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Hello, and welcome to the healthcare facilities network. I’m your host, Peter Martin, president of Gosselin/Martin Associates and the Healthcare Facilities Network. As always, thank you for clicking on this video. Today I am pleased to be joined by Scott Cormier. Scott Cormier is the Vice President, Emergency Management, Environment of Care, and Safety with Medxcel Facilities Management. Scott, you located out in Indianapolis at the corporate headquarters?
I am in Indianapolis. Yep. Excellent. So
Scott joins us from Indianapolis this morning. Scott, I gave them your title. But what do you do? Yeah,
that’s great. It’s a pretty long title. And good morning, everybody. You know, we break what we do up into four buckets. One is emergency management and health care. That means planning for responding to and recovering from disasters. Everything from utility interruptions to mass casualty events, to even space events, and how that can affect our communication. So we really have a broad set of this. And the second thing we do is safety. Now, safety is a really unique term in health care, because we have fire safety that deals with our fire alarm, and fire extinguishing systems. We have life safety that deals with barriers like doors and walls when it comes to smoke and fire. We have patient safety, making sure that clinically, we are caring for our patients appropriately. And then there’s the general safety that falls under my team. And so what we do is we help our, our associate safety people investigate any injuries. We do all the OSHA reporting that’s required if we have an injury that meets that, we walk the hallways and look for everything from chords, to expired equipment and medications. And then we also look a little bit more broadly with safety. So one of the things we do is that we help manage our planning, response and recovery from active shooter incidents. So since 2013, I’ve led a federal and private partnership that publishes guidelines that are published on the FBI website, on healthcare active shooter, we’ve really expanded that now to include workplace violence, and coming up with unique solutions to that. And then, the last thing is environment of care. And as you know, environment of care is everything that operates within the four walls of the facility. So our teams manage and lead the environment of care committees, we have a standardized agenda across the country. We cover everything from medical equipment, to utilities to security, to our sustainability program and goals. Wow. So that’s it in a nutshell.
You know, it’s funny when you said And lastly, the environment of care. Like, yeah, that’s that’s the last thing, right, with all the with all the accountabilities. So that’s interesting, Scott, because I asked Scott to appear on this episode, and he kindly agreed to it. Because at the annual, I saw a presentation that Scott and his team gave, and it was relative, or is regarding a situation in Texas Back in 2021, in the Dallas Fort Worth area, where they had cold and snow. And it was a very interesting presentation. And I thought to myself, I’m gonna have to ask Scott if he’ll appear. So that’s why Scott is on now, Scott, as you’ve talked about the different things you do, I mean, we could You could spend active shooter, just as one example, you could do an episode on that, so much of what you do, is is critical. So I do want to get into the downs. But the first thing I want to ask you about, you talked about space events, or you mentioned space events, as an increasingly space event. Can you talk a little bit about space events? And how I guess for lack of a better word, intrusive? Is that becoming into what you do? And is there a recent space event that you dealt with?
Yeah, recently, we have some solar flare ups last month, for example, which had the potential of affecting our communications. And it’s, it’s interesting. So me and my team spent a lot of time working with the federal government in salt, part of the health care and public health sector Coordinating Council. And my National Director of Emergency Management is the lead to work for potential space events. And what we’ve been doing with the government for the past year now is to look at all space events, whether it’s debris, whether it’s solar, solar flare ups, whether it’s solar storms, those types of things, and seeing how does it affect health care? You either directly communications go down, or indirectly, we can no longer do banking, and then putting together a plan. And the government’s doing that for each of the critical infrastructure sectors, so transportation and banking, and, and water systems and all those things. And so we’ve worked with them. And so that sparks our interest, our team is always looking for information, so that our leaders can make informed decisions about how we’re going to respond.
You know, it’s, it’s funny, since you deal with it, you’re probably aware of, but how, how we’ve come to count on all those things that we take for granted relative to communication and, you know, connecting with each other. You know, when you mentioned banking, now you have a solar issue. And, you know, what happens if people have forgotten how to use the phone, or those old modes of communication are almost out the window these days, you just,
yeah, and it’s, it’s so important. As a matter of fact, a few years ago, there was a hurricane that hit Puerto Rico. And so we were assisting the federal government with that. And it Puerto Rico is very interesting. 90% of the fuel centers are privately held. So when you go to a gas station in Puerto Rico, you don’t see the big signs. It’s, it’s a local mom and pop shop. And so when we were assisting them, the government said, we’re gonna focus on health care, Scott, we’re gonna make sure that we are driving health care, and all our assets are going there. And I said, great, but you know, the sewer system isn’t working, and they need generators, and I need you to send generators to them. And a water treatment plant isn’t working well. And the mom and pop shops don’t have enough really money or authority to get fuel trucks to come and deliver to them. So we need them, you need to support the local community, as well as the hospitals to make sure that we can recover appropriately. Yeah,
it’s all it’s all connected when you break it down like that, right? I mean, there’s no you’re not solving for one, there’s multiple things that go into that one area. So you have a you guys are the largest non nonprofit health system in the US. Since 1900 sites, including 131 hospitals in 24 states and the District of Columbia. And your role, how? How do you manage that? What are the that’s a big scope? So how do you break it down? And how do you manage it? And how big is your team?
