Hello all,   This will be my last official Gustav update.  The Convention Center shelter is now closed.  A Buddhist Charity came in to help with debit cards for gasoline, and the State sent a bus to load those who were bussed.  Transicare and Adapt Crisis services stayed until there was no more work to do.

Overall, I have to say that this went amazingly well, due to a combination of a lot of hard work, people willing to cooperate and step in to fill in the gaps when needed.  I was quite impressed with how well the entire operation went (from the Red Cross to the City’s response, Dallas Fire and Rescue, the Police, Texas Guard, OEM, the Medical providers, and the mental health community).  It was a truly amazing group effort

That being said, we were also blessed by a relatively small number (as compared to Hurricane Katrina) of evacuees.  This whole ordeal has been a great learning experience, and has given me several ideas for how to improve future large scale evacuee response.  I would PLEASE like to hear from those of you who were there in terms of what you thought went well and where we can make appropriate changes to our response to allow for the flexibility to respond to a much larger situation.

I do want to thank EVERYBODY who worked down at the Convention Center (and any other shelter site for that matter).  You guys did a great job.  People were calm and professional, which had a tremendously positive impact on the people whom we were serving.

I especially want to thank all of the people who were down on the floor helping out (and PLEASE forgive me if I do not mention you by name).  Dr. Jenkins beat me by several hours on the initial response.  Adapt Crisis Services and Adapt of Texas were outstanding, and they along with Transicare provided (without any hesitation or complaint) 24/7 onsite coverage.  ValueOptions NorthSTAR (especially Jack Szczepanowski and Sandy Potter) were there multiple times making sure that we received whatever we needed to provide care.  Dr. Baker and Dallas MetroCare Services were on-site and also offering their significant resources for the mental health as well as the special needs population.

Dr’s Tirado and Patel were very helpful with a few of the clients needing Methadone and or detox.

Dr. Ray Fowler was tireless in the same green T-Shirt he wore through the Katrina operations (He insists it is regularly laundered), and really was wonderful in terms of keeping the operation organized smoothly, and very much brought mental health services to the table so that we could coordinate more effectively with the medical care, and to be more aware of the overall operational situation.  Accurate operational information is crucial to determining what level of resources we needed during this time.

The residents and faculty at UT Southwestern Psychiatry Department were great in terms of being down at the DCC and at volunteering to be there.

Agnes Hamilton (my admin) and Janie Metzinger of MHA were amazing in their scheduling of services.  It would have been a total mess without their work.

Nancy Schierding, Vernell Brown, the entire staff at the Parkland Psych ER, who were already getting slammed before the evacuation, and received several people on an APOWW from the Convention Center.

Dr’s Garrett, Ghose, Pieper, Sayed, Butler, Gautam, and Islam at Parkland and Green Oaks who had to step up and cover for my not being at either ER during this time.

Also to Dr. Tyler who covered the last evening at the DCC so I could go back to the Psych ER to help out there.

There are many more people to thank, and I apologize for sounding like a lame academy award speech, and I sincerely apologize if I did not name you, but feel quite strongly that it is very important to recognize how MANY people it takes to make something like this go smoothly, and how amazing it is that so many people from so many agencies can make something like this work so well.

Thank you also to the many, many people who called to offer assistance.  I cannot tell you how calming it is to realize that you have multiple layers of backup for a situation like this.  I can state very clearly, when you are in the middle of an operation like this, you cannot help but multiply the magnitude of the operation by many different factors (all greater than 1) to understand how easily the need could have been 5, 10, 20+ times greater than it was.  It is very comforting to know that there are many lines of reserve.

Hello all,

The psychiatry clinic has been stood down. We will continue to offer 24/7 coverage with Adapt Crisis Services and Transicare. I am available for phone backup, and we will have about 2 hours of onsite psychiatry coverage per day, and transportation to Dallas MetroCare Services Crisis clinic (open from 1700-2200).

 Dr. Fowler will be on site for medical care for the next several days. EMS will be onsite 24/7.

 We will continue to reassess the situation daily for service needs.

