A dramatic helicopter evacuation of a Tennessee hospital Friday, as raging floodwaters from Hurricane Helene surrounded the building, underscores what health experts say are rising dangers to patients and caregivers as climate-related disasters strike vulnerable facilities.
Footage of Virginia State Police choppers rescuing 54 patients and staff from the Unicoi County Hospital roof went viral on social media in near-real time as the monster storm raced from the Gulf Coast to southern Tennessee with unusual speed, drenching the region with downpours and killing at least 100 people.
The storm’s widespread impact across the southern United States underscores how climate change jeopardizes the nation’s health care system. The brick and mortar buildings Americans depend on to recover from crises such as Helene are themselves in peril as rising temperatures intensify disasters.
The daring hospital evacuation stunned health officials because of the danger to patients, staff and rescuers. But extreme weather is having widespread consequences on the health care industry that often go unnoticed.
Several county health departments across Tennessee remain closed due to flooding, while other hospitals have paused outpatient surgeries and chemotherapy treatments in the wake of Helene.
Some emergency rooms in southern Appalachia are only open for patients who are giving birth, nearly a week after the storm made landfall on the Gulf Coast. And thousands of pharmacies across the southeastern U.S. are out of commission, leaving survivors with few places to turn for life-saving drugs after their medicine cabinets were washed away in the storm.
The public health emergency could worsen in the coming days, with more than 1.5 million people still without power as of Tuesday and hundreds of counties lacking clean drinking water. Mission Hospital in Asheville, North Carolina, has been inundated with people whose homes remain dark.
Health impacts like those still unfolding in Helene’s wake will become more common as increasing rainfall from warmer temperatures raises the risk of flooding, according to health experts.
“What we are seeing play out during and after Helene — this is the type of situation we can expect to see more of as a result of climate change,” said Caleb Dresser, an emergency physician who leads efforts to improve climate readiness of health care centers with Harvard University’s Center for Climate, Health, and the Global Environment.
A daring rescue
The drama at Unicoi County Hospital in Erwin, Tennessee, located at more than 1,600 feet above sea level, began just after 9:30 a.m. on Friday, when county emergency managers warned hospital staff to evacuate due to surging floodwater from the nearby Nolichucky River.
County officials sent ambulances to move 11 patients, but “the flooding of the property happened so quickly, the ambulances could not safely approach the hospital,” according to a social media post by Ballad Health, which owns the hospital and several others in the Appalachian Highlands.
The Tennessee Emergency Management Agency sent boats to help evacuate the hospital around 10:20 a.m., but “the water around the hospital, which had also begun intruding inside the hospital, became extremely dangerous and impassable,” preventing the boats from leaving the area, Ballad Health said.
Around 12:30 p.m., some 54 patients and staff members were sheltering from the floodwaters on the roof of the hospital, which “had been engulfed by extremely dangerous and rapidly moving water.”
High winds and heavy rains delayed helicopter evacuations for hours, until after 3 p.m. Video of the rescue posted by the Virginia State Police shows helicopters hovering over rushing, murky brown water as islands of debris careened around the hospital, where patients and staff huddled together. Everyone was safely evacuated by Friday afternoon.
Five days later, the hospital remains closed. Video posted by the Hamilton County Office Emergency Management and Homeland Security after the flood shows cars, ambulances and rescue boats buried in mud around the hospital.
It wasn’t the only medical facility that had to be shut down during Helene. Emergency crews also evacuated about 39 patients from Sycamore Shoals Hospital in Elizabethton, Tennessee, on Friday. The hospital is still closed to inpatients, though its emergency room remains open.
Meanwhile, damage from up to 30 inches of rain across the mountainous Southeast has forced dozens of water systems offline and left nearly 2 million people without power.
Those problems are affecting health care systems. Lack of water at Greeneville Community Hospital in Greeneville, Tennessee, forced officials to suspend all operations outside of its emergency room, except for “patients who are in active labor.”
As of Tuesday, some 31 health care facilities in Florida had been evacuated, while 11 others in Georgia and North Carolina were using power from generators, according to a briefing document from the Federal Emergency Management Agency. Four facilities in Georgia remained without water.
In response to the storm, the federal Department of Health and Human Services declared a public health emergency in Georgia, Florida and North Carolina, deploying approximately 200 personnel from the Administration for Strategic Preparedness and Response to assess the impacts on hospitals, nursing homes, dialysis centers and other health care facilities.