Well, you know, I’ve mentioned that we have a unique way of addressing safety and emergency management. So I’ve been in health care for a long time started as a paramedic. So I worked in a pre hospital field, went inside the hospitals, and how
long have you been paramedic for Scott?
Still paramedics. So I entered EMS in 1979. So it’s been a few decades. And I actually started, it’s interesting. I was a volunteer EMT when I was 16 years old. So my junior year of high school, I went to EMT class, shortly after that the state prohibited people under 18 from getting an EMT certification. I don’t think it was because of me. But I’ve always been interested in healthcare and the health care aspect. And as I’ve grown, understanding, pre hospital care, understanding hospital care, and really trying to merge those two things. So we’re not doing two separate things. But we’re really focusing on improving the health care the community by working together. And so I saw, you know, we’ll hire somebody for emergency management, or we’ll hire somebody for safety, or, typically, hey, you’re a facility director, you’re also going to do safety and emergency management or your ed director, or your I’ve seen administrative assistants given the role of emergency management. And they do that because a lot of healthcare leaders think, well, this is really regulatory. I mean, it’s not that hard to pass, CMS or joint commission or DMV surveys when it comes to emergency management. As a matter of fact, in my career, I’ve seen two hospitals fail their emergency management, and they were so horrible. They deserve to fail. And so they look at it as a regulatory piece. I don’t want to spend a lot of money, I’m not going to buy a bunch of radios, if something happens, we’ll figure it out. I know I have to have plans, because, you know, CMS requires me to do it. And so we looked at that. And before I came to this company, I worked for another large healthcare system. And we started to look at it from a well what does it really mean, when a hospital responds to a disaster? And you close services or you close and evacuate, and how does that affect the community? And how does that affect the revenue And we found some really unique things. I remember during one hurricane that was coming to a city that we operated in, it was only a category one, but it was large and slow moving. And we had some buildings that had been built in the late 1800s, early 1900s. And we did something unique. We brought in remediation teams, and we embedded them inside of our hospital. And we said, why wait till the storm passes until you start cleaning things up. And when we evaluated that, we saved almost $4 million in damage. And more importantly, we were able to keep keep eight o RS and 40 patient rooms open. And so the the financial impacts of that were pretty enormous. And even if you have insurance, which everybody does, and even if you have business interruption insurance, it never covers what you’re going to lose in revenue from a disaster. But more importantly, when you close services to the community in their greatest time of need, or you’re not really doing a service to them. And so we started to look at a little bit more, which is we had public water outages and hospitals around us were either going on diversion are closing. And we said well, there’s a great need in the community again, but how can we overcome it. And so he did things like putting water inlets into our water system. So we could bring in water tankers, pressurize our water systems use bottled water for potable water and stay open full service. And that, again, not only generated revenue, but the public saw, hey, you were open when I needed you. My hospital was closed. And so we’re changing the argument that emergency management isn’t a regulatory thing. It’s a revenue generating department of the hospital if it’s used properly.
That you know that comment that you made, you said something along those lines during your presentation. And it was your we look at these opportunities as an opportunity to generate revenue and just look at it differently. And I wrote that down. I wish I had my bright notebook with me. But that stuck with me because it was a little bit different, you know, a little bit different approach. Does that mine did it take? Did you find people who were willing to kind of buy into that vision? Was that a tough sell? Because you change the way things are done? Right? You’re very proactive. You’re you’re getting that remediation team, how early? Did you get them into the hospital for that hurricane example?
Yeah, we got them in. And we found we have a timeline, right 72 hours before landfall, you need to have generators in place, 14 hours before landfall, you need to have remediation teams in place. So we have this timeline. So two days before landfall, we got them in we bedded them down. We fed them. We had them walk the hallways. So they understood. We had our facilities people show them this is where it typically leaks. And what are some proactive things that we can do or staging of equipment in those areas? So it and I think other hospitals now are kind of looking at that, as well as how can we say save damage and recover?
Was that was that a easy sell to people to change how it’s done? And when I when I say people I’m talking about obviously, within your organization who aren’t part of your team, you know, local hospital leadership, others? Were they willing? Were they willing recipients of that message?
