# Fire, Flood, and Fragility: Disasters Through a Geriatric Lens About This Podcast Dr. Stephen Gamboa is an Adjunct Associate Professor at UNC and medical director of UNC Health Pardee's emergency department in Hendersonville, North Carolina. In today’s GEMCast episode, he shares his first-hand experiences from two major natural disasters: the 2017 Tubbs Fire in Northern California and Hurricane Helene, which hit Western North Carolina in 2024. As he joins host Dr. Christina Shenvi, the two talk about how these events have a disproportionate impact amongst our frail older patients, which can be attributed to age-related comorbidities, reduced mobility, and higher care needs. Tune in and hear a variety of innovative solutions brought about by the various challenges that these major events can pose. The immediate impacts of natural disasters, such as smoke inhalation and needing to rapidly evacuate homes and skilled nursing facilities (SNFs), are just the tip of the iceberg. Older patients with decompensation or exacerbations of chronic conditions made up a large proportion of the increased demand on EDs following these disasters. Coupled with power outages, electricity shortages, no internet connectivity, and pharmacies closing, Dr. Gamboa describes how his team had to adapt quickly and how system-level support from UNC during Hurricane Helene, including staff, equipment and transport, was crucial to providing care to these vulnerable patients. Play the Episode https://youtu.be/no3sGtdSops Subscribe on YouTube Subscribe on iTunes Key points Older patients often have multiple chronic conditions, dependency on medications and medical devices, and a narrow homeostatic margin, making them more vulnerable to disasters. Devices that require electricity and/or power such as nebulizers, home oxygen therapy or LVADs.   Decompensation or exacerbations of chronic conditions, notably CHF and COPD, were a primary concern. SNF residents are especially vulnerable. Consider if an entire SNF had to be evacuated, is there a plan in place? Where will these patients with high care needs go? Medication access is vital for older patients. As community pharmacies shut down during Hurricane Helene, the hospital pharmacy stepped up. Common discharge medications such as prednisone, doxycycline, Zofran, paracetamol and codeine could be sent home with patients in "pre-packs". Consider how patients will be transported. Transportation during evacuations, as well as contingency plans for how patients may get to and from the ED, and transfers to other hospitals if needed. Managing logistics without internet, cell service, and power - this means no EMR and only in-person communication. Below are some examples of strategies used during Hurricane Helene: Twice daily huddles with the inpatient & ED teams. Pivoting to POC labs, provided by UNC, where possible (chemistries, troponin, haematology). Real-time interpretation of imaging: physician-read bedside x-rays and a 24/7 radiologist sitting in the CT suite. Help manage ED and inpatient surges with proper triaging. ED physicians can identify who needs what and direct patients to care locations based on their needs. For example, patients who just required access to power for their oxygen devices were triaged to a “oxygen bar” – a converted conference room in the basement of the hospital. Annals of Emergency Medicine| February 2026 Lessons Learned From Helene: The Role of a Rural Community Hospital in Disaster Response After a Major Hurricane A recent article by Dr. Gamboa, Dr. Chelminski and Dr. Shenvi detailing the events, challenges and lessons of Hurricane Helene. Read Article British Geriatrics Society | February 22, 2021 Silver Book II: Disaster medicine involving older people A chapter written by Dr. Chris Carpenter reviewing how to best care for older people during disasters. View Chapter PODCAST | November 5, 2025 Getting Hotter: Heat Emergencies in Older Adults Dr. Geoff Comp and Dr. Christina Shenvi do an in-depth review of heat-related emergencies in older adults. Listen Now TOOLKIT | November 2, 2023 Rural Hospital Geriatric Emergency Toolkit A collection of resources specifically curated for rural emergency departments interested in improving care for older adults. Explore Toolkit Next, listen to The 17‑Hour Turnaround: Rapid, Safe Observation Care for Older Adults with Dr. Meredith Busman. Play Episode View All Rural Resources >