 Some of the South Texas evacuees are leaving today and in the morning. The situation for the Louisiana evacuees is less clear, and some of them may be in the area for several more days.

I will continue to send out updates as needed. I am hopeful that we are winding this down, and that the other 2 named storms will not necessitate a reactivation. We are looking at what went well and what needs to be improved. I welcome your feedback on this.

 Again thank you for all of your hard work and flexibility and cooperation.

Frank Webster, MD

 Medical Director,  Psychiatric Emergency Services, Parkland Memorial Hospital/UT Southwestern

 Medical Director,  Integrated Crisis Services, Green Oaks Hospital

NEED: People available to come in if necessary. Those scheduled until 1700 to come in.

 Hello all,

 As of 1200 today, we are seeing a fair volume this morning (this is in fact the busiest it has been). The decision has been made (by those above my pay grade) to suspend the formal medical treatment as of about 1600 today (this decision was just made).

The shelter component will likely be going on for another week, depending on how long there is need for it. Some of the South Texas evacuees will be leaving today. Louisiana has not given the green light for people to return there, and we do not know when that will be. Most of the people in the Dallas Convention Center are from South Texas.

Dr. Fowler will continue here from 0800-1700 providing medical care. EMS will be here 24/7.

For mental health services, both Transicare and Adapt Mobile Crisis will continue here 24/7. I will be on site for approximately 2 hours per day on Wednesday, Thursday and Friday (unless someone else wishes to volunteer to do this). I was planning on being here midday, and being available by phone all day. We plan on using the Dallas MetroCare Crisis Clinic if necessary for evening coverage (thank you in advance Dr’s Graves and Baker).

 I would greatly appreciate people being available if necessary to come in.
Hopefully demand will be light, and the abovementioned contingencies will be adequate.

 I anticipate that psychiatric coverage will be needed until 1700 tonight. If you have signed up to come in before that time, please either come down to the Convention Center, or call me on my cell  (not posted on web version) before leaving to come down. Any scheduled to arrive after 1700 tonight will not need to come in.
 

I realize that this was a rather rapid change in plans, but such is the nature of emergency response.

I cannot be more grateful for the massive amount of support that our local mental health community has supplied.

Hurricane Ike is the next major storm that could affect our area. It is due to be trackable at the 120 hour forecast on about Saturday this week. I will still be sending out updates after this one, but as this was major news, I wanted to get this out quickly.

 Again thank you for all of your hard work and flexibility and cooperation.

 Frank Webster, MD

 Medical Director, Psychiatric Emergency Services, Parkland Memorial Hospital/UT Southwestern

Medical Director, Integrated Crisis Services, Green Oaks Hospital

EMERGENCY OPERATIONS CENTERS
The City of Dallas, Dallas County, Collin County and the State of Texas all have their Emergency Operations Centers in full disaster mode, manned 24/7. These centers monitor and control disaster response and recovery operations for all first responders.

EVACUATIONS
Two million people across the gulf coast and eastern Texas evacuated in anticipation of Hurricane Gustav.  327,000 fled New Orleans , with only 10,000 people remaining in the city.

 NEW ORLEANS LEVEES
As of Monday evening, the levees in New Orleans are holding. The Industrial canal levee has overtopped, but there has been no breach.  The levee in Plaquemines Parish is leaking, but being shored up with sand bags.

 FLOODING, WIND DAMAGE, and TORNADOES
Many locations in Grand Isle Louisiana are under 6 feet of water. In New Orleans , the French Quarter has not suffered flooding. The low-lying parts of New Orleans are experiencing some flooding, but not catastrophic damage.  Flooding is reported across the Gulf coast, in Biloxi , Gulf Port , Baton Rouge , and other communities. Ocean Springs Mississippi is flooding.

The storm is slowing as it moves inland. It could stall, resulting in 6-12″ rainfalls across Louisiana and into east Texas . Spin-off tornadoes are possible across Alabama , Mississippi , Louisiana and perhaps Arkansas .

POWER OUTAGES
Power is out in New Orleans and across the Gulf Coast . One million people are without electricity.  Public utility teams are on standby to begin restoring power, as soon as the storm abates. Backup generators are keeping New Orleans drainage pumps in service.

PROJECTED DAMAGE
It is anticipated that 78,036 buildings have been damaged by Hurricane Gustav, and 13,286 buildings have been destroyed.

SHELTERING

The Dallas Convention Center and Samuel Grand Recreation Center shelter locations are at capacity, housing 1,150 visitors.  Overall, there are approximately 2,382 people in North Texas because of Hurricane Gustav.
In addition to sheltering people, the City of Dallas is also operating a facility for pets. Located a few blocks from the Convention Center shelter location, the Dallas Animal Services temporary shelter is providing vaccinations and other services to 67 dogs, one cat, and a turtle named Champ. 

Evacuees are anxious to return home, but damage throughout the Gulf coast has not yet been assessed. Search and rescue teams will go in tomorrow, as soon as it is safe, to assist anyone in need, and to determine if it is safe for residents to return.

VOLUNTEERS
Both the Red Cross and the Volunteer Center of North Texas have put out calls for volunteers. About 400 volunteers are needed every day to assist with shelter and feeding operations.

 2-1-1 ACTIVITIES
Through Saturday evening, 2-1-1 specialists assisted callers who wanted to register for transportation assistance to evacuate. They also gave out information on evacuation routes, locations and comfort stations and how to find shelters. On Sunday, registration for the Transportation Registry stopped, but 2-1-1 continues to assist callers with all their needs. Roadside electronic signs and the media encourage people to call 2-1-1 for helping meeting their needs… 

 MORE STORMS PROJECTED
This is the peak of the hurricane season and the Atlantic is full of stormy weather.
Tropical Storm Hanna is now a hurricane, and headed for landfall on the east coast, perhaps in the Carolinas . Two low depressions are just east of Hanna. Just east of these depressions, Tropical Storm Ike is gaining strength in the middle of the Atlantic and will become a hurricane in the next 24-48 hrs.

Finally, a tropical wave has moved off the coast of Africa and is showing signs of tropical development. If this pattern continues, a tropical depression could form within the next 24 hours.
 All emergency operations will be watching the weather closely for the next two days, and monitoring the status of potential flooding in east Texas . Decisions on repatriation of evacuees will depend on emerging information about flooding and damage reports.

DEFINITE NEED:  ONE PSYCHIATRIST covering convention center Tuesday 09.02.08  from 0800 to 2200 

POSSIBLE NEED:  PSYCHIATRIST(S) coverage Wednesday 09.03.08

TO VOLUNTEER:  CLICK ON Gustav: How to Volunteer in Category Box above these posts

Hello all,

 As of 2200, Gustav is a tropic storm over central Louisiana. It is moving Northwest, and is now forecast to move over Northeast Texas and into Oklahoma.

 We have had a small volume of patients into mental health. It is possible that we will have an increase in evacuees depending on what happens with the storm. It is also possible if the storm loses energy quickly that we will be able to shut down operations in the next day or two.

 So, in the mean time, we are still wanting one psychiatrist covering the Convention Center from 0800-2200, with some overlap if necessary. I am backup for the psych ER at Parkland tomorrow and I have a 0700 meeting at Green Oaks. I will be at the Convention Center on and off all day. We should still plan for coverage on Wednesday for the same hours. By mid day tomorrow, I should have an estimate on how much longer we will need to provide services, or at least information that we do not have an estimate.

Again thank you for all of your hard work and flexibility and cooperation.

Frank Webster, MD

Medical Director,  Psychiatric Emergency Services, Parkland Memorial H ospital/UT Southwestern

Medical Director Integrated Crisis Services, Green Oaks Hospital

2000 CDT Monday 09.01.2008 From Janie Metzinger of MHA Greater Dallas

We have a lot to be proud of in the mental health response to the Hurricane Gustav evacuation. Three cheers for Dr. Frank Webster, Jack Szczepanowski, the NorthSTAR service providers, UT Southwestern, and NTSPP who have sent staff and/or members on site to provide mental health care!

The Dallas Convention Center shelter is now full with approximately 1000 people or more, and there is more that needs to be done.