Yeah. And it started with when I started at that other company. It was a new role. And they they realize what was going on with emergency management and saw that they needed some help. And within the first three months of me starting we had three significant events. And so in prior to me coming, they would hobble together an incident command team, they would give people vests and radios and clipboards and eight stare at them going, What am I supposed to do with this? And so when I started, I said, you know, we don’t need any of that stuff. What we need is we need to flex our management, we need to provide support to our local facilities. And we need to interact with the local government. And that’s exactly what we did. So we simplified the thought of incident command, we still do it. We just simplified the thought of it. And then we made some, some very good decisions and help them make very good decisions so that we could continue and so we built a trust. And so once we had that trust, then we were able to move on to some things like we really think this would be a good idea. And when I talk to emergency managers, I tell them that you really need to skills boardroom presidents and executive speak. You know, if you need $10,000 radios, you don’t go to your CFO and say I need $10,000 For radios because they’ll say no. What you say is as part of our emergency management plan. We are putting a plan together for loss of communication There’s a couple of avenues we could go with, you know, we’ve had three events in the past year. One is do nothing. And when we do that our patients can can get in touch with us. We have problems with, you know, getting lab results. The second thing is we can get some satellite phones, but satellite phones are very expensive. Here’s the cost for it. And, and you typically don’t use them a lot. And the third thing is we could get radios and we could deploy radios. Here’s our plan. It’s about $10,000. To do that, when you give a request and a perspective of all the information, they need to make a decision, it’s a lot easier for them to make a decision. And so we really have to change the way emergency managers are talking to their leaders, and way leaders understand emergency management and safety. How
far along in the process, are you with that? Would you say Oh,
when I came to the new company, I spoke upfront about what the vision was. And they bought into it. And so very early, we were able to establish ourselves. And disaster always brings people together. So within six months of me starting, we had a hurricane. We came in and it was interesting. I was working with our hospitals in Florida. And I saw we know hurricanes we can put and I said okay, well, and we sat back and watched and they were a bit disorganized. And so we just brought organization to them. They said, wow, that’s that’s a little bit easier for us. And hey, you know, we really didn’t think about that. And yeah, you’re right, we should bring a generator in 72 hours before Yeah, because but after that people are all scrambling trying to get in. We do need national contracts, and so prove your value, and then build upon that. So when COVID-19 came around, and we had the second case in the US in January of 2020. Really, where was that Scott? It was in Illinois, it was kind of our hospitals. And then five days later, we had the seventh case in the US, but the first human human transmission, it was the first person in the US that wasn’t over in China that that got cut away. They welcomed us in and said, What do we need to do. And for three years, we ran a national emergency operation center, we had standardized processes procedures to get through COVID. And the lessons we learned and the way we were organized, we never had to reuse PPE, we never had to use homemade PPE. And we were able to care for all of our patients. One of our physicians actually went to the White House to talk about using a single ventilator on multiple patients, right. So all that innovation we were able to bring together and manage through COVID. Wow,
when you look, no not asking, particularly when you look back at that those very early days like January 2020. What comes to your mind? Is there anything? Not like? I’m asking you to answer the question, not kind of forgetting what you know now. But if you were like what comes to your mind when you think back to that?
Well, part of my team does information and intelligence. So in the military, I was an interrogator, I worked at the Defense Intelligence Agency. And so information intelligence was really key. So we saw what was happening in China. We also knew that China is not very forthcoming with accurate information. And so my National Director of Emergency Management i We’re always debating is this going to be bad is it not going to be bad and we’re, we have a really good sort of ying yang to ourselves, but we prepare. So when COVID hit, we were very prepared, we actually we’re having calls with the federal government every day about what we were doing, what our projections were, we saw things like furlough, we saw things like the need for negative pressure rooms, and how to do that in a regulated environment. And so after those patients went home, and by the way, they really didn’t need hospitalized they weren’t ill enough to be hospitalized. But it was a novel virus that we wanted them in the hospitals so that we can make sure that we cared for them. And when they went back, when we discharge them, we actually sent people to their apartment building to make sure that our partner was clean that they had food in the refrigerator, as well as talk to their neighbors and say, hey, you know, your neighbors were on the news. But here’s the truth of everything. Wow. So we could get them back into the community. And then we spent the rest of January and February and March preparing for what we thought would be a wave of COVID which did come
You were right on out on. I’m going back to you know when you talked about the the remediation team. When people say things, it automatically triggers an image in your mind. So I’m picturing a team of remediators in the hospital during the hurricane, just running, running from location to location as these you know, as these leaks come in and as different areas of the hospital are impacted but so as far as the remediation part of it during the hurricane itself. They’re active and working so that when the hurricane clears, you’re getting back up on line. What does that process look like in the hospital?
Yeah, so we do two things. One is we put our facilities people on a mobile patrol, okay. So they’re walking hallways, they have some remediation equipment with them. And then our larger professional remediation team is responding to some of the larger events. So the prompting of all that comes through our facilities, people identifying leaks. And then the other thing we do is that we have a leak hotline in our hospital command center. So when people see water intrusion, then they call that hotline so we can quickly get somebody to it, we don’t want a very convoluted process. The other thing you do, which, which seems simple, but before the hurricane, we bring in a raglan and we don’t want nurses using pillowcases and sheets and towels to absorb the water, we need that for the patients. And if we can get a linen delivery, right, we’re gonna have to conserve our linen. So we bring in a bunch of rags for people to absorb all the water, so we don’t have to affect our patient care.
What a great simple idea. I mean, it just seems so simple. Yeah, you don’t always it’s not you don’t always think of the simple. What else do you guys do? That might be a little bit different.
