ERWIN, Tenn. — April Boyd texted her husband earlier than she boarded the helicopter.
“So, I don’t want to be dramatic,” she wrote on Sept. 27, “but we are gonna fly and rescue patients from the rooftop of Unicoi hospital.”
Earlier that day, Hurricane Helene roared into the Southern Appalachian Mountains after shifting north via Florida and Georgia. The storm prompted a lethal flash flood that tore via Unicoi County in jap Tennessee, trapping dozens of individuals on the rooftop of the county hospital.
The fast-moving floodwaters had made earlier rescue makes an attempt by ambulance and boat unattainable. Trees, trailers, buildings, caskets, and vehicles swept previous the hospital in murky, brown rapids that overwhelmed the one-story construction with 12 toes of water on all sides.
Hospital staffers and emergency responders tried to evacuate sufferers first by ambulance after which by boat when the Nolichucky River overwhelmed Unicoi County Hospital throughout Hurricane Helene. Eventually, everybody was evacuated by helicopter.(Ballad Health)
Hurricane Helene prompted a lethal flash flood that tore via Unicoi County in jap Tennessee. (BALLAD HEALTH)
No one knew how lengthy the hospital’s body would maintain or if the rising water would breach the highest of the 20-foot-tall constructing. Little greater than a mile downstream, six individuals at a plastics plant in Erwin’s industrial park died within the flood.
“I do not feel good about this,” Boyd, a flight nurse for Ballad Health, texted her husband at 1:41 p.m., simply earlier than takeoff.
She wrote that she liked him. “If anything goes wrong,” she needed him to inform her daughters “how much I love them,” too.
Her fears had been well-founded.
In 2018, Unicoi County Hospital relocated from increased floor within the coronary heart of Erwin to the southern fringe of city, between Interstate 26 and the Nolichucky River. The new hospital was inbuilt a recognized flood plain, however the facility wasn’t designed to accommodate helicopter landings on its roof. Boyd and her staff weren’t certain the roof may bear the burden of their 7,200-pound Eurocopter in good climate, not to mention throughout a flash flood.
“I had a horrible feeling about it,” she stated.
By many accounts, the evacuation of 70 individuals, together with 11 sufferers, by helicopter that day was a shocking success. The hospital was destroyed, however nobody died. No one was even bodily injured by the ordeal.
Yet, earth scientists, emergency administration officers, and others who spoke to KFF Health News describe the slender escape from Unicoi County Hospital as a cautionary story. As local weather change forces well being care leaders and public officers to arrange for extreme storms in landlocked elements of the nation — the place residents haven’t traditionally paid a lot consideration to hurricane warnings — they should be strategic about each the infrastructure design and the areas chosen for brand spanking new tasks, like hospitals.
The Biden administration finalized a rule this 12 months designed to make the development of such tasks that obtain funding from the Federal Emergency Management Agency extra resilient to flooding. But a evaluate by KFF Health News recognized about 20 different Tennessee hospitals already inbuilt, or close to, flood plains.
Patrick Sheehan, director of the Tennessee Emergency Management Agency, stated previous climate patterns can lull individuals right into a false sense of safety. But, he added, “past is not always prologue. We’re going to experience novel, new ways of having disasters.”
Historically, the Southern Appalachian Mountains have been the place “where hurricanes go to die,” stated Ryan Thigpen, an earth and environmental sciences professor on the University of Kentucky whose analysis focuses on flooding within the area. But because the Gulf of Mexico turns into hotter and storms, like Helene, that transfer northward into the mountains carry extra moisture, climate occasions will turn into extra extreme.
“It’s apocalyptic,” stated Thigpen, of the harm in Erwin. “The next storm may come before they are finished recovering from this. And that’s kind of scary.”
The entrance foyer of the hospital after a flash flood throughout Hurricane Helene destroyed the constructing.(Maddy Alewine for KFF Health News)
All week, Michelle Matson had been anxious about Unicoi County Hospital within the oncoming storm.
As a district coordinator for the Tennessee Emergency Management Agency, Matson works with native officers to plan for worst-case eventualities.
Leading as much as Hurricane Helene, she’d been in common communication with the county’s emergency administration director. The hospital’s vulnerability subsequent to the river stored developing.
“That was the only place we were worried about,” Matson stated.
