got to find a solution for X.” “Okay, let’s find a solution [0:57:00],” right? It was very much a collaborative atmosphere to try and say, “Okay, we’re all here. Every person here on the medical side, on the Red Cross side, on the City of Houston side, and on just people showing up, are here to take care of these 10,000-plus people who are, you know, having the worst day, potentially, of their life.” I think that part to me was really rewarding — really cool to kind of see how it all came together and to note that atmosphere wasn’t dark and gloomy and miserable, which is kind of where I expected it to be, right — kind of what I was prepared for or tried to be prepared for.
It was hard. Don’t get me wrong. It was — it was hard to walk through those halls and see these people who had literally lost everything. And you know, you’d go home, and my — you know, personally, my house, we had a little roof leak. That was about it, right? And my wife was safe, and we had power. And we had water. We were fine, and I could go home in [0:58:00] those hours I had off during the day and actually sleep in my own bed. And that was kind of — I almost wanted to get back and get back to help and get back to work.
CSh: If you don’t mind sharing, was there anything unpleasant or any experiences that shocked you more than expected?
CSo: I went blind, so that was unpleasant and shocking. But that had nothing to do with the actual work I don’t think — just bad luck. I don’t — I mean, I was only there like three days, so I don’t really have any unpleasant experiences. I — you know, I share with him — just once people heard and started volunteering, whether that’s businesses volunteering and bringing food, the hotels volunteering and bringing towels —
KS: We had — we were out of —
CSo: We were overwhelmed with donations. Like we had mountains of donations [0:59:00].
KS: Yeah, we were at our wit’s end for oxygen. We were running out in the fire department. We were running out everywhere. And it was — yeah, whether you believe in fate or whatever else, some guy comes up, and I see him talking to another medical director. And they point at me. And this guy walks over, “Hi, I do –” You know, I feel terrible. I don’t remember the name of the company. He goes, “I work for — I’m the so and so.” It’s some small company. “And we do durable medical equipment. What do you guys need?” I said, “Can you fill oxygen tanks?” He goes, “Of course, we can.” And I said, “Great, how many can you fit in your car?” And he loaded up the car full of oxygen tanks and took them and got them filled up and brought them back. And the next thing you know, we have oxygen.
It was — you know, the hard part — the difficult part — you know, to your question, yeah. I had a couple — there were a couple of days when I got home. It was really kind of heavy, right? And it was just about seeing that volume of, you know, suffering. And people weren’t — and kind of going, “Wow, these people are super strong, because they’re really — they’re really impressive. Because they’re not, you know, all depressed and [1:00:00] moping around. But knowing that the people in that shelter were there with the clothes on their back and having, you know, the tables of donated diapers and donated shoes, and donated, you know, clothing, which when you looked at them on side, it’s like, “Hey, look at all this great stuff that people are willing to donate to help.” And the other side, it’s like, okay, putting yourself in that situation of like, “If people didn’t donate a pair of shoes my size, do I have shoes to wear?” Right? That became very heavy, especially as, you know, the weeks wore on. It became — so that was a lot. So that was probably the most — kind of the most unpleasant part of it as the time went on.
CSh: Are there any insights you gained from your experiences at GRB that you would use in the care of a future disaster?
KS: I could write a book.
CSo: Yeah, the obvious answer is yes.
KS: Yeah, I think [1:01:00] — I mean, on the — on the medical side, I mean, there’s plenty of medical, logistical stuff that’s not really pertinent — how to get oxygen, how to do dialysis, how to all these things. You know, that stuff certainly — you know, stuff we hadn’t planned for — you know, now — next time, we’ll have a plan for it, and we probably won’t need it. We’ll need something else, right? But I think probably the biggest insight I gained was just in, you know, stopping and taking account of what resources were available, right? Because we tend to think and operate within a certain realm of resources, right? I know what the fire department has. I know what they carry on a ladder truck. I know what they — I know what I can get through my normal channels, right?
I don’t know where to get, you know, pipe and drape — you know, hanging draping walls, right? Now, I’m thinking like that. If you don’t have something and you think you need something, rather than go, “Well, shoot, we don’t have any of that in the fire department,” you know, just [1:02:00] ask people, right? You’ll be amazed at what people will come up with. You know, and those — I think that was a big kind of insight to take away from — is you can’t — worse thing that happens is you ask and everyone looks are you like, “Nope, don’t got any of that.” I think that was one big piece of it — probably the biggest, new kind of global-type insight that I had. I mean, certainly — like I said, there’s a whole lot of things that I’m going to have a plan for next time. And those plans probably won’t work next time, because something else will come up that we can’t do it that way, but.
CSo: Yeah, I was just — you know, it’s — the same thing happened with Katrina. You don’t realize the amount of capability that exists within this city when — you know, when the city’s presented with a problem and the amount of support that just sort of seemingly comes from nowhere, you know. It may be on the news, “Hey, we need X, Y, or Z,” but — and then you’re just overwhelmed with how much help you get [1:03:00]. So I think — you know, unfortunately, it takes those kind of things to like get the city to work together to solve a big, you know, challenge. But that’s always, you know, sort of inspirational to see.
