Before Hurricane Maria hit Puerto Rico and every day since, federal response personnel from the U.S. Departments of Health and Human Services (HHS), Defense (DoD), and Veterans Affairs (VA) and the Federal Emergency Management Agency (FEMA) have been coordinating efforts with local emergency response officials to ensure that medical care will be available for Puerto Rico residents as soon after the storm as possible, and to re-establish the island’s healthcare infrastructure.

When Hurricane Maria struck Puerto Rico, it devastated the island’s infrastructure, shutting off communication and transportation to the island, and causing widespread power outages. In its wake were people who would need medical care, either for chronic medical conditions or issues arising as a direct result of the storm.

Saving Lives:

The healthcare infrastructure on Puerto Rico was devastated by Hurricane Maria. To address the medical needs arising following the storm, HHS coordinated with DoD to transport medical personnel from HHS’ National Disaster Medical System (NDMS) and the U.S. Public Health Service Commissioned Corps (USPHS) as well as needed medical supplies to the island.

Today, there are more than 600 HHS medical personnel on the island to help those affected by the hurricane. To address medical needs on the island, HHS is operating a three-tier system of care in coordination with the Puerto Rico Department of Health. The first tier of care HHS is providing is at Centro Medico in San Juan, which is the only Tier 1 trauma center on the island. For the second tier of the strategy, HHS medical personnel are supporting hospitals in each of the regions by providing supplies and patient care. For the final tier of the system, through a collaborative effort with DoD, each of the remaining hospitals that are operational in some capacity have liaisons from DoD assigned to them to help ensure they are receiving the supplies they need to continue providing care to their patients.

Traveling around Puerto Rico to aid residents affected by Hurricane Maria is the U.S. Navy’s hospital ship USNS Comfort, which includes facilities allowing for resuscitation and stabilization care, initial wound and basic surgery, and postoperative treatment.

After receiving care at hospitals, some patients require help with ongoing healthcare needs. HHS is in the process of setting up four Federal Medical Stations, each capable of housing up to 250 patients at a time, which give these patients a place to stay while receiving the care they need.

To date, HHS medical personnel have provided care to more than 3,800 people affected by Hurricane Maria.

HHS also coordinated with VA before Hurricane Maria hit to ensure that patients suffering from end-stage renal disease, who are among the most vulnerable populations during disasters because their health depends upon regular dialysis treatment, were transported to more stable environments where they could receive care. VA and HHS transported more than 350 dialysis and critical care patients to more secure locations in San Juan; Miami; Shreveport, Louisiana; Atlanta; Columbia, South Carolina; and Jackson, Mississippi. Most of these patients were transferred from the U.S. Virgin Islands to San Juan to receive care after Hurricane Irma devastated those islands only two weeks before Hurricane Maria made landfall in the islands.

Ensuring their proper care also required coordination with non-governmental organizations to provide the patients with personal assistance services, emergency financial assistance and renal diets. The coordination of resources was enabled by HHS’ Centers for Medicare & Medicaid Services’ End Stage Renal Disease Networks and their partners.

After the hurricane hit Puerto Rico, HHS also played an important role in addressing critical needs at some of the most severely impacted dialysis facilities so that patient care could continue. HHS has worked with the Puerto Rico Department of Health to prioritize resources needed for dialysis facilities on the island and facilitated with FEMA to help ensure critical supplies were delivered where they were needed. The supplies received by the dialysis facilities proved vital to a number of them continuing to operate in some capacity, which is critical to people whose health depends upon regular dialysis treatments.

To help ensure that uninsured residents of Puerto Rico can continue to receive the prescription medication upon which their health depends, HHS activated its Emergency Prescription Assistance Program. This program provides 30-day supplies of certain medications free-of-charge through participating pharmacies. More than 750 pharmacies in Puerto Rico participate in this program, and residents of Puerto Rico who were displaced by Hurricane Maria can access the program through local pharmacies where they currently reside.

Stabilizing the Healthcare System:

In the three weeks since Hurricane Maria made landfall in Puerto Rico as a powerful Category 4 hurricane, the island’s healthcare infrastructure is showing signs of stabilizing. Nearly all medical facilities are operating in some capacity and 45 of the island’s 51 dialysis centers are reported to be fully operational. More than half of the hospitals in Puerto Rico are receiving electricity through a power grid that, at times, has proven unstable.

Communications continue to improve for Puerto Rico residents. To help overcome the continuing communications challenges, DoD personnel are positioning communications equipment at each open hospital to ensure supplies can be coordinated.

HHS also is working to confirm the operational status of the hundreds of elder care facilities in Puerto Rico to ensure their needs are being met.

HHS has held daily calls with private-sector partners to ensure that critical infrastructure needs for the healthcare sector are identified so they can be addressed and appropriately prioritized. Through these collaborative efforts, private sector interests that typically may be in competition with each other continue working together to address the needs of those affected by the storm.

For example, pharmaceutical and medical device manufacturers in Puerto Rico are vital to the supply chain in the continental United States. HHS is working closely with these manufacturers to quickly identify potential disruptions resulting from the devastation caused by Hurricanes Maria and Irma, and to support their efforts to maintain the availability of critical healthcare products in Puerto Rico and the continental United States. Additionally, the U.S. Food and Drug Administration was able to expedite processes and procedures to help pharmaceutical manufacturers adjust production levels at facilities unaffected by the storm to ensure that overall U.S. supply was not jeopardized by damage to facilities on Puerto Rico.

In addition to the efforts provided by HHS and DoD, VA provided both commodities and services for several tons of medical supplies, food, fuel, and water. VA collaborated with two HHS Federal Medical Stations to provide care to Veterans and serve as a Community Based Out-Patient Clinics. VA forward deployed mobile medical centers, pharmacies, counseling units and 196 volunteers to support both Veterans and the public. VA was able to self-sustain and feed employees and families with more than 33,589 meals. VA deployed satellite communications for the VA Hospital, Regional Office, and Clinics to enable communications throughout its Healthcare System. VA further assisted the community by providing Damage Assessment Teams to assess civilian hospitals throughout out the island.

Information on health, safety and HHS actions are available at www.phe.gov/emergency. Public Service Announcements with post-storm health tips are available at https://www.cdc.gov/disasters/psa/index.html. A full toolkit with text messages, social media, phone prompts, and other information to share with people in the affected areas can be found at ‎https://www.cdc.gov/disasters/hurricanes/diaspora_toolkit.html.

Residents in the continental United States are encouraged to provide these tips to family members and friends in Puerto Rico and the U.S. Virgin Islands.

Updates and health information also are available at: