Drones, cones, satellites bytes

Here are just a few samples of the high-tech tools that hurricane specialists will toss at the storms this year.

The WHARF forecast model

Real-time Doppler radar, satellite and other readings create what is essentially a rolling, three-dimensional image of the storm.

Storm surge forecasting map

Issued with storm updates to give coastal residents a heads-up on how high the seas are expected to climb on land.

A smaller forecast cone

It will show potential hurricane tracks, the result of more powerful computing and improvements in the tracking model.

Drones

3-foot-long, propeller-driven, remotely operated aircraft with retractable wings. They are able to dive where hurricane hunters can't go, near the water surface, to gauge air pressure, temperature, winds and moisture.

That could help forecasters predict whether a storm is strengthening as it nears the coast.

National Oceanic and Atmospheric Administration

A Pacific hurricane more powerful than ever recorded in May flared up last month before weakening. A potential cyclone in the Atlantic was watched by forecasters but dissipated.

Welcome to the tropics.

Sunday is the official start of the 2014 hurricane season and it begins with one of the larger concerns left hanging: Evacuations. The state's plan is still largely untested. It's not if, but when a hurricane again makes landfall, forecasters like to say, and Lowcountry residents will wrestle with whether to evacuate, where to go and what might happen to their homes if a powerful hurricane closes in.

The issues are far more complicated for institutions such as hospitals. Charleston area hospitals plan to shelter in place for most storms, as the safest option. Yet the lessons of what happened in New Orleans after Hurricane Katrina, or in Charleston after Hurricane Hugo, aren't lost on them.

The bottom line is: Be prepared.

The federal forecast this year calls for a "near normal" number of storms, 8-13, with about half becoming hurricanes and one or two major hurricanes.

The "season" runs from June through November each year, although tropical systems can and have formed earlier and later. The Cape Verde period in which powerful trans-Atlantic storms are most likely to threaten the Lowcountry runs from early August into October. Tropical storms also have formed just offshore and made landfall in little more than a day.

A storm powerful enough to force a Charleston area evacuation hasn't threatened in 15 years, although those storms have passed by out to sea.

'Black swan'

A single storm can wreak havoc on the best laid plans for dealing with powerful hurricanes.

"If a 'black swan' event happens like Hurricane Katrina - if a category 4 or 5 hurricane stalled just south of Charleston and pushed water into the harbor for more than a day, there's just no way we can plan for something like that," said Dr. Richard Lauve, the chief medical officer at Trident Health.

Lauve was working in Baton Rouge when Hurricane Katrina hit New Orleans. He knew doctors working at Memorial Medical Center, which became a Hurricane Katrina horror story.

The hospital lost power and backup generators failed in the flooded city, leading to dozens of deaths, criminal charges (later dismissed) against medical staff accused of euthanizing some of the sickest patients, and, eventually, a $25 million class-action settlement with pre-Katrina hospital owner Tenet Healthcare.

"Some of my contacts had patient care responsibilities, and some of them had to make some very difficult decisions," Lauve said.

"These people had no food, no sleep, there were armed thieves on the floors below them," he said. "For three or four days they kept many patients alive by taking turns ventilating them with a bag - literally squeezing a bag to inflate their lungs."

For Charleston, the horror was reminiscent of the crises during Hurricane Hugo in 1989, when people crowded up on tables to keep their heads above water in a flooded McClellanville shelter and storm surge swamped the generator keeping Roper Hospital's intensive care ward running in Charleston. Two maintenance workers took turns hand-cranking the generator's fuel pump in water up to their heads, keeping people alive.

Hugo had taken an unexpected turn toward the coast to come in at Charleston with little more than a day's warning. Hospitals here had little time to evacuate but moved patients who could leave. Nursing homes in vulnerable areas were evacuated, but then there was trouble tracking where the residents were moved to.

Hurricane Katrina and more recently Hurricane Sandy prompted emergency management officials to look closely at hospitals' plans to respond to catastrophes.

Lauve said hospitals can, and do, take steps to minimize risk where there's a hurricane threat.

An orderly evacuation of a hospital could take days, but a hurricane threat may not be clear until the final days before landfall. So, hospitals focus on procedures and supplies needed to shelter in place.

The S.C. Department of Health and Environmental Control can order a facility to evacuate if supplies and other emergency gear aren't in place, but uses reports hospitals file to determine if they can shelter in place.

Cooperation

Getting people to safety is the driving force behind all the forecasting, tracking and warnings that accompany hurricanes each year.

After years of refining the process, evacuation is still a cumbersome, uncertain work in progress. South Carolina's current plan is a zoned evacuation based on how vulnerable or close to the coast people are. The idea is to move people in groups rather than all at once; a million people or more are likely to be on the Lowcountry coast during vacation months. The plan also mandates that people who are in certain spots travel specific roads rather than overload Interstate 26.

Put into place after the Hurricane Floyd evacuation gridlock in 1999, the plan hasn't yet been tested on a large scale. It depends so much on public cooperation that there's still a huge potential for hours-long traffic gridlock like the Lowcountry saw during Floyd, or loss of life.

Shelter in place

The medical community nationwide is concerned about stricter regulations forcing their hands in what ought to be a storm-by-storm, facility-by-facility decision about who and when to evacuate.

Late last year, the federal Centers for Medicare & Medicaid Services proposed new regulations to standardize and toughen emergency preparedness plans and equipment for all Medicare and Medicaid providers in the United States, including hospitals, nursing homes and rehabilitation centers. It hasn't been well met.

The federal government said the regulations may cost providers more than $200 million to implement during the first year alone. The American Hospital Association said regulators need to make sure the demands don't add to costs, cause confusion, burden administrators or impose a time frame that can't be met for an evacuation decision.

Hospitals continually plan and stock for emergencies, and plans are in place for hurricanes, said Lauve and Jerry Flury, Roper St. Francis Health Care hospital emergency management director.

Patients are moved that can or must be. Despite their competitive relationship, hospitals cooperate during disasters, Lauve said.

On a broader scale, plans for responding to disasters can only be truly tested when a disaster strikes. State officials gather each year at the beginning of the season to reinforce the message that residents and institutions should be prepared.

Flury points out the Katrina catastrophe was caused not by the storm, but by flooding after the swamped levees broke.

"In Charleston, we're lucky that way, because the waters are going to recede very quickly," she said. "We are very capable of caring for our patients safely in the hospital."

Lauren Sausser contributed to this report. Reach Bo Petersen at 937-5744, @bopete on twitter or Bo Petersen Reporting on Facebook.