ERWIN, Tenn. — April Boyd texted her husband earlier than she boarded the helicopter.
“So, I don’t need to be dramatic,” she wrote on Sept. 27, “however we’re gonna fly and rescue sufferers 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. Timber, trailers, buildings, caskets, and vehicles swept previous the hospital in murky, brown rapids that overwhelmed the one-story construction with 12 ft of water on all sides.
Nobody 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 folks at a plastics plant in Erwin’s industrial park died within the flood.
“I don’t be ok with this,” Boyd, a flight nurse for Ballad Well being, texted her husband at 1:41 p.m., simply earlier than takeoff.
She wrote that she cherished him. “If something goes flawed,” she wished him to inform her daughters “how a lot I really like 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 brand new hospital was inbuilt a identified flood plain, however the facility wasn’t designed to accommodate helicopter landings on its roof. Boyd and her staff weren’t positive the roof might bear the load 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 folks, together with 11 sufferers, by helicopter that day was a surprising success. The hospital was destroyed, however nobody died. Nobody was even bodily injured by the ordeal.
But, earth scientists, emergency administration officers, and others who spoke to KFF Well being Information 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 components of the nation — the place residents haven’t traditionally paid a lot consideration to hurricane warnings — they have to be strategic about each the infrastructure design and the places chosen for brand spanking new tasks, like hospitals.
The Biden administration finalized a rule this yr designed to make the development of such tasks that obtain funding from the Federal Emergency Administration Company extra resilient to flooding. However a assessment by KFF Well being Information recognized about 20 different Tennessee hospitals already inbuilt, or close to, flood plains.
Patrick Sheehan, director of the Tennessee Emergency Administration Company, stated previous climate patterns can lull folks right into a false sense of safety. However, he added, “previous shouldn’t be at all times prologue. We’re going to expertise novel, new methods of getting disasters.”
Traditionally, the Southern Appalachian Mountains have been the place “the place hurricanes go to die,” stated Ryan Thigpen, an earth and environmental sciences professor on the College of Kentucky whose analysis focuses on flooding within the area. However because the Gulf of Mexico turns into hotter and storms, like Helene, that transfer northward into the mountains carry extra moisture, climate occasions will change into extra extreme.
“It’s apocalyptic,” stated Thigpen, of the harm in Erwin. “The following storm might come earlier than they’re completed recovering from this. And that’s form of scary.”
Hospitals in Flood Plains
All week, Michelle Matson had been apprehensive about Unicoi County Hospital within the oncoming storm.
As a district coordinator for the Tennessee Emergency Administration Company, Matson works with native officers to plan for worst-case situations.
Main 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 saved arising.
“That was the one place we had been apprehensive about,” Matson stated.
However 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 Well being Alliance on the situation that Mountain States would assemble a hospital in Erwin to exchange the outdated 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 introduced the placement as fascinating as a result of it was close to the interstate and the panorama would supply “a therapeutic setting by benefiting from the pure fantastic thing about Unicoi County, with the river working alongside the east facet of the property.”
Relationship again many years, although, flood maps revealed by FEMA put the complete property in a flood plain. The constructing itself was in a 500-year flood plain (which means a 0.2% likelihood of flooding in any given yr), whereas the one highway on and off the property was in a 100-year flood plain (which means a 1% annual danger).
Nevertheless it wasn’t solely FEMA maps that forecast this chance. In 2001, a report revealed by Unicoi County marked this land as being in a “flood hazard” space. The report warned of “appreciable stress” to develop flood hazard areas throughout the county “on account of inhabitants enhance and the necessity 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 main streams,” together with the Nolichucky River, which flows northward out of the Blue Ridge Mountains of western North Carolina straight via Erwin.
“Should you begin trying on the river’s historical past, there are a variety of those notable flood occasions, and fairly just a few within the twentieth century. They simply didn’t attain this magnitude,” stated Philip Prince, a geologist with Appalachian Landslide Consultants. His YouTube movies about mountain flooding throughout Helene have been considered lots of of 1000’s of occasions. “Individuals ought to have been anticipating greater than they did. However once more, we have now not seen something 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 in the course of the planning course of concerning the location, however he conceded there weren’t many massive, flat locations to construct a hospital in Erwin.
Amid a wave of rural hospital closures throughout the USA, Erwin residents celebrated when the brand new hospital opened in 2018. One lawmaker instructed the Johnson Metropolis Press it was “essentially the most fashionable facility on the planet.”
Alan Levine was CEO of Mountain States Well being Alliance throughout that point and later turned the top of Ballad Well being, when Mountain States merged with a competing hospital system in 2018 to type the biggest state-sanctioned hospital monopoly within the nation.
Levine stated Mountain States was conscious the property carried flood danger however famous that the hospital system added levees to guard the constructing from river flooding on the advice of out of doors 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 really feel like all the pieces we did after we constructed it was accomplished the appropriate approach,” stated Levine, a former well being care chief in Louisiana and Florida.
Even so, Matson, who lives in Kingsport, about 45 minutes northwest of Erwin, stated some residents had been quietly important of the brand new hospital’s location.
“All of us thought that it was a silly concept to construct a hospital in a flood plain. It’s like, who does that?” Matson stated. She stated her opinion doesn’t characterize an official place of the Tennessee Emergency Administration Company.
However 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 Well being Information discovered.