Yeah, again, our approach is, if you look at this is we’re revenue generating, right? Keeping hospitals open, and we’re keeping open full service. The other thing we’re doing, though, is that healthcare is changing dramatically, and not just in the post COVID world. But we’re moving a lot of services to our outpatient centers. We’re doing joint replacement surgeries and outpatient centers that we used to do in the hospital. And we used to have a three to five day inpatient stay because of it. And you know, the model for outpatient centers for emergency management in the past has been closed and everybody home. And then when things get better will open. We can’t do that anymore. Because the community is depending upon that outpatient center being open, whether it’s a freestanding ad, whether it’s an ambulatory surgery center, whether it’s a clinic, to care for them, so they don’t have to drive the 45 minutes to the hospital, they can get care in our community. And so our emergency management plans have to expand to include those outpatient centers to serve the community and make sure we’re continuing to generate revenue. And then the other thing we’re working on is sustainability. So a lot of health care systems and us included, are looking at at being more sustainable. That means shifting to alternate means of power generation, such as solar and wind, and also electric vehicles. Well imagine our polar vortex and Texas in 2021, where six of our hospitals lost public power 6pm last public water, how am I going to charge an electric fleet? And will they even charge at below zero temperatures? And so our emergency management plans now are including how to sustain emergency management, when you have these alternate power sources and electric vehicles. You know, I had a hospital in Alaska and mount readout in 2010 erupted. And ash went all over the place. And we knew we had to do filter changes in our hospital every 72 hours. That’s a lot of filters. Yeah. What if we had solar panels up there? And they were covered with ash or they got covered by snow? And the Northeast? How are you going to continue to generate and so we’re looking at emergency plans in a sustainable world?
Yeah, yeah, that brings up a question I’d want to ask you, relative to the scope of what you do, and where you’re located, you know, across the United States, and when so I’m up here in New England, just outside of Boston. And, you know, prior to joining the consulting world, I worked for a hospital when we were systematizing. And we made a mistake very early on. And it wasn’t just kind of it was well intentioned mistake. It was just we were forming a system and, and we looked at our hospitals in a much smaller footprint than what you have. And we kind of equalized all of them as far as snowplowing was concerned, you know, similar contracts, similar sanding, but that didn’t work because you have some hospitals that are a little bit further north that that need more, and you had some hospitals that were on the south coast, but the snow changes terrain, do you so we learned from that mistake that we can’t You can’t do everybody’s not equal. I have to imagine everybody’s not equal as far as what they need. Have to imagine you must. Do you do that with your hospital planning and look at geographic sections and say, okay, you know, you’re on the Gulf Coast, you’re prone to hurricanes. You’re in the Midwest, you’re tornadoes. You have to think that way. You change your thinking based on where you are, where they are. Yeah,
we do. And you know, we’re a pretty compact unit. So of all the sites we care for, I have about 100 people on my team. I’m a pretty frugal guy. And I don’t want a bunch of emergency management people sitting in an office twiddling our thumbs, having lunch with whoever waiting for the next storm. So that’s why we combine safety and emergency management, because our people are working every day. And when an emergency comes, they pivot and they do that em roll. And it fits well with the within the environment of care. But we help the federal government develop a risk assessment tool, it’s called ri SC. Alright, Sc, RI SC is called Risk Identification and say criticality, and it’s free of charge. A lot of people use what’s known as the Kaiser tool for hazard vulnerability analysis. And it’s very subjective. And so this risk tool pulls upon 25 years of federal databases to get really detailed information. And it’s interesting when we first started developing this back in 2015. In Oklahoma, we had earthquake is a top 10 vulnerability. And I dropped to 12. Because we had a database that showed it differently. So we can really pinpoint what our vulnerabilities are. Now, we love to standardize and optimize. So my ELP template is exactly the same across the country. But there’s a third piece that people sometimes forget, which is you have to localize. Yeah. And so we’re farther up north in New York, for example. So we know we’re a bit isolated. And that’s going to be different than, you know, somebody that is in downtown Baltimore, we have where we have a lot more assets. The other thing we do too, is when I’ve looked at Emergency Management, Safety and other large healthcare systems, it’s sort of a cooperative, you know, the local hospitals do what they want to do we meet kind of regionally, sometimes we standardize things within our organization, everybody working in safety and emergency management reports up through my chain of command, not the chain of command of the hospital. Okay, so it’s not hard for me to standardize and optimize, yeah, and make sure that what we’re doing in Oklahoma is the same thing that we’re doing in Tennessee, and the same thing that we’re doing in Alabama, because they report directly through my chain of command. And, and it works well, with our C suites. They get it they understand it, and they like that we have that consistency.
I was gonna Yeah, I was gonna ask you that relative to the reporting structure has it? Did you implement that when you came in? Did you take it away from local? And how did the I mean, listen, this isn’t talking badly about the C suite. I remember, everybody likes to have that control locally. But they were happy to give that up to you. Did that take any effort on your part to do so? Or how did that evolve? Well, no executive
is ever happy to give up power. But the way you counteract that is to prove and then the value. And our safety officers are in the C suites regularly, and we talk to them. And it’s interesting that we’ve built this trust. And as I said earlier, you have an event, you show your value, people trust you. Yeah, our C suite leaders, if we have an event, our safety or emergency management person doesn’t act as a liaison to the public safety. Our safety emergency management person is at the head table, as I like to say, which is we’re standing next to the incident commander or we are the incident commander. And we’re advising them. And that shows you the trust that they have in their role.
