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U.S. Department of Health and Human Services

Responding to Hurricane Florence: Coordinating State Medical Support Shelters through an HCC-centered State Medical Response System

On September 14, 2018, Hurricane Florence made landfall just south of Wrightsville Beach, North Carolina with winds whipping at 105 miles per hour. The hurricane would eventually require over 700,000 evacuations, impacting patients from over 250 medical facilities – including those requiring dialysis, mental health care, and long-term nursing home needs. The response required the coordination and movement of hundreds of patients with specialized health care needs, many of whom had varying levels of notice to arrange for their regular treatments or medication. Thanks to the state and HCC-coordinated response, the foundation of which was funded by ASPR’s Hospital Preparedness Program (HPP), these vulnerable populations were relocated, cared for, and far from forgotten.

North Carolina’s Health Care Coalitions (HCC), funded by ASPR’s HPP, were ready and able to lead the response. HCCs foster partnerships and planning between hospitals, public health agencies, emergency medical services, emergency management, and other members of the health care community. They also use HPP funds to develop action plans, conduct trainings, and implement interoperable communication systems throughout the year to prepare for and respond to emergencies. Doctor and nurse transporting a patient down a hall


In the days leading up to Hurricane Florence, North Carolina activated all eight regional HCCs through their State Medical Response System (SMRS). Once activated, HCCs began command and oversight for five State Medical Support Shelters, coordinating staffing and logistics for each. HCCs held daily calls with hospitals to receive patient lists, verify information, and initiate over 112 patient transfers to hospitals across the state and over 300 patient transfers to a State Medical Support Shelter.

Multiple HCCs, including Duke Healthcare Preparedness Coalition, Mid Carolina Healthcare Preparedness Coalition and CapRAC Healthcare Preparedness Coalition, teamed up to establish a 100-bed State Medical Support Shelter, which provided 24/7 medical care for patients that had lost their community health care support due to the storm. This shelter was designated to treat at-risk patients who required assistance with activities of daily living or skilled nursing home-level care beyond what a general shelter could provide. Fortunately, the HCCs had done extensive preparation, and already had advanced plans to set up the shelter operations, obtain equipment, and staff the shelter with qualified physicians, nurses, and paramedics.

The HCCs also played a vital role in integrating the shelter with the community, both by connecting with health care stakeholders across the state and by facilitating a continued sense of compassion within the shelter. For patients who were evacuated with little to no notice, HCCs coordinated with local pharmacies and hospital systems to obtain their necessary medications so the drastic effects of the hurricane would not be compounded by patients missing vital medications. Additionally, HCCs identified nursing homes and home care providers who could more thoroughly accommodate the long-term needs of patients in the shelter – an effort the HCCs will continue to work towards incorporating in future preparedness planning.

“Thanks to the HCCs, these vulnerable patients received continuity in their care and were able to stay outside the already crowded emergency departments, where at-risk patients so often end up during disasters,” said Dr. Brenda Lanan, Medical Director of the Duke Healthcare Preparedness Coalition, who provided on-the-ground support in the State Medical Support Shelter. “Our entire community was invested in making sure the shelter was operating successfully, and had the right materials in place for patients requiring specialized medical attention. HPP and the Duke Healthcare Preparedness Coalition allowed us to not only direct patients to the right shelter, but also ensure that our most vulnerable were not overlooked.”  

  • This page last reviewed: April 13, 2020