In southeastern Texas, about two dozen hospitals remained closed as of midafternoon Wednesday, and several Houston hospitals remain under threat of flooding from nearby reservoirs.

But things are looking up. Some hospitals that had been evacuated have reopened, and others are restoring services they had temporarily suspended. Many never closed at all.

A catastrophic medical operations center, housed within Houston’s emergency center, has been coordinating with hospitals throughout the storm and continues to field calls about patients needing evacuation or immediate medical attention.

All Things Considered host Kelly McEvers spoke with Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, which runs the catastrophic medical operations center.

This interview has been edited for length and clarity.

Interview Highlights

While the storm has largely left Houston, the flooding continues. What is the situation with the hospitals you’re working with?

The flooding is devastating, and we have at least two reservoirs where water is having to be released and is, in fact, flooding neighborhoods as we speak and has placed three hospitals in harm’s way.

The three hospitals are monitoring the water coming from the two reservoirs very closely, and they could, depending on the flow of the water, find that they could become inaccessible to EMS agencies. We are tracking that very closely.

The situation with residents in their homes — some are on the second floor of their homes — the evacuation process [for those neighborhoods] continues, and, as a result, it’s unclear what the demands on the health care system may be. However, most hospitals are up and fully functional, and we believe we can handle any new demands that happen today or tomorrow.

Has the catastrophic medical operations center ever handled anything like this?

No. The phone lines at one point became inundated. The amount of resources needed began to exceed what we had available. The calls included patients needing dialysis who might be at home. It included hospitals saying we need to evacuate. One call was asking for 50 wheelchairs to be sent to a shelter. We didn’t have 50 wheelchairs left. Fortunately, our governor declared a disaster and the president declared a disaster and resources have been brought in from all over the state and all over the nation to help us.

How did you get those 50 wheelchairs?

I’m not clear on how they ended up getting the 50 wheelchairs, but I can tell you, it can be accomplished just through one or two tweets to Houstonians. Those with wheelchairs perhaps in their attic or stored [elsewhere] could bring an abundance of wheelchairs, perhaps more than you even need. So there are methods to solve every problem. It’s just having enough people to make the calls or to be innovative and creative to solve the problems. This community has come to the call.

A number of hospitals did evacuate, either prior to the storm or during. How difficult is it to evacuate a hospital?

It’s not as simple as pulling up a bus or a convoy of ambulances and moving patients from one hospital to another hospital. My organization makes sure that the receiving hospital meets the need of every single patient they agree to receive. As a result, the evacuation of a hospital might mean we must identify 10 different hospitals to meet the unique needs of each patient.

Every day, three times per day, we have hospitals electronically advise us of beds that they have available and the type. So a pediatric patient goes to a pediatric bed.

And we’ve also spent time making sure the receiving hospital is not in harm’s way so that the patient would not have to be evacuated twice. We have worked with the [Texas] Department of State Health Services to also identify hospitals with beds available in cities such as Dallas or San Antonio or Austin or even further away so that a patient doesn’t move twice.

We’ve heard news of at least one hospital being short of food. Has that been resolved?

Yes. I was intimately involved in the Ben Taub [Hospital] decision to evacuate, and I was aware of their call for food. It was not a problem that was devastating or affecting patient care to any significant extent, and it did not last throughout the disaster period.

We do have to deal with situations where we have to dig down and find out the truth and make sure our response is responding to facts and not to stories that might have had some facts at one point, but as days went by, it became a little distorted.

[Editor’s note: Ben Taub Hospital confirmed to NPR that they have reopened, that supply lines are steadily improving and that they have received a food delivery and are expecting another one today.]

A number of Houston hospitals added flood protections as a result of other devastating storms, including Allison in 2001. Have those worked?

Absolutely. We had a situation where in prior storms, water came into a tunnel system that connects the Texas Medical Center hospitals. [The tunnels] make it easier to go from one hospital to another hospital. However, waters came in and flooded every hospital through that tunnel system.

The Texas Medical Center invested in submarine-type doorways, and when there is a risk of flooding, they now close those doorways. So each hospital is compartmentalized. As a result, this storm — even though flooding devastated our community, it did not devastate Texas Medical Center. So, congratulations to the Texas Medical Center.

Do the hospitals have the staff they need right now?