Would you say that, relative to creating a structure that you’ve created in your you’re still creating was Trust, the most important part to build that? What were what were the some of the more important factors to take a program nationally and get the C suite locally? On board with what you’re doing? Yeah, and
in any case that I’ve seen, the first thing is that senior leadership has to buy into it, and they have to support it. Because you’re gonna get grumbling. Yeah. So if it becomes an enterprise strategy of what you’re going to do, it’s a lot easier. And sometimes you have to lean on that, hey, I know, I know, you want to go off in a different direction and have our safety and person do something different. And we’ll listen to that. If it’s great. We’ll change it across the country. But we have a standardized program and we have a standardized program because we’ve optimized it. And then again, you have to have an event and build a trust and they have to the value that you have. That’s that is really key. And being at that head table. I’ve been to a lot of hospitals where they’ve stood up incident command. Any emergency manager is sitting in the back corner of a room and other people are talking and they have better information everybody else talking and that information intelligent is kind of key as well. I mean, imagine during COVID, all the information coming out from CDC, the World Health Organization, local news, national news, Facebook, social media, and what do you do with it? And so we we learned very early on, we need to control the information. And so we sent out a newsletter to all of our hospitals and clinicians and our and our staff every day, which said, here’s what you heard news. Here’s what it means. And here’s our direction. And so when you control that information, people are gonna build trust in you. Yeah, same with weather events, you know, we subscribe to a private meteorological service that has a GPS coordinates of all of our hospitals. Now, if weather is one of the greatest vulnerabilities I have, why do I only invest in a TV to watch what the national news is saying? And it makes a huge difference. So hurricane Michael was a category five hurricane that came into community where we are, but we knew for our forecasts, we were only going to see category one storms. That means one
a couple years ago that was out in the Gulf is a five and then it weakened as it approached
Panama City. Yeah. And we stayed open, and the other hospitals in the peony closed, and we stayed open, and we served our community. And we also supported the federal government with some of their search and rescue teams. Huge, huge deal. And so when I first came here, and we started our weather program, I would get on calls, Hey, Scott, I just saw the national news and you know, and urologists is coming to town, so you know, it’s going to be bad. To say, Okay, well, here’s our meteorologists, and they’re going to talk to you and they do they get on our phones and answer your questions, and your turret to turn into. Did you see the silly stuff? They were saying on TV? Thank you for giving us the right. Yeah, well,
yeah, it’s funny. I think, as I said, when we were emailing back and forth, I love meteorology. I love weather. And, you know, here we’re, we’re located in New England, it can be a little complex, because you get the interaction between the ocean and the cold and what it does to storms and all. And I mean, I study this stuff. I’m not I’m not a meteorologist. So like, I tell my friends, and they’ll ask me for forecasts because the people on TV, listen, they’ve got the degree, they know what they’re doing. But it’s all hype. I mean, they’re doing it for ratings. And so they can tell you X but it’s going to be why you can’t the level of trust, it just isn’t like it shouldn’t be because they’re about ratings and getting eyeballs to it. So that might like I said, my family will always upbeat, what’s going to happen? Because they’re saying this? What do you think? Not that I’m any better? But I just I live here and I’m not about it.
Yeah, and I grew up in the New England area as well. You know, I grew up. I was born in New York, lived in Connecticut. My dad grew up in Brockton. So every turn every summer we were there at the Cape, so I was shoveling driveways in Brockton during my winter break.
Brockton brachten like during a nice nor’easter they can really clean up with some good snow totals. Oh, I didn’t I didn’t realize that. So yeah, there’s a nice diversity of weather here.
Yeah, there is in the sea makes a big difference. And we have some coastal northeast coastal hospitals as well, that we’re always watching out for, you know, the northeast, or is that come up? Yeah, yeah. And that’s why it’s so important to have that accurate information of what weather you’re gonna see how
long Scott, have you used the meteorological firm.
I started my private company. So I’ve been using them since 2007. And, and they have more meteorologists in the National Weather Service, they do a lot of work with shipping, and they do work around the world. And they’re very accurate their models, and their modeling is very accurate. And so we’ve really developed a trust in them. That’s
nice. Last Last thing on weather because we’re not here to talk to weather. I do want to go to Dallas, but I think part of the issue is like people want like, especially in today’s world, people want an answer, like is it gonna snow and how much snow we’re gonna get? When’s it gonna start? And as you know, it’s doesn’t always work that way. It’s a pretty complex environment up there and people want answers, but weather does, you know, sometimes you don’t know until you’re, you know, 1224 hours out.
