On a typical Saturday or Sunday, Charleston Area Medical Center Health System uses approximately 7,200 gallons of water at its three hospitals in West Virginia's capital city. Usage jumps to 11,000 gallons on a weekday.

So, you can imagine the call to action that went out last Thursday when health system officials, like everyone else in the Kanawha Valley, were told that they couldn't use tap water. At all. For anything. A freak accident at Freedom Industries dumped thousands of gallons of 4-methylcyclohexane methanol — a chemical used to clean coal before it is burned, among other things — into the Elk River. The contamination set off a rush on bottled water at grocery stores, Sam's Club and just about everywhere else.

"When we got the call, we set up a central command center and then a command center at each of the three hospitals," the health system's CEO and President David Ramsey told me yesterday. "Our central command center coordinated communications with state agencies; we centralized purchasing for food service, water and ice. We then communicated with the command centers at the hospitals which were really the boots on the ground."

While getting the command centers up and running on Thursday, the health system's Level 1 trauma center, the only one in Charleston, had to go on diversion. Transfers were halted. Elective surgeries cancelled.

During the next 22 hours, health system officials worked with vendors — Coca-Cola, Pepsi and others — to get bottled water and ice shipped in. By Friday, they had enough water on hand to reopen the trauma center, accept some transfers and begin delivering water and meals again to patients. Challenges remained though, like getting laundry done and sterilizing surgical equipment. In fact, the three hospitals carted 460 surgical trays to their sister hospital 28 miles away. Staff at the 70-bed Teays Valley Hospital worked around the clock last weekend to sterilize the trays and get them back to Charleston.

"We had so many questions about what could be done," said Dan Lauffer, COO at Thomas Health System, also in Charleston. "There wasn't really a good understanding of the chemical. How many parts per million were safe to drink? Is it water soluble? Is a diluted concentration safe?"

It took 14–16 hours to get word from regulators that the chemical is rendered inert once heated to 250 degrees Celsius. Sterilization occurs at 270 degrees. In the interim, Lauffer said health system officials were in consultation with the National Guard about potentially setting up a MASH unit. They also considered having a tanker truck feed directly into the sterilization system.

"While staff were executing the emergency plan, they were also thinking two to three steps ahead," he said. "We were looking at all of the what-ifs."

Lauffer said that the health system plans for utility failures, but typically for such things as a water main break. "When you talk about water and water shortages, we do have water storage on hand, but for this large of an area and this long of a time, it was hard to keep resources on hand."

Even as they struggled to keep operations running, hospital staff never lost sight of their top priority — patient care, both Lauffer and Ramsey said. Infection prevention protocols were still in place. No soap and water? There was plenty of hand sanitizer flowing. Baby wipes were used as necessary for sanitation. Thomas Health System bought clean linens and hospitals in neighboring communities stepped up and offered to wash laundry.

More than anything, Lauffer and Ramsey were effusive in their praise of staff. In fact, Ramsey wrote a letter to the health system's board commending staff efforts during this crisis. "You should be proud of them, because I am," he wrote.

As things slowly get back to normal in Charleston, attention is turning to accounting for the disaster. Direct costs — buying ice, water and supplies — totaled $2 million at CAMC, according to Ramsey. Lauffer didn't have a total, but guessed the costs would be in the "hundreds of thousands." Of course, that doesn't include lost revenue from canceled elective procedures and diversions.

"Given all of the other pressures we are facing with meaningful use, ICD-10, the exchanges and higher co-pays, this certainly is going to have pressure on our bottom line," Lauffer said.

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