Lars Thestrup has lived in Houston, Texas for ten years, originally coming from Fairfax, Virginia. Thestrup has been involved with EMT since he was eighteen-years-old and is now the assistant medical director of the Houston Fire Department. Prior to living in Houston, Thestrup had one experience with a flashflood in Baltimore, equipping him with an understanding of the command structure and how to make an effective plan when dealing with bare minimum resources.
During Hurricane Harvey, Thestrup worked a medical area at the George R. Brown Shelter as a shelter-in place location for those who needed medical help. Thestrup recounts how operations ran at GRB, with private companies donating medical supplies and medications, and the use of many refrigerators to hold different medications for patients. Thestrup mentioned that the volunteer rate was so high, he had to turn away many individuals since they were taking up space. Thestrup mentions the different cases he saw at GRB, some with lice, others with eclampsia, psychiatric cases, dialysis – he stated that the shelter ran like a typical ER. Thestrup’s main priority at GRB made the realization of all the outside flooding difficult to see, although his property remained undamaged. One of the key pieces of advice Thestrup offered for those experiencing similar future storms is to evacuate when the news and authorities say it is time to. A few minutes of the interview are spent on Thestrup recounting a SWAT experience with a nursing home in the Kingwood area during the flooding, as well as his experience with FEMA providing support for the geriatric population in the GRB. When discussing how the efficacy of GRB was established, Thestrup acknowledged the importance of an authority ladder. Decisions had to go through certain people in order to not crowd other volunteers. Thestrup finishes his interview recounting a story of a retina exam taking place in GRB, and discussing potential shelters for future storms.
Interviewee: Lars Thestrup
Interview Date: November 22, 2019
Interview Location: Houston Fire Department
Interviewer: Christina Shibu, Debbie Harwell
INTERVIEWER: My name is Christina Shibu. Today is November 22, 2019. We will be interviewing Dr. Thestrup. And we are at Houston Fire Department.
CS: So for the personal information section, please state your full name.
LT: Lars Thestrup.
CS: Please tell us when and where you were born and a little bit about your life growing up.
LT: Fairfax, Virginia. And it was pretty much a normal, suburban life for me — nothing exemplary, except I used to live my summers in Denmark, but that was about it.
CS: How long have you lived in Houston?
LT: 10 years.
CS: What inspired your interest in medicine?
LT: I always wanted to save a life — very simple.
CS: Did you always want to be involved with the fire department or emergency medical services [0:01:00]?
LT: It started off in college. I became an EMT, because I thought it was going to look good for med school. And then I fell in love with it and just — I haven’t been out of it since I was 18 years old.
CS: When did you begin working with HFD and EMS? And what is your current role?
LT: 2009 when I moved here. And I’m the Assistant Medical Director.
CS: Can you tell us about your training specifically as it relates to preparation for mass casualty events and evacuation?
LT: As in training? Well, I mean, I think a lot of my training actually came from fellowship. We had some events that occur. I do large-scale events in residency in Baltimore. And then when I went off to fellowship, I actually had to staff a mobile hospital at a city where their hospital just — a flashflood just took out the whole hospital, and the entire infrastructure was in the basement. So I had to run that for about a month. And then [0:02:00] basically all the typical ICS classes — and then a lot of it was just from experience in seeing things happen here.
CS: So now we’re going to move onto our interview questions. Did you have any previous experiences in natural disaster responses?
LT: Yes, in that one episode, yeah.
CS: And how did those experiences prepare you for this event?
LT: I think it helped with understanding the command structure and how things should flow and also in how to set — I don’t know how to put that — how to actually make an efficient treatment area when you are dealing with the absolute bare minimum.
CS: So I understand that you were involved in administering care in the George R. Brown shelter. And when we spoke with Dr. Persse, he indicated that the City’s plan was not to use GRB as a shelter again [0:03:00]. So how did that change impact your planning and provision of care?