Rebuilding the facilities will be a challenge given the damage to roads. In North Carolina, Gov. Roy Cooper (D) said at a press conference Sunday that he “made it a primary objective to get power back to the hospitals and make sure they’re operating.”
Federal personnel from the Health and Medical Task Force and Disaster Medical Assistance Teams are on the ground in North Carolina to treat patients at two hospitals in Asheville and Spruce Pine. The federal government has sent 200 ambulances to the state.
‘Preparing for what’s next’
Cooper and FEMA Administrator Deanne Criswell on Monday visited Mission Hospital, where 20 water tanker trucks have been used every day since the storm to feed air-conditioning chillers.
Greg Lowe, president of the North Carolina division of HCA Healthcare, which owns Mission Hospital, said there is a constant stream of patients arriving with family members and pets because they did not have power at home. During the visit by Cooper and Criswell, about 80 emergency room patients were waiting to be admitted.
The hospital has also purchased three mobile morgues to help handle increased deaths as storm recovery operations continue.
“We’re preparing for what’s next,” Lowe said, according to a pool report.
At the same time, more than 200 roads are closed in the state, including parts of I-40 and I-6. The state National Guard and federal officials are sending supplies to Asheville, then air lifting them to other parts of the state that are inaccessible by land.
“The problem is that the mountains of North Carolina are beautiful, but there is a lot of rugged terrain,” Cooper said on CNN on Monday. “When landslides have occurred and flooding has occurred, it is almost impossible to traverse.”
The storm’s death toll is over 100, but officials expect that number to rise, in part due to the lack of power and water.
Nearly 400 drinking water systems across the Southeast have boil water advisories, according to FEMA. A similar number of wastewater systems remain at least partially inoperable, raising concerns about people becoming infected by drinking contaminated water or having contact with dirty floodwater.
“Even as rain and winds have subsided, the challenges for people there increase,” Cooper said Sunday.
Hundreds of thousands of people in the region rely on medical equipment that requires electricity, like at-home oxygen supplies and dialysis machines. As of Friday, nearly a half-million Medicare beneficiaries who use those machines were under extreme weather advisories in Florida, Georgia, North Carolina and Tennessee, according to federal data.
Data tracked by the nonprofit Healthcare Ready shows that more than 18,600 pharmacies in seven states are still closed or their status is unknown.
“A large portion of the American population requires daily medications, dialysis every few days, chemotherapy infusions or other contact with the health care system for treatments that maintain their health, and all of that can be interrupted when power is out and critical infrastructure is damaged,” said Dresser, the Harvard doctor.
Climate impacts
Helene isn’t the first disaster to pummel the nation’s health care system this year.
Hospitals and nursing homes in Iowa had to be evacuated in June after torrential rains swamped parts of the state and shut off electricity and drinking water.
The same month, patients at a chemotherapy center in Fort Myers, Florida, became stranded when a heavy rainstorm submerged surrounding roadways.
And the disruptions are expected to get worse.
A 2022 study found that even relatively weak storms can pose serious flood risk to hospitals along the East Coast. That study, which looked at hospitals in 78 metropolitan areas located within 10 miles of the Atlantic and Gulf coasts, found that climate change increases the odds of hospital flooding by 22 percent.
Even if hospitals themselves do not flood, inundation of nearby waterways could still disrupt health care. In 18 metro areas, a Category 2 hurricane would put at least half the roads within 1 mile of hospitals at risk of flooding.
“With prospects of more intense hurricanes making landfall atop higher seas owing to climate change, greater resilience to hurricanes will be necessary to insure that healthcare remains viable when it is needed most,” the researchers found.
At least one hospital was ready for Helene.
Two years ago, Florida’s Tampa General Hospital built a large energy plant 33 feet above sea level to provide the hospital with “a reliable protected power supply in the event of power disruption.” It was built to withstand a Category 5 hurricane, and houses generators and boilers to create steam and hot water.
The hospital also owns a portable 15-foot-high “AquaFence” floodwall that it deploys ahead of hurricanes to protect its facilities.
On Friday, after Helene had moved on from Florida to wreak havoc on southern Appalachia, the hospital posted photos on social media to show that it “remains open and our team stands ready to care for our community.”
It said the AquaFence “stood strong against #HurricaneHelene.”