You’re right. And I remember a hurricane that we had moved assets 72 hours before landfall into Florida. And then it shifted and it was going to hit Mississippi and so we shifted our assets there. We ended up keep kept shifting our assets until all of our stuff was in Texas where it hit. And that’s the hard decision for a healthcare leader. I don’t want to evacuate I want to wait till the last minute to do things and we know that that’s not prudent to do that you have to make this decisions, and then be able to pivot from those decisions. And a great example is we had a hurricane in Texas and in 2008. And we made a decision one of our hospitals near the coast coast. We did a partial evacuation, which means we evacuate all have our ICU patients. We keep med surg there. And we evacuated our NICU, which had 42 babies in it. So the next morning, I get a report, and I’m saying, Okay, what’s our census? And they said, we have 47 babies in our NICU. I said, How can that be? We just emptied it? Yeah, well, a hospital down the street, that had a NICU evacuated the last minute, just before landfall, there was no place for them to go. So we took them into our hospital. And so we ended up temporarily hiring their NICU nurses, to put them to work to help care for the patients. But you know, you have to look at emergency management as a community effort, because what other hospitals are doing are affecting what I’m doing? Yeah, that’s why we spend a lot of time meeting and lecturing so that we’re all on the same page. So we don’t get caught, like we did in Texas.
What does it take for you to what would it take for you to close the doors to a hospital what type of an event
and I have I’ve evacuated hospitals in the past, it has to be that we cannot sustain our operations. And it’s too dangerous, either from the infrastructure side of it, our building envelope, or from us getting supplies for that. And so we have in some hurricanes, evacuated our hospitals, I almost evacuated a hospital. Due to heat temperatures were above 100 degrees, we lost our public power. Our H fax system wasn’t working. And there’s really no way around that. You know, the I think somebody suggested to me go to Lowe’s get a bunch of box fans to call the hospital, right? You were able to overcome that. Those are really the decision processes we have either it’s too dangerous to be in that facility. Or we can’t maintain the safety and care of our patients.
How do you you know, I want to get does, how do you though close off the noise? Like take that example? The one you just gave him? With the heat and the humidity? And the H package? I’m sure you have people communicated with you chirps. Scott, what are we doing? You somebody, you must have all of these inputs coming. But yet you need to kind of remain steady and focused and you with the task at hand? How do you close that out and just make a decision?
Yeah, at the end of the day, you have a handful of information. And that’s what you have to go on. You know, we don’t fly by the seat of our pants, all of our decisions are going to be based upon information that we can track back to it. Yeah, and sometimes that handful of information is a small handful. But always considering the best thing to do for your patients. And I think I think all hospitals do that, whether they make the right or wrong decision, what’s the best for our patients? We’re just able to look at scraps of information, and use that to help us make a decision.
Okay, let’s jump to talking about what happened in the Dallas Fort Worth area and 2021. But before I do that, you mentioned the risk document that was developed, where can people find that if they wanted to? It
is on the Asper, which is part of HHS website. But if you just use your search engine, and type in RI SC risk assessment, it’ll come up. And we’ve just released the new tool with the federal government. And so every one of our hospitals as well as our outpatient centers use this. But you can do it for a community level as well. So in Texas, where I have 13 hospitals in Austin and a hospital in Waco, I can combine those to see what my risk is in the state of Texas. So it’s a great, unique tool. Our people are actually putting together a training video for the federal government on how to use the tool successfully. But I encourage everybody to go out and look at that. It
sounds like it actually sounds like one of those documents that might just kind of suck you into using and running all these different tests on it or queries on it.
It is one of those programs that you can put down and that’s a good thing because we want our safety and and people in a tool and using it and for some things like it asks you questions about your IT infrastructure and your risk for cybersecurity events. Well, we use a standardized approach for cybersecurity across the country. And so we were able to answer those questions once and then share it through the platform for those answers. Obviously localizing A few of those questions. Right.
I’m glad you brought that up. Thank you. So what happened in 2021? In the Dallas Fort Worth area, relative polar vortex and snow?
Yeah, it was, for us. It was actually in Austin and Waco, Texas, and in Waco, and you know, if you look at Texas, Texas is not used to snow. And so when we build hospitals and outpatient centers, we don’t build them like we do in Wisconsin. And so we don’t have a lot of insulation in the walls, and we don’t insulate our pipes. As a matter of fact, if you look at the towns and cities, they don’t have a lot of salt trucks, and they don’t have a lot of snow plows. They’re just not expecting it. And so they don’t spend for that. And we had a huge polar vortex came in. And there were actually two separate events that combine that ran into each other. And it caused a lot of snow. And it caused power outages and it caused outages with the public water system. Now, we didn’t have massive plans for a polar vortex in Texas. We had hurricane plans. We had wind plans, we had flooding plans, and we had some cold weather plans, but not to that extent. But we have really good winter weather plans up in Wisconsin and New York and our other northern states. So it wasn’t new to us. We knew what would affect us. And so we had about a 10 day heads up from our meteorological people. Okay. And then in the presentation, I shared you that first thing that says, hey, we’re seeing this kind of brewing. Yeah. And so we started to look at our preparedness for it. And there’s a lot of things we can do it for cold weather. In those southern markets, first of all, is looking at your water piping and systems. Are there water pipes that you can shut off and close to prevent them from freezing? Or can you add auxilary heat or increase the temperature in those areas, so the pipes don’t freeze. We started to order a lot of salt, we do our own landscaping. And so we have solved some landscaping trucks there that plowed during the winter. So we were at a lot of salt, we got our crews ready for that. We brought in extra water. And we did that because we just anticipated maybe something’s going to happen with with utilities. We also checked our boilers, our boilers are dual fuel so they can go natural gas, or they can go diesel. And we topped off all of our diesel tanks in case we had a natural gas interruption. And so when the weather hit, it hit all the hospitals in a couple of different ways. Roads were closed. So associates couldn’t get to work. And then associates had power outages and their kids schools are closed. And so they had to deal with that. And so we looked at how does this affect our associates? And how can we how can we keep them at work? How is this affecting our ability, public transportation getting supplies in? And so one of the tricks we have is we load up on supplies. So if we think that a storm is coming on Friday, on Monday or Tuesday, we’re getting extra supplies in our hospitals so that we can we can have an interruption in that. And a lot of hospitals only have maybe two to five days worth of supplies on hand at any time. So you’re depending upon those shipments.
