COMMENTARY Radiation Oncology in the Face of Natural Disaster: The Experience of Houston Methodist Hospital Matthew Mireles, BS, MBA, Ramiro Pino, PhD, DABR, Bin S. Teh, MD, Andrew Farach, MD, Adrienne Joseph, MBA, and E. Brian Butler, MD Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas Received Nov 20, 2017. Accepted for publication Dec 3, 2017. Houston Methodist Hospital and the Radiation Oncology Department have successfully weathered natural disasters, such as tropical storms (Allison 2001) and hurricanes (Ike 2008), both having dramatic impacts on departmental oper- ations. In 2001, tropical storm Allison hit the greater Houston area, dumping approximately 40 inches of rain over a period of 3 days. At the time, Houston Methodist Radiation Oncology had 2 locations (at the Medical Center): Dunn Tower basement and Annex (ground floor). The damage at Dunn Tower basement was devastating: 3 treatment ma- chines, 1 simulator, a brachytherapy program (high-dose-rate afterloader and low-dose-rate sources), quality assurance equipment, and patient paper records were lost (damaged beyond repair). The hospital also lost power, including emergency power, because of water damage to emergency power generators. In contrast, Hurricane Ike’s disruption of departmental operations was due to pre-event evacuations, large storm wind fields causing regional damage, and sus- tained power loss across the Houston metropolitan area. Most recently, Hurricane Harvey dumped almost 50 inches of water over a 4-day period while the storm slowly meandered across the region, but we lost no equipment or data whatsoever. With all these events, the most critical and pressing issue for our patients was the need for us to resume operations as soon as possible to continue their treatment. Our paradigm for disaster planning is very similar to the treatment planning process: assessment of risks and development of response plans, tracking of information germane to any evolving event, identification of key critical structures that need special attention, implementation and adapting plans to changing situations, and finally assess- ment of outcomes to determine whether additional actions are necessary to provide the desired outcome. Our response plan to Hurricane Harvey is a good case study on our adaptive approach. Once Hurricane Harvey was forecast to threaten the Texas coast, we entered the next phase of readiness that includes assessment of current patient schedules, heightened monitoring of weather in- formation and risk models from local authorities, and completing weather event preparations based on the most relevant risks to our operations. As the storm strengthened, weather forecasters predicted that the hurricane would not follow the typical pattern of quickly exiting the region north/north eastward but rather would meander along the Texas coast for days, dumping record-breaking rainfall over large parts of Texas, resulting in catastrophic flooding. The first phase of our response plan was to implement a department command center that would serve as a centralized communication hub within radiation oncology and would be a point of contact for hospital and physician’s organization clinic command centers. Our system’s response strategy is that each department relays information to the relevant command centers regarding damage to equipment, status of personnel, availability of power, and ability to care for patients. As Hurricane Harvey began to dump rain on the Houston metropolitan region, the central command centers gave Reprint requests to: E. Brian Butler, MD, Department of Radiation Oncology, Houston Methodist Hospital, 1130 Earle St, Houston, TX 77030. Tel: (713) 790-2637, ext. 100; E-mail: ebutler@houstonmethodist. org Conflict of interest: none. Int J Radiation Oncol Biol Phys, Vol. 100, No. 4, pp. 843e844, 2018 0360-3016/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.ijrobp.2017.12.002 Radiation Oncology International Journal of biology physics www.redjournal.org