KS: The other big insight that came – and it’s kind of along those lines – is that, you know, when you study this stuff, right — when you’re a student of disaster management and disaster planning and emergency management stuff, a lot of emphasis is put on the DMATs, the federal teams, the federal resources, the state resources, the — you know, all the mutual — even mutual aid from your surrounding communities. But one of the insights I got is, “That’s all fine and good. That’s great, you know, to think about what’s out there. And I’ll see it in three days,” right? And I’ve got to get from here to Tuesday, right, before I’m going to see — and I’m not knocking it at all, right?
I mean, they had to fly the team in from North [1:04:00] Carolina and from Minnesota. They had to fly them into Dallas, because they couldn’t get into Houston — had to get them on a bunch of busses and then find a route that wasn’t flooded to get there, right? And you know, with police escorts at the whole nine yards, like they did, you know, feats that you wouldn’t imagine to get there to help. But it’s seeing that — you know what? We can stand up, and we can do this from nothing, you know, within our own community — Houston — the whole Houston Strong thing, right? Houston can come together, and we can — we can manage this thing. And we’re going to need help.
You know, one of the biggest reasons we needed help from the DMATs was that our medical volunteers had to start going back to work, because the hospitals were opening up. The clinics were opening back up. They had to go back to work. They couldn’t come volunteer at the shelter, because they had to go to work. So that’s where we really needed those federal volunteers.
And then the other thing is that anything can be a landing zone, because we were landing Black Hawks on 59 behind the — behind the shelter. They told me one day, “Hey, Doc, they need [1:05:00] you to go check out a patient up behind the shelter.” I’m like, “Okay, where do you want me to go?” “Here, get in this patrol car.” “Okay,” get in the cop car. They drive me up onto 59 — because 59, you know, it dips on both sides. It was flooded on both sides. I pull up, and there’s three Black Hawk helicopters — military helicopters parked on the freeway. And they had pulled one guy out. And they’re like, “Here, does he need to go to the hospital? Or can he come into the shelter?” I’m like, “Okay.” And he needed to go to the hospital — put him back on the Black Hawk and flew him to Hermann. So it was just — you know, things like that are just — everyone’s got stories like that crazy stuff, but.
CSh: Have there been any occasions where you get to visit with former patients you had served?
CSo: I haven’t had any.
KS: I haven’t had any from the patient standpoint. I did make some really interesting friends — people that I probably never would have met. They were less patients and more people who helped. Like I [1:06:00] mentioned, Jennifer McQuade and Regina, Chris Newport, who used to be in city government and now is doing some private stuff. He’s kind of, you know, somebody who I probably never would have met. And you know, he was one of the managers of the shelter later on. And then several of the DMAT personnel I’ve become pretty close friends with. I stay in touch with several of the doctors and nurses from all over the country from the DMATs that we kind of worked with. So those are some people, but I haven’t had the chance really to visit with patients.
But our patients were really — you know, it really was more of an — it was like an ER, right? So our patients would come in and get the treatment they needed, and then we’d try and get them back out into the population to make room for more. Because at the time we were at our highest, based on kind of average volume, we were the busiest ER in the city of Houston. You can look at it that way. When that — that Wednesday, Thursday — Tuesday, Wednesday, Thursday, the busiest ER in the city of Houston was behind a bunch of pipe and drape at George R. Brown [1:07:00]. And that was a — you know, that was kind of a cool experience to be part of. I’m okay not doing it again. But you know, that was — so the people we — that we kind of build that experience with, we became — several of us kind of became pretty close.
CSh: What advice about safety would you give to people in the face of a natural disaster based on your first responder and care provider perspectives?
CSo: In a flooding event?
CSo: Or — well, you know, I mean, the basic stuff. You don’t know how big the flood event is going to be, so if you can safely leave, leave before you’re unable to leave, you know. I don’t — you know, you want to get to where you’re dry.
KS: One of the big one specific to this kind of thing and to our experience is if you have — if there’s a [1:08:00] concern for a flooding event, for a hurricane, for any natural disaster that you have any kind of preparatory time for is make sure that you have your — anything you need for personal medical, right — at least a couple of days’ worth, right? Medicines —
CSo: Like a go bag of —
KS: Kind of — yeah, if you know there’s a storm coming, right, packing a backpack full of clothes that’s going to get soaked in the rain is probably not a terrible idea, but more importantly is to make sure you got your pill bottles. And make sure that you go to the pharmacy a couple days ahead, and make sure you have full pill bottles if you can, right — if you need refills. That, I think, would be one big piece from a medical health and safety standpoint. And then certainly take the advice of — you know, one — take the advice of the authorities, the news, whatever it may be, right? People put out all kinds of interesting, you know, and useful information about, you know, tricks and tips and things to do, right? If you’re worried about [1:09:00] losing power, fill your bathtub with water. You know. All the kind of things that you can do, they’re — they make sense, right? A lot of them make sense. You know, but some people kind of a little overboard on — some people just — “Oh, that’s fine. I’ll figure it out if it happens.” And I think that — you know, kind of listen to some of that stuff, because it’s not completely made up. Like there’s somebody behind — there’s probably somebody like one of us behind a lot of those — that advice, you know. We’re just not the guy on the news talking about it.