Dave Hogan has asked me to schedule mental health professionals for the dormitory area, to engage with the evacuees and get them to an assessment if needed. Volunteers for this task will report to Dave Hogan when you get to the Convention Center, and I will send him a daily list of who is scheduled.

We also need mental health professionals for the other 2 shelters at Samuell-Grand Park in Dallas and Center Park in Irving. Volunteers for this task will report to the Red Cross shelter manager, and I will notify my Red Cross contact that you are coming.

Below this note is a sign-up grid for the rest of this week through next Monday. Please type the word YES in all of the squares that indicate the time(s) that you are willing to work. It really helps me to know when the best times for you are.

If you do not already have a badge from Dallas County Health and Human Services, please pick one up by going to their office at 2377 Stemmons Freeway on the 4th Floor. You will need to bring proof of your identity and your professional license if you have one.

If you were not part of the Katrina effort, or if you have no experience in crisis response, please go instead to the American Red Cross at 4800 Harry Hines Boulevard for a very brief training before picking up your badge. I will notify my Red Cross contact so that you will be expected.

If you have any questions, please send an e-mail to JMetzinger@mhadallas.org or call me at (214) 871-2420, Ext. 114.

Thank you so much for your willingness to help, and your flexibility (which Dr. Webster says you will have ample opportunity to employ!).

You all are fabulous!

Sincerely,

Janie Metzinger, Public Policy Director, Mental Health America of Greater Dallas

(214) 871-2420 Ext. 114            JMetzinger@mhadallas.org

 Addendum from Dr. W at 1630 CDT 09.01.2008:  Dr. Tirado recommends limiting any unverified methadone doses to a max of 25mg/day

1300 CDT  09.01.2008       Hello all,   A quick update on those evacuees who will need Methadone. We will need triplicates to write for them. Transicare will take the meds to Step Med for filling. If you do not have triplicates, Dr. Fowler has agreed to cover scripts for Methadone

If we need Suboxone, we can either have Transicare send to Solace for Dr. Patel to see (or for ambulatory detox), or Dr. Tirado has graciously agreed to be on call to come down to the Convention Center to write the initial scripts, and then they can follow up at Solace. 

Transicare is picking up the drugs from Step Med.   Matt asked me to see if you and I could prompt docs to make sure the triplicate prescribing form is used going forward.

Thank you all for your cooperation.

Frank Webster MD

Medical Director, Psychiatric Emergency Services, Parkland Memorial Hospital/UT Southwestern

Medical Director,  Integrated Crisis Services, Green Oaks Hospital

If you wish to monitor the storm’s progress, here is the National Hurricane Center/NOAA link:

http://www.nhc.noaa.gov/graphics_at2.shtml?5day#contents

0024 CDT 09.01.2008 Monday  From Janie Metzinger, Public Policy Director of MHA

At present there are over 500 residents of the Gulf Coast staying at the Dallas Convention Center with other shelter sites opening in the area. 

We need psychiatrists, mental health professionals, substance abuse treatment professionals and peer/family advocates to assist especially between the hours of 8:00 a.m. and 10:00 p.m.
                                                                                                                                         Dr. Frank Webster is in charge of the mental health and substance abuse response. 

ALL VOLUNTEERS:    I am coordinating scheduling for all psychiatrists, mental health professionals, substance abuse professionals and peer/family volunteers, so all please register with me via the form below.  

PSYCHIATRISTS ONLY:  Per Dr. Webster’s requests, psychiatrists only  please double register:  with me via the form below AND with Agnes Hamilton at Agnes.Hamilton@utsouthwestern.edu.  

ValueOptions, Transicare, Metrocare and Adapt have assigned mental health professionals to assist, but many more will be needed in upcoming days.

If you have not already done so, please provide me with the following contact information and fill out the attached grid to let me know when you are able to give some time.  There will be a credentialing procedure to provide you with an entry badge, and as soon as it is determined what the procedure is, I will pass the instructions on to you.    

Name:

E-Mail:

Work Phone:

Cell  Phone:

Qualifications:
Availability:  Please type YES in the squares to indicate the time(s) that you can serve:

Thank you very much!