But concern over the hospital’s location wasn’t new.
In November 2013, Unicoi County Memorial Hospital, which opened in 1953, was acquired by Mountain States Health Alliance on the situation that Mountain States would assemble a hospital in Erwin to exchange the previous one.
Two years later, Mountain States bought a 45-acre tract of land subsequent to a bend within the Nolichucky River, simply off Interstate 26. A hospital system press launch on the time defined that due diligence had been carried out to make sure, amongst different issues, that the hospital constructing wouldn’t be in a flood plain. It additionally offered the situation as fascinating as a result of it was close to the interstate and the panorama would offer “a healing environment by taking advantage of the natural beauty of Unicoi County, with the river running along the east side of the property.”
Dating again many years, although, flood maps printed by FEMA put the complete property in a flood plain. The constructing itself was in a 500-year flood plain (that means a 0.2% likelihood of flooding in any given 12 months), whereas the one highway on and off the property was in a 100-year flood plain (that means a 1% annual threat).
The Nolichucky River, which flows north via Erwin, Tennessee, was reworked right into a lethal flash flood when rainfall from increased mountain altitudes drained into the river. The turbulent waters lower a path of destruction via Erwin that killed eight individuals.(Maddy Alewine for KFF Health News)
But it wasn’t solely FEMA maps that forecast this risk. In 2001, a report published by Unicoi County marked this land as being in a “flood hazard” space. The report warned of “considerable pressure” to develop flood hazard areas throughout the county “due to population increase and the need for vacant land.”
The identical report acknowledged a historical past of damaging flooding within the county and the dangers it confronted being located alongside “three major streams,” together with the Nolichucky River, which flows northward out of the Blue Ridge Mountains of western North Carolina straight via Erwin.
“If you start looking at the river’s history, there are a number of these notable flood events, and quite a few in the 20th century. They just did not reach this magnitude,” stated Philip Prince, a geologist with Appalachian Landslide Consultants. His YouTube videos about mountain flooding throughout Helene have been considered a whole bunch of hundreds of occasions. “People should have been expecting more than they did. But again, we have not seen anything like this.”
Matthew Rice, a former Unicoi County commissioner, served as chair of the Hospital Visioning Committee for the brand new hospital in 2015. He stated some committee members raised questions throughout the planning course of concerning the location, however he conceded there weren’t many giant, flat locations to construct a hospital in Erwin.
Amid a wave of rural hospital closures throughout the United States, Erwin residents celebrated when the brand new hospital opened in 2018. One lawmaker told the Johnson City Press it was “the most modern facility on the planet.”
Alan Levine was CEO of Mountain States Health Alliance throughout that point and later turned the pinnacle of Ballad Health, when Mountain States merged with a competing hospital system in 2018 to type the largest state-sanctioned hospital monopoly within the nation.
Levine stated Mountain States was conscious the property carried flood threat however famous that the hospital system added levees to guard the constructing from river flooding on the advice of outdoor consultants. One levee already existed alongside the river’s edge. And the hospital itself was intentionally constructed on a excessive level of the land, on the identical elevation because the interstate, Levine stated.
“I feel like everything we did when we built it was done the right way,” stated Levine, a former well being care chief in Louisiana and Florida.
Unicoi County Hospital in Erwin, Tennessee. (Maddy Alewine for KFF Health News)
More than two months after Hurricane Helene, the restoration continues. (Maddy Alewine for KFF Health News)
Even so, Matson, who lives in Kingsport, about 45 minutes northwest of Erwin, stated some residents had been quietly crucial of the brand new hospital’s location.
“We all thought that it was a stupid idea to build a hospital in a flood plain. It’s like, who does that?” Matson stated. She stated her opinion doesn’t signify an official place of the Tennessee Emergency Management Agency.
But Unicoi isn’t the one Tennessee hospital inbuilt a flood plain. Eight others throughout the state had been inbuilt moderate- or high-risk flood zones, and a dozen different hospitals are located simply outdoors them, KFF Health News discovered.
The hospitals in danger span the size of the state, from Memphis on the western edge to Knoxville within the east, and embrace big-city normal hospitals, smaller rural hospitals, and behavioral well being amenities.