LT: So I ran the day shift of GRB. And we used — so the GRB wasn’t supposed to be used, but it was. And it wasn’t my decision to use it. It was above me that someone decided to use it. And basically, we were told to make do. And we used to have push packs, which were large supplies. Did they go into this at all? Push packs? They used to have large push packs for supplies for — basically, supplies for a medical area to care for people who were sheltered medically — minor stuff. And they no longer existed. And so we were sort of dealing with everything that we could grab off of the ambulances initially to manage whatever patients that we came across. From that standpoint, I think [0:04:00] we — there wasn’t a plan of equipment coming at the GRB initially, because I don’t think anybody expected us to be there. That’d be my interpretation of it. But all that happened above me, and I was just told, “Go there. Figure it out.”
CS: Can you please describe your specific role at GRB?
LT: So I don’t know what title you want to give me, but I ran the medical area for the day shift — so basically, 7A to 7P. Kevin was the opposite. I don’t know what title he gave himself from 7P to 7A. But what — our job was to keep it flowing, take care of patients, make sure they’re dispo-ed appropriately, make sure we’re not using up unnecessary resources from EMS or basically loading our hospitals up with patients that don’t need to be there, and then find solutions to problems as they arise.
CS: What were some common needs of patients that you had to respond to [0:05:00]?
LT: We saw everything. You name it. We saw eclampsia. We saw a stroke. We saw people having chest pain, shortness of breath, lacerations, psychiatric cases, dialysis — not being able to get their dialysis and then trying to come up with solutions for them. I mean, you kind of name it. We saw it. It was more or less just like any typical ER.
CS: During Harvey, did you respond to any other serious injuries? And if so, can you please describe them?
LT: Seriously injuries?
CS: Uh-huh, like accidents or anything like that?
LT: So I was — the first day — the first day, it was still raining. I was out with SWAT. And I was out with them in their — in their AV, their assault vehicle [0:06:00], because it can go into five feet of water. And we were out there doing rescues. And it wasn’t so much of injuries that I saw but just people sort of stranded everywhere throughout the city. And it also gave a good view of just how much devastation there was.
The interesting thing — and it’s not injuries, but what a lot of people don’t understand is — a lot of people have great big hearts, and they open their facilities to help people. It’s like, “Come on in.” And like, “Hey, come in,” especially churches do that. The problem is once they start getting a load of patients there or a load of evacuees, their church starts getting trashed. And they don’t know how to sustain them. And they don’t have the food. They don’t have the supplies. And then we end up doing this sort of, “Alright, load everybody up. Let’s move them again. Let’s move them again.” So you sort of play a little leap frog. The way it’s supposed to work is you have these lily pads where patients or evacuees are located. And then you come and you grab them, and you send them to the main location, which is the GRB. So I saw a lot of that.
It wasn’t so much injuries. I never really saw any crazy injuries [0:07:00]. It was just people stranded in dry spots everywhere, which was very interesting to just drive around and see and then pick them up and then move them to a lily pad where they could get moved to the GRB.
CS: What were some of the immediate resources and facilities that were available to you to work with in GRB?
LT: Refrigerators. They took the refrigerators that were used for soda and used them for medications. It wasn’t — there were tables and stuff like that. It wasn’t like there was a lot to use. Tables, chairs, and then we commandeered the refrigerators — and then space. That was really what we did. The rest just came from donations. It was all donations. I remember we had a literal mound of diapers at one point, but it was just — people drop by medications. They’d drop by things and just — I had [0:08:00] — at some point, I would have some CMO of some company calling me, asking me if I wanted — what medical supplies I needed. And I’d just start walking around with a list in my pocket of stuff that I wanted. And I’d just tell them, “Hey, just send a truck here with this, this, and this.” And sometimes it came. Sometimes it didn’t, but it was worth a shot. We just kind of pieced everything together over 24, 48 hours.
CS: So in your experience at working at GRB, were there any occasions where you had to think, plan, and act outside of your conventional training standards?
LT: Yeah, every few minutes — the whole time. There was nothing conventional about doing what we did. It was all spur of the moment. And I mean, what do you do about someone who’s got lice so bad their scalp’s peeling off? Or what do you do to isolate people that, you know, you think are really sick and could get everybody else sick? What do you do with a geriatric population [0:09:00] that’s spread out in the general population and they require higher need of care and they’re asleep in their own filth? Like how do you consolidate that? I mean, you’re just kind of going along doing the best you can and coming up with solutions as you can figure them out — what’s best for the people that were there.
CS: So I remember you mentioned a company that contacted you about supplies, but were there other professionals and organizations outside of HFD and EMS that you worked with?
LT: Yes, I could never remember who they were. I — you know, at that point, you didn’t care who’s helping you. You were just happy for the help.
CS: 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?
LT: I thought it was an amazing experience. I actually really enjoyed it [0:10:00]. Being able to — well, from a personal growth standpoint, it was amazing just to be able to be in a situation where you have to think on your feet and make decisions rapidly that have a huge impact on how everything else flows. That was a ton of fun. And being able to see how those decisions help people was a huge amount of fun. And then seeing all the help that was being — willing to be poured in was amazing to watch — to the point where I actually had to start turning doctors away.
So I actually said, “People, you need to go home. I don’t need you. Come back tonight.” And none of them want to come back at night, but we literally were turning people away. I mean, I had an entire class of med students show up. And that doesn’t help me really in a medical area where I already have a billion doctors hanging out. But you know, they were more than happy to go help the general shelter staff with just helping everyone there — and just, you know, spreading out blankets or, you know, newspapers. You name it [0:11:00]. They would help take care of it. So it was fun to watch all the help that was coming in. It was a great experience.
CS: If you don’t mind sharing, what experiences had shocked you more than expected?
LT: I think — I think mainly when I was out with the team — is seeing just how bad it was, because we all watch TV. My neighborhood flooded. I mean, I lost stuff. I didn’t — my house didn’t flood. I was pier and beam. I was lucky, but that’s a small little microcosm. But then seeing the scale of the flooding and just how many people were completely devastated and know that likely they would never be able to rebuild, repair, or get back to the way things were. I think that was very difficult to see.
CS: Are there any insights you gained from your experiences at GRB that you would use in the case of a future disaster?
LT: I think there is. I think [0:12:00] — I think that you have to look at this disaster as a little different than other disasters, because this was a shelter in place. It wasn’t an evac. So because it was a shelter in place, it was a very different dynamic than not having anyone there.
So for example, my dialysis patients, the last thing I want to do is send them to the hospital and clog up an ER waiting for dialysis, right? It makes no sense when hospitals are functioning at, you know, 120 percent capacity. So being able to open up dialysis centers around town — and they don’t care who they take. They just take them and dialyze them and then ship them back to the GRB — was huge. But that’s only because I had nephrologists and nursing staff that was still in town. If we’d done an evacuation of the city for a direct hit, you know, like we’d done in the past, I don’t — none of that would have worked. So I think in my head one of the things I delineated is what kind of disaster it is and what are we doing with the population, because that’s going to affect what I do in my role [0:13:00] in running a shelter.
And I think that’s the forethought that I don’t think I ever had prior to this. I mean, we all have plans and all this other stuff, but that’s the kind of thing that you don’t think of until you’re in it and you realize that, “Wow, we have all these assets still here. Let’s utilize them,” or, “We have nothing here. What are we going to do?” And then a lot of those typical plans will kick into place.
CS: Have there been any occasions where you get to visit with former patients you served? 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?
LT: What advice? When they tell you in a neighborhood to evacuate, evacuate. Don’t wait for the water to rise, because it’s going to. And people just wouldn’t get out of their neighborhoods in time. I know it was hard to do, but there’s a reason why they say it. And don’t try to stay in your house when they come by with the truck and your house already has an inch of water, because they’re there for a reason. Because you’re going to get more [0:14:00] and more and more water in your house. And eventually, you’re going to end up on the roof. And that’s no place to be.
CS: I remember you mentioned previously about working with the SWAT team. So can you share more about that in relation to Harvey?
LT: Well, they were out doing rescues. I mean, we were going to neighborhoods that were — that they were just helping evacuate. And a lot of times, they’d send them into places where maybe it was not as friendly or maybe there was something that happened that regular HFD didn’t want to go into. I didn’t see any of that, but we would just go in and help evacuate people.
There was a nursing home. I wasn’t with them on this one. They evacuated a nursing home up north. I think it was in the Kingwood area, but we would just go to the neighborhoods and do the best we can. And that’s where I came across these churches and other little places that were harboring all these people. And speaking with the pastor of the church or the people who ran the church and hearing their side of the story, that was [0:15:00] — that was very enlightening as to what was going on. But that was — that was an interesting thing for me to see that before I was in the GRB for the next two to three weeks. So I kind of appreciated that I took that opportunity to do that.
