Rapid Reinstatement of Cancer Care after Hurricane Ian

Abstract

Category 4 Hurricane Ian brought significant destruction and challenges to western Florida's healthcare facilities. A Radiation Oncology practice network serving the area minimized interruptions in care by implementing planned and improvised solutions. Examining actions that allowed rapid recovery of care could assist others in disaster response. The National Hurricane Center issued a hurricane warning 36 hours prior to Ian's landfall. Center closures were based on evacuations and scheduled take down of the power grid. Computers were unplugged, elevated and wrapped in plastic. The LINAC was isolated from the power grid at the main breaker. Staff and patient contacts were printed. Communication techniques were agreed upon for post-storm scenarios with or without cellular service and internet. Hurricane Ian made landfall on September 28 with 150 mph sustained winds and gusts of 216 mph. Unsafe conditions prevented action on September 28. Facility assessment began on September 29. The majority of facilities were inaccessible due to impassible roads and entry hazards, or could not be safely occupied. Based on location and condition, one center from the network of facilities was selected for immediate operational restoration. After confirmation that the site's restored power would remain stable, the LINAC was powered on. An onsite engineering evaluation was done to assess machine functionality and vacuum integrity. Medical Physics then performed monthly QA and isocenter verification due to concern for building vibrations from extreme winds. Interfacing with patient charts in the Aria database was more complex than anticipated. Aria is a hub that uses relative paths to refer to plans, structure sets, images, and radiotherapy treatment records stored in remote servers. These Aria servers could not be accessed because the remote sites had no power. As the Aria servers could not be moved, teams went to retrieve the related Adaptivo servers to allow re-import of patient plans. When booted these servers had no common network and no graphical user interface. Using command line tools, the servers were added to the hub network and IP addresses were assigned. MS-DOS command Robocopy allowed a large-scale resumable transfer from Adaptivo patient folders to the Eclipse import directory. Plan validation and QA followed. Records could not be updated with delivered treatments, necessitating reconciliation of total dose when normal operations resumed. Within 72 hours of Ian passing, treatment resumed for all patients within the cancer center network who were able to access the restored site. Within days, seven of the eight regional centers were operational and patients were redistributed. The unexpected challenges posed by data and network access suggest that improving data location and back-up networks could facilitate center response and resiliency in future disasters.