Some of the hospitals are many years previous. Parkridge East Hospital in Chattanooga, for instance, was constructed within the Seventies inside a high-risk flood zone. Others are more moderen — like Creekside Behavioral Health in Kingsport. That constructing, which opened in 2018, straddles high- and moderate-risk flood zones.
Then there are amenities like Pinewood Springs in Columbia. The 60-bed psychological well being facility, which opened in 2020, is in a low-risk space, however the principle highway main out and in of the hospital lies in a high-risk flood space.
To establish these hospitals, KFF Health News regarded for licensed amenities in or close to areas that, in keeping with FEMA, have both a excessive flood threat (with a 1-in-100 likelihood of flooding in any given 12 months) or average threat (a 1-in-500 likelihood in any given 12 months).
But FEMA’s maps likely underestimate the true flood risk, researchers and authorities watchdogs agree, as a result of they’re largely outdated and don’t account for present or future circumstances, together with extra frequent and extra intense storms and flooding related to local weather change.
Those maps are up to date on an ongoing however gradual and piecemeal foundation. Meanwhile, the federal regulation finalized this 12 months to broaden areas thought of in danger for present and future flooding additionally units extra stringent constructing requirements for crucial infrastructure tasks situated in 100-year flood plains and funded by federal taxpayers.
The rule turned efficient on Sept. 9, lower than three weeks earlier than Hurricane Helene ravaged the Southern Appalachians, however it’s unclear whether or not the incoming Trump administration will protect it.
After he took workplace in 2017, President Donald Trump revoked federal flood safety requirements arrange beneath the Obama administration. Karoline Leavitt, a spokesperson for the incoming Trump administration, didn’t reply to emailed questions for this text.
An ‘Antiquated and Broken’ System
On Sept. 24, three days earlier than the hospital evacuation, the National Hurricane Center issued the primary of a number of warnings predicting important river flooding and landslides within the Southern Appalachians. Two days earlier than the flood in Erwin, a satellite tv for pc workplace of the National Weather Service in Morristown, Tennessee, predicted “life-threatening flash flooding” close to the Tennessee-North Carolina state line.
The warnings stored coming. The National Weather Service in upstate South Carolina forecast on Sept. 26, a Thursday, that Helene would quantity to one of many area’s most important climate occasions “in the modern era.”
“I don’t think people knew what that meant,” stated Prince, the geologist. “We just didn’t have a precedent.”
(Maddy Alewine for KFF Health News)
(Maddy Alewine for KFF Health News)
(Maddy Alewine for KFF Health News)
Ballad Health didn’t anticipate that Unicoi would flood throughout the storm, Levine stated, despite the fact that a hazard vulnerability evaluation carried out yearly for the hospital identifies exterior flooding because the second-highest threat dealing with Unicoi County Hospital, behind solely a civil disturbance. The identical 2024 evaluation rated the hospital’s preparedness for a flood as a “3” or “low,” the worst attainable rating.
But a doc outlining the hospital’s emergency alert procedures makes no point out of flood threat. If something, hospital leaders stated they had been anticipating a surge of sufferers throughout Hurricane Helene if Erwin and the encircling space skilled widespread energy outages.
“There was no conversation I had with anybody, anywhere about the risk of flooding before Friday morning,” Levine stated.
The day earlier than, Jennifer Harrah, the hospital’s administrator, had referred to as a gathering to debate the storm. Sean Ochsenbein, an emergency medication doctor and the hospital’s chief medical officer, recalled that the group gathered “just to kind of circle the wagons, make sure everybody was on the same page.”
Later that day, Harrah spoke to Unicoi County’s emergency administration director. But “let me be very clear,” Ochsenbein stated. “Nobody gave us — as Ballad or our hospital — any kind of indication that we would have floodwaters.”
And but little greater than 24 hours after their planning assembly, each Harrah and Ochsenbein had been stranded on the hospital roof, actually praying to God for his or her rescue.
“I called my husband, and I called my sons,” Harrah stated. “I told them that I loved them.”
Dozens of hospital sufferers, staffers, and first responders had been rescued by helicopter after floodwaters from the close by river overwhelmed the constructing.(Maddy Alewine for KFF Health News)
One motive the impression of the storm appeared to catch individuals off guard was a disconnect between the sturdy warnings issued by the federal companies and the low expectations that many individuals within the area, together with Ballad Health leaders, had of the potential flood threat.
