This case study documents Harris County hospitals’ flood preparedness and mitigation efforts before Hurricane Harvey, their collective response experience during Hurricane Harvey, and their lessons learned in the storm’s aftermath.

The case study was constructed using a survey of hospital emergency managers, semi-structured interviews with local agencies involved in public health, emergency management, and health care, and an analysis of news reports and other documents from a variety of government agencies, local organizations, and hospitals themselves.

Harris County hospitals learned their most valuable lessons through their direct and repeated experience with flooding over the years, leading to improved preparedness before Hurricane Harvey. Hospital emergency response successes included infrastructure improvements, staff resilience, advanced planning, and pre-established collaboration. However, hospitals still experienced challenges with staff burnout, roadway flooding, and patient evacuation.

Although the current state of hospital flood preparedness and mitigation is rather advanced and mature, it is advisable that Harris County takes steps to strengthen emergency management efforts in hospitals with fewer financial and staffing resources and less direct flood experience.

Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts.

We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy).

Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental health; and 4% for injury. The Red Cross treated 41% of clients within the shelters; however, reporting of disposition was often missed. These results are comparable to previous hurricanes.

The capacity of Red Cross shelter staff to address the acute health needs of shelter residents is a critical resource for local public health agencies overwhelmed by the disaster. However, there remains room for improvement because reporting remained inconsistent.

To determine the extent of service disruption among home health agencies impacted by Hurricane Harvey.

Structured interviews with optional open-ended questions were conducted with home health agencies in and around Houston, Texas. A random sample of 277 agencies was selected and contacted via telephone during the study period, from February to May of 2018.

Only 45% of 122 participating agencies indicated that their offices were open during Hurricane Harvey, and three-fourths reported that home visits were disrupted. The length of disruption varied: 7% reported a disruption of 1 day or less and 46% indicated a disruption of 1 week or longer. Disruption occurred even though nearly all (99%) of the agencies had—and close to all (92%) of them activated—an emergency preparedness plan.

Although most of the participating home health agencies activated their emergency preparedness plan, significant disruption in home health services occurred. While agencies are required to have clear, detailed plans in place, gaps in effective implementation of emergency preparedness plans remain.