Nurses use critical-thinking skills every day. On extraordinary days, some are called on to become critical commanders. Kim Ryan, the new CEO of Emory Eastside Medical Center in Snellville, knows what that's like.

Ryan, RN, MS, MBA, was chief operating officer of Tulane Medical Center in New Orleans when Hurricane Katrina struck on Aug. 29, 2005. She led the hospital's command center, which safely evacuated all 178 patients and 1,100 physicians, employees and their families during the flood that followed.

Photos by BARRY WILLIAMS/Special (ENLARGE)

Kim Ryan had this montage made of photographs taken after Hurricane Katrina. She gave copies to several people who worked in the command center at Tulane Medical Center.

(ENLARGE)

Kim Ryan shares a light moment with Wally Kocon, a former volunteer and a patient at Emory Eastside Medical Center in Snellville.

Ryan was already a veteran of dealing with severe storms, having weathered eight hurricanes in seven years.

"We had opened our command center many times — when hurricanes threatened the city and just to practice for emergencies," she said. "That practice was instrumental in our success with Katrina. We all knew our own and each other's roles."

Hospital directors were already closely monitoring the weather three days before the storm hit. At 10 a.m. on Aug. 27, the hurricane gathered strength, shifted direction and headed for New Orleans. Ryan opened the command center immediately.

Nursing leaders and medical officers assessed patients and released those who could be discharged safely.

"Because of the high acuity of some patients, we didn't plan a full-scale evacuation. We had patients on ventilators and two on heart pumps," Ryan said. "We began preparing to shelter."

She called in two shifts of staff members — one to work while the other slept — and secured rooms at nearby hotels for their families. The operations staff began securing the physical plant — boarding up windows and moving the ground-floor emergency room and pharmacy to the third floor of the hospital.

Ryan told her bosses at HCA Tristar Health System in Nashville — which owns Tulane Medical Center — that she was afraid of losing emergency power. They supplied a tanker truck of diesel fuel for the emergency generator, and she obtained portable gas generators to power equipment needed for patients on life-support systems.

The staff worked around the clock on Aug. 27 and Aug. 28 to get ready for the storm. That work paid off.

"Two things led to our success. We communicated with everyone — nurses, doctors, physicians, residents and family members — twice a day. They knew everything we knew," Ryan said. "The second was a strategic decision to move all the patients [who were] on life support — from neonates to 90-year-olds — together in one place.

"Forecasters said this storm was like no other, and we thought we might lose emergency power."

When the storm hit — on the morning of Aug. 29 — the hospital lost power but the emergency power system took over.

Although Ryan could see roofs blowing off nearby buildings, Tulane Medical Center suffered very little wind damage. By 9:30 p.m., the staff had moved the emergency room and pharmacy back downstairs.

But soon afterward, the hospital's physical plant director reported that the first floor was flooding at a rate of one inch every five minutes.

Evacuation starts

Knowing that the emergency generator switches were below sea level, Ryan tried to call the hospital CEO and division president. With cellphone towers out, it took an hour to get through. The decision was made to evacuate the hospital.

With New Orleans flooding, HCA hastily made arrangements for helicopters to evacuate patients from the roof of the hospital.

"We didn't know the coordinates to tell pilots, and whether the roof would hold. The whole city was dark," Ryan said.

Ryan's 25-year-old daughter was with her at the hospital to set up day care for staff members' children. Her husband and twin teenage sons were at home across Lake Pontchartrain. Ryan had no way to contact them, and it would be Aug. 31 before a helicopter pilot delivered a note saying that they were safe.

The helicopters were life-savers, but Ryan never knew what type of copter was coming and how much weight each one could handle. Staff members on the roof used walkie-talkies to relay information, such as how many patients and what equipment each copter could transport. Neonatal and pediatric patients on ventilators were the first flown to other hospitals.

Things got hairy when the hospital lost emergency power on Aug. 30. All the patients who were on ventilators had been airlifted, but not the ones on heart-pumps.

Staff members began siphoning gas from cars to power the portable generators.

There was 3½ to 5 feet of water on the first floor of the hospital, where workers had to go to get supplies.

"It was 120 degrees — you can't imagine how much we sweated — and dark. We had to walk through water and sewage and everyone's feet got infected," Ryan said.

On Aug. 31 shots fired at some of the helicopters caused rescue efforts to be suspended overnight. A SWAT team arrived at the hospital because a call [which turned out to be false] had been made to the governor's office about a hostage situation at Tulane Medical Center.

"We had no idea what was happening most of the time, but our administrators did a phenomenal job and all our patients were out by Thursday night [Sept. 1]," Ryan said.

The last of the staff members left the next day.

Back to work

Ryan had already gone to set up a staging area at the airport for the evacuees to leave New Orleans. Tulane Medical Center employees went by bus to an HCA hospital in Lafayette, La. Ryan left on the last bus, grateful to have food, water, a blanket and decontaminated feet for the air-conditioned ride.

With the initial crisis over, Ryan spent two days reuniting with her husband and sons, who were staying with her sister in Chicago. She returned to New Orleans, and, by Sept. 4, HCA had decided to reopen the hospital. It would take two-and-a-half years to fully remediate the facility.

"We had no idea of the challenges when we started," she said.

Water damage had corroded the steel and plumbing infrastructure. Mold had destroyed equipment. About 80 percent of hospital employees had lost everything, and administrators had to find housing for employees and bus some in from as far away as Baton Rouge.

"Everything we did was a work-around, but we reopened with 63 beds, emergency and operating rooms, catheterization labs and other services on Feb. 14 [2006], before the city's first Mardi Gras after the storm," Ryan said.

Tulane Medical Center was the first of the city's hospital that had been flooded to reopen.

Lessons learned

Since Katrina, Ryan has traveled the country, telling health care groups about the lessons learned from the disaster — and the value of teamwork and preparation.

"I tell them to do multiple disaster drills. We had to face a hurricane, flooding and civil unrest — all on top of each other," Ryan said.

She also reminds disaster planners to remember the personal needs of their workers. Psychologists counseled Tulane employees, most of whom have suffered from post-traumatic stress disorder.

"I could never have walked away when we were rebuilding the hospital," Ryan said.

The bonds were too strong and her emotions were too attached to Tulane Medical Center. But when the rebuilding was over, Ryan was ready for a new challenge at Emory Eastside Medical Center.

She considers her job as CEO of the 200-bed hospital a gift.

"I've found a lot of talented people and the largest base of volunteers I've ever experienced," Ryan said.

It fits her "participative leadership" style. "I like to build a diverse team, make a strategic plan and implement it," she said.

Ryan has plans to expand and take the hospital to a new level of care. No one doubts that she will.