Lessons Learned From Helene: The Role of a Rural Community Hospital in Disaster Response After a Major Hurricane.

Hurricane Helene struck Western North Carolina in September 2024, leaving an entire region without power, clean water, or internet connectivity for more than a week. A small, rural, community hospital and its emergency department, which normally sees 84 patients per day, suddenly became the sole source of medical care for an estimated 200,000 residents and experienced a 70% surge in patient volume. Although structural damage to the hospital was limited, the complete loss of digital connectivity rendered electronic medical records, laboratory information systems, radiology, pharmacy, and routine communication tools inoperable. Forced back into an analog system of care, clinicians rapidly redesigned workflows: in-person huddles replaced digital messaging, point-of-care testing replaced central laboratory processing, radiologists interpreted imaging in real time at the scanner, and paper charting was used. When patients dependent on powered medical devices such as oxygen concentrators and left ventricular assist devices overwhelmed emergency department space, the hospital created a staffed medical device shelter in a nearby high school. Paper medication administration records and take-home medication packs were developed to allow safe discharge despite pharmacy closures. This experience revealed that, in modern hospital disaster planning, uninterrupted internet access is a critical contingency to plan for. Backup generators cannot compensate for the loss of digital connectivity. Hospitals should prepare for extended digital outages by maintaining point-of-care diagnostics, physical copies of critical order sets, and plans for alternative care locations for medically fragile patients. Here, we share lessons learned from the connectivity outages during Hurricane Helene and its aftermath, and how small, rural hospitals can serve as community anchors during prolonged infrastructure failure.