DH: Excuse me. I have a question.
DH: You were mentioning about the different populations that you saw at the GRB. So the person with lice, the people who were sick —
LT: Oh, everything, yeah.
DH: – geriatric population. How did you separate or compartmentalize those folks to get the care they needed and to not spread disease?
A. So we had an isolation area for cases where we — where — for example, lice and what not. We had a little isolated area. And we declared that being our isolation area. As far our — I don’t want to call it a nursing [0:16:00] home, but we had patients who were bedridden or wheelchair bound or just needed extra care. You can imagine putting an 80-year-old in a bed in GRB where the lights never go off. What happens, right? They all sundown. They just really get confused and altered.
So what we started doing is we took the — FEMA basically came in and set up what they call their hospital. It was 150 beds, and we just decided, “We’re not using this. We’re waiting for them. Let’s just move them all over here.” So we moved that entire patient population over here. And then when Baylor called me, and they asked, “Do you need anything?” I said, “Send me some geriatricians.” I had spoken to Dr. Persse about it. He’s like, “I need geriatricians.” I was like, “I need geriatricians. I’m looking at this population. I have a couple internal medicines doctors I put in charge of this, but they don’t normally do this. Please send me some geriatricians.” These two geriatricians showed up — said, “Hey, where do you need us?” I said, “Right over there.” And by the end of the [0:17:00] day, everybody was calm, quiet, taken care of. All the medications had been reconciled.
We had a psychiatric area that we developed with a bunch of barricades, because obviously, we have an issue with the psych population. No one’s getting their medications, and they’re also the people that have PTSD or depression or — so we cordoned off an area over here to just use for psych. And we had faculty just interview patients and working through patients over here, which was great.
And then we even — I mean, then we had basically divided our care area into red, yellow, green. We made it very simple. So green, I actually left — I came in one day, and I decided, “Okay, we’re going to set this up kind of like an ER,” so I was like, “Let’s have acute beds. Let’s have, you know, our yellow 3s or 4s, you know, triage. And these really non-sick people, we’ll put them out here. And family practice people and internal medicine people will be out here taking care of the non-acute — taking care of whatever their issues were. Then the ER doctors [0:18:00] or whatever surgeon will be back here taking care of the sick people.”
And that’s sort of how we kept everybody segmented. And it also made it easy for us to remember who needed to be transported and not be transported. That was until the DMAT showed up. And then they had their own hospital. And basically, they’re set up the same way we are, green, yellow, red. And they did the same thing just on a larger scale. So it worked out pretty well — I mean, no bad outcomes that I’m aware of.
DH: That’s good.
CS: Do you have other questions?
LT: But there were a bunch of people involved in this. Like the — bunch, like the health department, doctors from all over, and obviously, medical direction. I mean, there were a bunch of us that went into creating this thing. So it was a lot of work, but it was fun.
DH: How does leadership work in that circumstance?
LT: You just sort of have to [0:19:00] exert yourself as a — you need one person running it. You really do, because the problem I had on my first day there was every two minutes I was interrupted with a question or an issue. And so I had — so what I wanted to do was create at least a layer — a buffer, because I don’t have to deal with every problem. Some problems just don’t need to — I’d — because I’d never be able to get anything done. So I would just start saying, “Okay, this needs to be run through me. You two are doing this and this. And then you report to me.” And then we created that sort of ladder — the lattice work. So eventually, all these problems that didn’t — no one knew who to go to, they had someone to answer to. So that’s all we did — is create a span of control, where — you know, if it got up to where the person who’s running the area knew it was a big problem that needed some resources or some help that was above and beyond what we had in our area.
And that usually involved a phone call to David Persse or [0:20:00] someone. And that was kind of our job, because in the beginning, it was just overwhelming — the number of people. “Hey, I need a — what do you want me to do with this? We have a bunch of needles over here. What do you want me to do with them? What do you want me to do with this?” And you’re like, “I don’t have time to answer all this, because I’m just trying to make this flow.” So I think, as a leader, you have to be able to recognize how to create that structure, where you can efficiently work. I — that’s — I don’t know. That’s what I felt. Whether that’s right or wrong, I don’t know, but it worked for me. And when Kevin came in, he didn’t seem to mind either.