Sincerely,
Janie Metzinger
Public Policy Director, Mental Health America of Greater Dallas                                      214-871-2420, Ext. 114   JMetzinger@mhadallas.org
 
 

1830 CDT Sunday 08.31.2008 Dallas Gustav Update  From Frank Webster MD

 Hello all,

           As of 1830 today, we have about 500 evacuees at the Convention Center.  They are housed in the parking level that is below the Main Convention Center Floor on the “A-B-C” side of the Convention Center.

          Adapt Crisis services, Transicare, and ValueOptions are on the floor.

          The Medical staff has seen about 30-50 patients.

          We have seen about 6 in mental health, and 3 have seen the psychiatrist (Dr. Jenkins is here).

          It is not clear if there will be any more busses headed here tonight.  What is clear is that the convention center will only treatment place, and that those needing treatment will be transported back and forth as needed.

          Things are calm at the moment.  We may or may not have a significant influx in the next 24 hours.  We are currently planning to have 24/7 coverage on site with Adapt Crisis Services and Transicare.  Psychiatric coverage is currently scheduled until 2200 tonight, and from 0800-2200 tomorrow.  Agnes Hamilton is (desperately) seeking additional coverage.  I will be providing after hours coverage as needed, but I would appreciate some rotation in coverage for this 2200-0800 shift if there are any volunteers for phone backup.

          We have a short form for evaluations that are being used.  Also, please log any hours that you spend here providing care (there is a form I will send out later).

          A brief comment on the situation here.  Please understand that as a health care professional providing medical care in a crisis situation like this,  you will be seen to be in a leadership role irrespective of whether you think of yourself in this role or not.  This is very much a group effort.  It will be disorganized in certain aspects, and it can easily be frustrating (I would say, I am quite impressed with how organized and calm it is at the current time).  As a leader, it is very important that you remain calm, collected, and not allow the stress of the situation to get the better of you.  Many of the people here are having to be evacuated for the 2nd time in 3 years, and they will be observing you and your reactions, and they will take cues from you.  One of the most important things that you can do for them clinically is to convey a sense of calm.  Feel free to ventilate to me or after you leave.  Please do not attempt to instruct others on how best to do their jobs, (unless asked for the consult of course  I am sure that you will all do very well here, but being the rather obsessive individual that I am, I felt compelled to state this before the action starts in earnest.

From Frank Webster MD 1400 CDT Sunday August 31 2008

 Hello all,

    As of 1400 today, we have about 200-300 evacuees at the Convention Center.
    Adapt Crisis services, Transicare, and ValueOptions are on the floor.  I am heading there in a few minutes.  I apologize for the late notification, but I was just able to get through to the powers that be about 2 minutes ago.

    It is a smaller group than the Katrina evacuation, and the area is smaller.  Sandy Potter estimates that we need 2-3 doctors for the evening.  We also will need people available for the next several days, as per Janie Metzinger’s email.

    I have conflicting information regarding bading (sic) (badging?).  I am told we are to go to the County health department (4th floor across I-35 from the Medical Center Complex.)  I am told that they will be closed after 1500 today.  I do not know if they are open tomorrow, but I assume that they are. I am also told that for those who have a UT/Parkland ID that this will suffice.

    I am heading out now, and I am going to ask Agnes Hamilton to be calling for additional assistance.  Please email her at Agnes.Hamilton@utsouthwestern.edu if you are interested in going out tonight or in the morning.  We may need to provide 24/7 coverage for psychiatry, so any that are interested in the graveyard shift, I appreciate that.  I do not know how much access I will have for email after I leave.  I am hoping they will have some set up, but I am told there is not currently any.  I am going to ask Agnes and Janie Metzinger, Public Policy Director at MHA, JMetzinger@mhadallas.org, to work on coordinating a schedule for later tonight and tomorrow-Tuesday.

     Thank you all for your cooperation.
    Please forward this as needed, as I realize my list of names may be incomplete.
    If you wish to monitor the storm’s progress, here is the National Hurricane Center/NOAA link:
        http://www.nhc.noaa.gov/graphics_at2.shtml?5day#contents