It was sunny outdoors when individuals had been evacuated from the hospital roof, Thigpen identified. It had rained about 5 inches in Erwin over a number of days, however that was nothing in contrast with locations within the North Carolina mountains that acquired greater than 20 inches over the identical interval. Rainfall at these increased altitudes ultimately drained into the rivers and streams that finally destroyed locations like Erwin.
But residents in Unicoi County had no clue what was coming their approach, Thigpen stated, as a result of there weren’t river gauges upstream to sound alarms about harmful water ranges.
“I think that our warning systems are antiquated and broken,” he stated. “These people in Erwin have seen floods — and a lot of big floods — and it’s never been anywhere close to this.”
Tennessee state climatologist Andrew Joyner is one in every of a number of specialists now calling for extra river gauges to observe water ranges and a community of climate stations in each county designed to gather reside precipitation information.
Thirty-eight states already function comparable techniques, he stated, estimating that establishing and staffing climate stations throughout Tennessee would price lower than $4 million within the first 12 months.
But the state has did not act earlier than. Following a catastrophic flood in Waverly, Tennessee, that killed 20 individuals and destroyed a whole bunch of properties and companies in 2021, the Tennessee General Assembly denied a $200 million request to relocate 14 public faculties throughout the state that had been deemed weak to future flooding.
‘Might Not Make It Back’
On the morning of the flood, Matson had stood with the county’s emergency administration director behind Unicoi County Hospital and watched the rising river. “We both had this, like, sick feeling in our stomach that said we’ve got to evacuate,” she remembered. “I said to him, worse comes to worst, we evacuate, nothing happens. Just blame it on me.”
They made the decision to begin shifting sufferers out of the hospital simply earlier than 9:45 a.m. Less than half-hour later, the river had breached its banks, chopping a brand new channel in entrance of the hospital and eliminating entry to the one highway on or off the property.
When an ambulance evacuation turned untenable, the Tennessee Emergency Management Agency referred to as in swift-water groups, specifically designed to rescue individuals in turbulent waters. But the flash flood had turn into so violent and the river was so filled with particles that the boats couldn’t safely carry sufferers away. Meanwhile, harmful wind circumstances prevented helicopters situated to the east or west from instantly flying that morning to rescue everybody by air.
“To be honest, I really thought we may not make it back” from the rescue mission, Boyd, the flight nurse, stated.
When the wind began to die down that afternoon, Virginia State Police deployed two helicopters to rescue sufferers. Eventually, three Black Hawk helicopters from the Tennessee National Guard assisted within the effort. Pilots had been required to make a number of spherical journeys between the hospital and the native highschool to evacuate 4 or 5 individuals at a time who had been stranded by the flood. Some sufferers stranded in boats close to the hospital had been hoisted into helicopters, whereas those that had been stranded on the roof had been both carried onto the plane or climbed aboard whereas the helicopters frivolously touched down on their skids.
As the afternoon wore on and the evacuation was nearing its completion, pilot Jeff Bush with the Virginia State Police stated he realized that the hospital constructing was weakening. They weren’t certain how for much longer it might maintain.
“It was intense,” he stated. “The fact that the building is still standing is, I think, kind of amazing.”
Ballad Health, which owns the hospital, hasn’t introduced when or the place will probably be rebuilt.(Maddy Alewine for KFF Health News)
Ballad Health evacuated two different hospitals and one nursing residence by ambulance inside 24 hours of the flood in Erwin, however none of these sustained harm. Meanwhile, what’s left of Unicoi County Hospital stands subsequent to the Nolichucky in a area of mud and displaced river rocks.
For now, Ballad Health has opened a short lived pressing care middle and plans to ascertain an emergency division on the website of the previous Unicoi County Memorial Hospital in downtown Erwin.
Levine stated Ballad Health will ultimately rebuild a full-service hospital, however he estimated the challenge would price $50 million, roughly twice as a lot because it did in 2018. It stays unclear the place it might be constructed.
Probably not in a flood plain, Levine stated. “I would avoid it if I could.”
(Maddy Alewine for KFF Health News)
Lauren Sausser:
lsausser@kff.org,
@laurenmsausser
Holly Okay. Hacker:
hhacker@kff.org,
@hollyhacker
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