CS: Is there anything else that we haven’t specifically asked you that you would like to share with us about?
LT: I’m sure there will be an hour from now, but I can’t think of anything. I’m sorry. I’ve got so much snot like packed in around my face right now. I’m just like — I can’t even think straight.
CS: That’s okay. Well, thank you for your time [0:21:00].
LT: Did that help? Is that what you want?
LT: Is that any good? Was it profoundly different than what Kevin and Chris said? Chris was there for a little while. Did Chris tell you his story?
DH: About his eye?
LT: The one random ophthalmologist we had sitting there.
DH: Oh, no, he didn’t tell us that.
LT: Oh, well. I don’t know if I should say it.
DH: He just like — he almost went blind. He had a detached retina.
LT: He did. And I’ll tell you the other half, because it has nothing to do with HIPAA. So we had a random guy who was hanging out. He was an ophthalmologist. He came up to me. He said, “Hey, I’m here to help.” And I was like, “Dude, I don’t know if we’re going to have anything for you to do.” I was like, “I have no idea.” I was like, “Stick around for a while. We’ll see.” And then Chris as like, “Lars, I think — I’m seeing this curtain.” And I’m like, “Oh, shit. That’s your retina.” And so we got him hooked up with Chris. He did the exam on him. Chris was in the OR a few hours later. I mean, talk about divine intervention. This random guy — why was he a retinal specialist sitting out in our care area [0:22:00]? Like there’s no reason. It was just — it was amazing.
But we had a lot of those weird sort of things. There was a lot of luck and a lot of miracles. We had an oxygen guy that showed up out of nowhere to give us oxygen when I was begging and pleading for oxygen for three days. He just showed up and gave us a ton of oxygen. I had an OB who I had to tell — I was like, “I don’t think we have much OB going on.” And she was the one who solved — I put her in charge of solving our dialysis issue. And she turned out to be this big administrator in a hospital, and she knew all these nephrologists and got them all to open up their dialysis centers. It was just pure luck — I mean, just amazing how it all worked out. I’m not so sure I’ll get that lucky again, but.
CS: I have another question actually. In relation to OB, were there any serious cases?
LT: We had one case of eclampsia — yeah, one case of eclampsia — suspected [0:23:00] eclampsia that we treated. And of course, she wasn’t — the OB wasn’t there that day. But we didn’t have a delivery, if that’s what you’re wondering. I can’t think of anything else. That was our — yeah, that was the most severe OB thing we saw.
DH: If the George R. Brown isn’t intended to continue to be a shelter, what would be our alternative in the future?
LT: Oh, I don’t know.
DH: I feel like that at some point we will need one in the future.
LT: There are a lot of suggestions, but I — that is a loaded question. I don’t know. I don’t know. I know, but I — nobody wants it. Nobody wants to do it. It’s hard. Did you ask Persse that question?
LT: You should have. That’s a good question for him. I don’t know. I don’t know where it would be. I mean, we opened the Toyota Center for a little bit to help offload, but it was such a — it was so difficult [0:24:00] just moving resources there and back and having people there and back. We decided just send them over to the GRB. I don’t know. GRB’s — I think GRB is set up very well for it. I mean, we were landing helicopters on the Pierce Elevated right behind it. I mean, we were — it’s what you did. It worked out well. I mean, yeah, we became inundated very quickly, but I think that’s the best location I could think of right now.
DH: How about in other parts of the city? I mean, there were people that couldn’t get down there to GRB.
LT: So there are some other shelters around the city. There were — smaller. We also had Reliant. Reliant — I’m not sure how many people they had. It was smaller, but Reliant was run by Harris County. It’s not run by the City. That’s Harris County property [0:25:00] even though it sits in the City. I think we had a few north and south, but the reason — I mean, the problem was — you know, somebody went over the radio and said the GRB is open. And then every truck started loading and going to the GRB. And I’m sorry. I’m on call today.
DH: That’s okay.
LT: Give me one second.
CS: Okay, so that ends all the questions that we have. So thank you for your… [0:25:37]