CSo: One place that — you know, that it was a challenge was assisted living and nursing homes, especially with non-mobile patients. And so, you know, I guess my advice would be, if you’re a family member of someone in those facilities, you should probably make sure they, you know, know their plan for natural disasters, because the sad part is — you know, if there’s a national — a natural disaster, you may not be able to get there, right? And so at least you want to know what their plan [1:10:00] is, so you can either know it and be comfortable with it or bring up the idea that they have actually not a plan yet. And you know — because a lot of those patients that require round the clock care — and this was a problem. Even with hurricanes, it’s an issue. A lot — a lot are on machinery that requires electricity. And the electricity goes out for three days, four days, what’s the plan? What’s the back-up? And so it’s not so much looking out for yourself in these cases but for your loved ones that might be in those facilities — to make sure that there’s a plan for them.
KS: Yeah, we had to build, essentially, a small nursing home in the shelter for people who needed care. And that was something that, you know, people — and several of them didn’t have family members around to kind of help with that piece.
CSh: Those are all my questions. Is there any other information that you’d like to share?
CSo: Pretty much covered it [1:11:00].
KS: I think so, yeah. It’s — it was — it was certainly — it was certainly an event we’re going to remember. I think we learned a lot from it. I think we got some interesting insights to some things, like you’d asked. And as you can tell, there’s lot of — there’s lots of stories. There’s lots of interesting experiences, but you know.
CSh: Well, thank you for your time.
CSo: Okay, thanks a bunch.
KS: Thank you.
DH: Thank you.
A. Not a problem.
DH: I have a question.
DH: Did you all put showers and sinks and whatnot in the GRB like they did during Katrina?
KS: Yep, they had the big trailers — big shower trailers. They’re tractor-trailers with multiple showers in —
DH: Oh, I didn’t even know.
KS: And they actually rolled them right into Hall A up against — essentially right up by Rusk on that end of the building. And they had them all lined up in there. And they had male and female segregated.
DH: Is that something new that they’ve developed?
KS: I don’t know where they [1:12:00] — I have no idea where they came from but yeah.
DH: I’ve — I lived in Memphis when Katrina hit. And I came to U of H not long after that. And one of my co-workers was the person who did all the interviews with people post-Katrina. That’s how I got to know Deanna [1:12:24] and Dr. Persse and when we were working on that magazine. And I got the impression that, for Katrina, they actually constructed those inside the GRB and, I guess, maybe inside Astro Hall as well.
CSo: Astrodome. The Astro Hall was turned into like — was medical. Astrodome was shelter. Anyone that needed sick care was moved to the Astro Hall.
DH: Well, I remember —
CSo: That was all run by the county.
DH: I remember one of the pictures we had was this row of sinks that they had created, and there were nurses [1:13:00] in the picture washing their hands. And they had fixed it so they could turn them off and on with their knee.
DH: Didn’t have to touch the handles. And I got the impression that they had constructed all that, so that’s why I’m asking if the whole truck thing is a new phenomenon.
KS: I mean —
CSo: Yeah, I don’t — I don’t remember the truck being there. There was one truck we had at — during Katrina. It was a radiologic truck. So we were able to do x-rays at the George R. Brown.
KS: Yeah, we didn’t get x-rays.
CSo: The stuff just showed up. It was like —
KS: We got — the one thing we did get that was very helpful is we got — I got a — I actually wrote an email to Philips and got an ultrasound machine that like — one of their like local reps who had it to show and, you know, try to get you to buy it kind of thing, he came by. He dropped off an ultrasound machine and 10 AEDs and said, you know, “I need the ultrasound machine back. The AEDs you can have. You know, give them to shelters — whatever you need to do with them [1:14:00].” But we ended up — actually, we ended up with two ultrasound machines at one point. And we actually were able to make a bunch of clinical decisions and not send people to the hospital based on an ultrasound, which was really helpful. But you know, at the time, I never would have though, “Gee, where’s — I need an ultrasound machine.” I just — I kind of said, “I need an ultrasound machine out here.” And somebody goes, “Well, I know the guy at Philips.” I’m like, “Oh, okay. That’s another great idea. Let’s call him,” you know.
KS: But yes, they did set up showers and what not, so that was — that was available. My wife came and volunteered one night. I think she just wanted to see me.
DH: Well, hey.
CSo: See you awake.
KS: See me awake, yes. I’d go home at like 10:00, sleep for four hours, get up, and be back by like 3:00, 4:00. But she came. I was like, “Come on down.” And she’s a pediatrician. She was — came down and volunteered for the evening, so it was good, but.
DH: That’s nice. Well, thank you all [1:15:00]. I appreciate it.
KS: Of course. Thank you.
CSo: Not a problem.
KS: Thank you.
CSo: Y’all have a good afternoon.
DH: I’m glad your eye… [1:15:03]