I was going to ask you, Scott, how quickly did you so you said 10 days out? Excuse me, your Weather Service’s telling you hey, this is coming. When did you pull the trigger and start to act? How many days out? Were you?
The day we got the notification? Okay. Wow. Because it’s it’s such a significant event. Yeah, if we saw a snow event in Wisconsin, and it was interesting, I actually, I shared the weather alert to all of my regional directors across the country. And my Regional Director from Wisconsin and she’s a trauma nurse, she’s lived up there forever. She says we’re excited. It’s gonna make the ice thicker ice mission. Right. So their perspective is way different. Yeah. But we knew in Texas, it was much different. And so we got things moving right away. We supply a personal emergency preparedness plan for all of our associates. So we told them to talk and to talk through it. Some of our associates that are caring for out elderly parents, maybe it’s best for them to evacuate. Maybe they should get out of town. And we’ll encourage them to do that, you know, based upon their needs as well. And then we made sure we brought staffing in so that we would have them in house in case the roads failed. And we also worked with the local government to keep them informed and up to date. And then we spoke with the other hospitals in the area as well. And as the storm hit, and other hospitals were curtailing. services. You know, we were on these conference calls with them saying, well, we’ll take them. Yeah, our dialysis is up and we’re prepared. Yeah, we lost public water too. But we’ve been able to pressurize our system with water tankers. And there’s a great story with that, too. We have a lot of construction going on in the Austin, Texas area. And when you have a construction site, you have a lot of water tankers. Well, we just caught our construction partners and said, start sending those water tankers to our hospitals every couple of hours. So we can pressurize our systems, flush our toilets, which, which is a big to do in a hospital, and then use bottled water as potable water to wash hands or to drink or using cooking. So it came together well, but that having that experience up north helped us. We learned some new things too, because is in this past February, when other polar vortex came, it hit the entire country. Yeah. So in Chicago, we’re used to cold weather, what we weren’t used to is that the grease we use in our automatic doors, it’s rated to zero degrees. And Chicago was experiencing negative 20 degrees. And so our doors were freezing open, open. So you know, we take all these lessons, we learned them, we actually have a polar vortex annex to our emergency operations plan that talks about additional heating, turning off water pipes and doing fire watches, if necessary, the type of grease that you’re using in your doors, all those things that are part of the plan. And we tried to share that as much as possible, because it’s important for all the hospitals to try to remain up and and not just us.
Did you Did your Austin, your eight Austin hospitals in the Waco hospital? Did you guys stay open throughout?
We stood up in throughout full service.
Nice. How do you deal with that? How do you deal with? So you have your associates and they know what their role is? And they’re committed to their role, but they also have families and they live in those areas? Especially during if a hurricane is bearing down? Are you know, in Texas? How do you deal with the people component of it? You assuring them and because I’m sure that’s a challenge to I mean, they’re only human, you got a family at home, you want to protect your family, but you got to ask but you got to protect to what do you do? How do you deal with that? Yeah, that’s
such a great point. And a story from Texas is I remember being on a video call with one of my safety leaders. And they were at home with their family with a flashlight. And then we give them hotspots. And sometimes we’ll give them generators and things you know. And I’m sitting there going, how dedicated Are you? Yeah. And so the first thing I always ask is, how are you? And how are your family? How’s your neighborhood? How can we help you through this process? And there’s so dedicated and committed and I think we get that dedication and commitment. Because first of all safety and and people in health care. I mean, they have a mindset. Yeah, that that is so unique and special. And the second thing is they know we care for them. They know that we’re there for them. And whether it’s sending generators and gasoline to them or food. We try not to house pets and people in hospitals during disasters. We tried to make sure people have plants and that they can care for themselves. We help them evacuate if we need to. But it’s that dedication that really gets us through it. Because without those people we’re not going to be able to get through the storm. And we’re going to we’re gonna have to close
right? Yeah, you I mean you you know you need them. Did you what was your you in the in the Dallas area back out in the Dallas area in the Austin area back in 2021. Did you guys ever Were you ever able to assess total damage caused by by that incident?