The hospitals in danger span the size of the state, from Memphis on the western edge to Knoxville within the east, and embody big-city normal hospitals, smaller rural hospitals, and behavioral well being amenities.
A few of the hospitals are many years outdated. Parkridge East Hospital in Chattanooga, for instance, was constructed within the Nineteen Seventies inside a high-risk flood zone. Others are newer — like Creekside Behavioral Well being 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 Well being Information regarded for licensed amenities in or close to areas that, based on FEMA, have both a excessive flood danger (with a 1-in-100 likelihood of flooding in any given yr) or reasonable danger (a 1-in-500 likelihood in any given yr).
However FEMA’s maps seemingly underestimate the true flood danger, researchers and authorities watchdogs agree, as a result of they’re largely outdated and don’t account for present or future situations, together with extra frequent and extra intense storms and flooding related to local weather change.
These maps are up to date on an ongoing however gradual and piecemeal foundation. In the meantime, the federal regulation finalized this yr to broaden areas thought of in danger for present and future flooding additionally units extra stringent constructing requirements for important infrastructure tasks positioned 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 Damaged’ System
On Sept. 24, three days earlier than the hospital evacuation, the Nationwide Hurricane Heart issued the primary of a number of warnings predicting vital river flooding and landslides within the Southern Appalachians. Two days earlier than the flood in Erwin, a satellite tv for pc workplace of the Nationwide Climate Service in Morristown, Tennessee, predicted “life-threatening flash flooding” close to the Tennessee-North Carolina state line.
The warnings saved coming. The Nationwide Climate Service in upstate South Carolina forecast on Sept. 26, a Thursday, that Helene would quantity to one of many area’s most vital climate occasions “within the fashionable period.”
“I don’t assume folks knew what that meant,” stated Prince, the geologist. “We simply didn’t have a precedent.”
Ballad Well being didn’t anticipate that Unicoi would flood in the course of the storm, Levine stated, although a hazard vulnerability evaluation carried out yearly for the hospital identifies exterior flooding because the second-highest danger 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 doable rating.
However a doc outlining the hospital’s emergency alert procedures makes no point out of flood danger. 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 dialog I had with anyone, wherever concerning the danger of flooding earlier than Friday morning,” Levine stated.
The day earlier than, Jennifer Harrah, the hospital’s administrator, had known 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 “simply to form of circle the wagons, make sure that everyone was on the identical web page.”
Later that day, Harrah spoke to Unicoi County’s emergency administration director. However “let me be very clear,” Ochsenbein stated. “No person gave us — as Ballad or our hospital — any form of indication that we’d 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 known as my husband, and I known as my sons,” Harrah stated. “I instructed them that I cherished them.”
One motive the affect of the storm appeared to catch folks off guard was a disconnect between the sturdy warnings issued by the federal businesses and the low expectations that many individuals within the area, together with Ballad Well being leaders, had of the potential flood danger.
It was sunny outdoors when folks 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 finally drained into the rivers and streams that finally destroyed locations like Erwin.
However 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 feel that our warning methods are antiquated and damaged,” he stated. “These folks in Erwin have seen floods — and a variety of huge floods — and it’s by no means been wherever near this.”
Tennessee state climatologist Andrew Joyner is one among a number of consultants 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 methods, he stated, estimating that establishing and staffing climate stations throughout Tennessee would price lower than $4 million within the first yr.
However the state has didn’t act earlier than. Following a catastrophic flood in Waverly, Tennessee, that killed 20 folks and destroyed lots of of properties and companies in 2021, the Tennessee Common Meeting denied a $200 million request to relocate 14 public faculties throughout the state that had been deemed weak to future flooding.
‘Would possibly Not Make It Again’
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 each had this, like, sick feeling in our abdomen that stated we’ve obtained to evacuate,” she remembered. “I stated to him, worse involves worst, we evacuate, nothing occurs. Simply blame it on me.”
They made the decision to begin shifting sufferers out of the hospital simply earlier than 9:45 a.m. Lower than half-hour later, the river had breached its banks, reducing 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 Administration Company known as in swift-water groups, specifically designed to rescue folks in turbulent waters. However the flash flood had change into so violent and the river was so stuffed with particles that the boats couldn’t safely carry sufferers away. In the meantime, harmful wind situations prevented helicopters positioned to the east or west from instantly flying that morning to rescue everybody by air.
“To be sincere, I actually thought we might not make it again” 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. Finally, three Black Hawk helicopters from the Tennessee Nationwide 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 folks 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 flippantly touched down on their skids.
Because the afternoon wore on and the evacuation was nearing its completion, pilot Jeff Bush with the Virginia State Police stated he discovered that the hospital constructing was weakening. They weren’t positive how for much longer it will maintain.
“It was intense,” he stated. “The truth that the constructing continues to be standing is, I feel, form of superb.”
Ballad Well being evacuated two different hospitals and one nursing residence by ambulance inside 24 hours of the flood in Erwin, however none of these sustained harm. In the meantime, what’s left of Unicoi County Hospital stands subsequent to the Nolichucky in a area of mud and displaced river rocks.
For now, Ballad Well being has opened a brief 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 Well being will finally rebuild a full-service hospital, however he estimated the venture would price $50 million, roughly twice as a lot because it did in 2018. It stays unclear the place it will be constructed.
Most likely not in a flood plain, Levine stated. “I might keep away from it if I might.”
lsausser@kff.org,
@laurenmsausser
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