I can imagine some of the hospitals have fewer employees available to staff the hospital. Some members of their workforce have lost everything — their homes destroyed, their automobiles destroyed.

Tomorrow, we will be holding a meeting to discuss what do our hospitals need. And from there we will be identifying where we need to place nurses. We have an abundance of nurses from throughout Texas who have offered to help. We also have an abundance of physicians who have offered to help. Now it’s a matter of making sure we place them in the proper facilities.

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As floodwaters continue to rise in parts of Houston, health workers are trying to keep people safe and well, though that challenge is escalating.

“The first and foremost thing that everybody’s concerned about is just getting folks out of harm’s way with the flooded waters,” says Dr. Umair Shah, Executive Director of Harris County Public Health, whose own home came under mandatory evacuation Tuesday morning.

Before the storm hit, Harris County Public Health sent out a number of messages warning residents of to avoid hazards presented by flood waters: downed power lines, sewage contamination, rusted nails and the possibility of critters in the water — everything from snakes to spiders to alligators.

Now that people are showing up in shelters, efforts are turning to helping people with both health issues arising from the flood — including respiratory and gastrointestinal problems — and with getting care for preexisting conditions, some of which can be life-threatening if not treated promptly.

“That doesn’t even obviously take into account the numerous injuries and the mental health issues that all come into play. So it’s a very complicated response system,” Shah tells All Things Considered host Ari Shapiro.

Shah remembers that after Hurricane Katrina in 2005, health workers set up clinics in shelters and asked people with anxiety or schizophrenia to come forward. Many were not willing to do so. “So we actually had to fan into the shelter to identify ourselves mental health issues,” Shah recalls. “That’s a big component and something we’re also mindful of now.”

At the George R. Brown Convention Center in downtown Houston, licensed clinical social worker Brittany Burch showed up to help some of the thousands of people who have taken shelter there. As she tells NPR, she’s already seeing and hearing a lot of distress.

“A lot of people really overwhelmed, stories of having to jump in a boat or get a helicopter out, wade through waist-high water, losing everything,” she says. “So just a lot of people in shock, trying to adjust to what’s happened and what happens from here.”

Burch has heard from people who, before the storm, already suffered from chronic depression, post-traumatic stress disorder, bipolar disorder and other illnesses. “Some people haven’t been on their medications for a few days,” she says. “So there’s a lot of stress just being here, and then the extra mental health needs that arise in the midst of this [are] also very challenging.”

“There is such an unmet medical need,” says Kristin Malaer, another social worker who also showed up to volunteer. “Just going and connecting with people, you find out so many of them are diabetic or so many of them have chronic medical illness, that serving them all is pretty overwhelming.”

Among the more pressing medical issues is getting treatment to the sizeable population of people on dialysis.

DaVita, a leading provider of dialysis services nationwide, says the company normally serves approximately 6,700 patients in Houston. About a third of their 100 or so centers in the city remain open for all patients who need dialysis, according to Chakilla Robinson White, who oversees operations at DaVita’s dialysis centers in Texas and neighboring states.

“We are trying to call proactively and ensure that those patients we know need treatment are seeking treatment, either with us or within a hospital system,” White says. “We’re like, ‘Hey, we would like to see you in a center. What do we need to do to be able to get you here?’ “

For patients they reach who are stuck in their homes, surrounded by flood water, they’re trying to arrange transportation. “We’re alerting the authorities that this is a medical emergency so that they can get prioritized,” she says.

Gail Torres, senior clinical communications director for the National Kidney Foundation, says forgoing dialysis treatment for even a day can be extremely dangerous, particularly to the heart.

“Certain toxins can build up, but most importantly, potassium and fluid can affect the heart,” she says. “If you have a buildup of potassium, depending on what their baseline is, it can send them into cardiac arrest.” She says that delays in treatment can result in cumulative damage, as they saw after Hurricane Katrina in 2005 and Superstorm Sandy in 2012.

In Houston, DaVita is working to bring in enough staff to keep dialysis centers open, calling in workers from other cities and states and also finding ways to get their Houston-based colleagues to work.

“We’re working on bringing in boats to actually get our teammates in some of the neighborhoods where they’re unable to escape through the flood,” White says. “It’s amazing how many teammates have had hardships themselves, losing part of their homes and still showing up to treat our patients.”

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