Yeah, with with the damage. We had the repairs, we had to be made. All the extra support we brought in it was about $13 million. Wow. And so part of our program is I have two people dedicated to look at FEMA, public assistance and hazard mitigation. So public assistance is a program with FEMA that post disaster. They help reimburse you for costs incurred whether it’s damaged and you have to rebuild. Whether it’s I brought in a bunch of two megawatt generators, or I paid staff overtime to stay inside the hospital. they’ll reimburse up to 75% of that. And then a hazard mitigation program is here’s my risks and based upon the risks, I want to build a flood wall to so that I can stay open during a disaster. In the past five years, our teams brought in over $100 million worth of approvals from FEMA, and we’ve also brought in about $8 million in FEMA security grants for our security programs. And I don’t pay those two people $100 million. Obviously, it’s a but they deserve it. Obviously, it’s a great program for us. And so when we do capital planning now, when we’re building something in Oklahoma, or we’re building something in Texas, or Florida or Tennessee, we’re looking at the hazards and seeing if we can tap into the Hazard Mitigation Program to help offset offset the capital costs of that. And capital is very tight in healthcare, as you know, having that additional funding can be very frugal and getting your plans completed, as well as making sure you have a facility that can sustain disasters.
Yeah, I was just reading modern health care this morning that morning brief and they were talking about the number of hospitals that have been downgraded financially. And it’s it’s a you’re exactly right. I mean, capitalism isn’t out there on trees. It’s actually kind of scary. But not the point in this topic. I wanted to ask you that part of the challenge, Scott, relative to the Texas outbreak. And you mentioned it was multiple events. That was what how long was attended, what was the duration of that event? Because it didn’t quit? It didn’t.
The whole thing lasted about two weeks. Our focus was about six days, okay. And then things started to get restored. You know, part of our work, I said, we work with the federal government, we spent time with state and local governments as well. So for example, we needed some liquid oxygen transported to our hospitals up in Austin. And the liquid oxygen supplier is in San Antonio, Texas. And so we call them they said we’re snowed in and get out of the parking lot. So we used our state government contacts, to get the city of San Antonio to plow out that liquid oxygen center, and then we had state police escort that liquid oxygen tanker up to Austin, Texas. Wow, very creative. Yeah. And it’s important to have those relationships because sometimes, when a local government comes in and asks you to do something that isn’t right, you have to be able to tell them now, like it during one hurricane, landfall was, I think, around 11am. On Monday, the local emergency management came in around nine o’clock Monday morning and said, We need you to evacuate this facility. And we said, No, we’re not going to evacuate it and here’s why we’re not going to evacuate it. And we showed them all of our meteorological projection projections. And I said, so here’s my data, where’s your data? And they really didn’t have any? Yeah, they said, Okay, you can stay. But sometimes, I think hospitals when a local government comes in, and they’re telling you to do something that you don’t think is right, because you have better information. You just go okay, well, they told us to do it. And what we say is, well, let’s sit down and discuss this. Yeah. So we both have an understanding of why you want to go in this direction. And it’s really worked for us.
Yeah. And I think when the local government comes in, in a way it almost gives you it gives you a cover, not that you need it, but it’s Listen, the authorities are telling us this so nobody’s going to criticize that decision necessarily, because you’re being told by a entity above last question. I know Scott, we gotta go. I could talk to you all day. Scott Cormier from med Excel VP of emergency management, environmental care and safety when you are managing these events. Number one, do you ever wish you could be on seeing you probably can’t because you’d be traveling everywhere. And number two, are you man? Are you up in Indianapolis? How does that work? From your around relative to the management of them? Yeah, listen,
I had my fun back in a day. Terry, and in public safety. I had my fun. I have a great trust in my teams. And so I don’t mind not being there. Yeah, we run typically a virtual emergency operation center that is supporting our local Incident Command teams. So very similar to what FEMA is teaching about ICS EOC interfaces. I did after Hurricane Michael. I remember I was talking to my Regional Director, and and she’s been through a lot of hurricanes. But I got on a call with her one day and she was in a T shirt and sweatpants. And she had been there about four or five days. And I said, You know what time for you to have a break. And I teach my people, we have to be visible leaders have to be dressed well, you have to be clean shaven. If you’re a male, your hair has to be neat. You have to walk in as a shining sun in the middle of a depressive disaster. Yeah. And so I flew down there and I spent about four or five days there. And then I brought in another Regional Director to relieve me. But that’s really the sign for me is that if we can’t be this shiny, visible leader that’s giving hoped everybody in the middle of this disaster then you need a break.
Well, that’s a that’s a great way to end our conversation in Scotland. It that’s a visual and it’s a visual for you. Okay, time for me to move. You’re right. You’re absolutely right. Scott Cormier, thanks for appearing on this episode. A lot of information. We’d love to have you back on again too. I mean, just kind of hitting the tip of the iceberg.
Yeah, appreciate the time opportunity. Have a wonderful day.
Thank you, Scott. You too. It’s Peter Martin from the Healthcare Facilities Network. Thank you for watching.