FARGO — Shawn Stuhaug had just returned to work at Bethany Homes after fighting the flooding Red River at his home. It was 10 o’clock at night and he planned on reviewing some preparation notes and getting some sleep.

Tired from days with little rest, he’d packed an overnight bag. But two days would pass before he would get a night’s sleep.

Soon after Stuhaug got to his office the phone rang. Emergency preparedness and health officials had summoned him to a telephone conference call at 11 p.m.

He was told he would have to supervise the evacuation of all 375 residents of Bethany Homes. In fact, all nursing homes as well as some group homes in Fargo-Moorhead were told to evacuate — forcing an emergency exodus of frail, elderly residents.

“I just remember my heart sinking and thinking this is all happening,” said Stuhaug, Bethany’s president and chief executive officer. “It was surreal.”

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Stuhaug’s sobering call came the night of March 26, 2009, two days shy of the Red River's record 40.84-foot crest in Fargo.

That night, ambulances lined up outside MeritCare Hospital, which had decided to evacuate its 183 patients.

The decision fell upon Paul Richard, executive vice president and general counsel, who was the shift incident commander who made the call to evacuate.

“We were hearing things like dikes were breaking and a lot of things like that,” Richard said. “We were getting at the point where we had never seen before.”

The concern: What would happen if a north Fargo dike failed? Even if the hospital stayed dry, administrators worried about the potential loss of services, including electricity, water and sewer.

“If that all disappears, then what’s the plan?” Richard said.

Richard quizzed the eight or 10 others huddled around the hospital’s incident command center, a big table in a conference room near the cafeteria that had been staffed 24/7 for several days at that point: Could they safely care for patients if services were cut off?

The unanimous verdict: No.

A few other factors helped to tip the decision. The ambulances were available at the time — but soon would be needed to evacuate nursing home residents — and the weather cleared, allowing critical care patients to be flown by air ambulance.

“It was the cumulative weight of many factors coming in from the standpoint of risk,” Richard said. “You make the decision based upon what you’ve got in front of you.”

It took six hours to evacuate the patients. Although the hospital’s inpatients were evacuated, the emergency department remained open and continued to treat patients. Because of the flood, the hospital already had started to limit elective cases to pare its census.

Many neonatal intensive care unit patients were flown to the former Sioux Valley Hospital in Sioux Falls, S.D. Conversations that grew out of the placements resulted months later in the merger of MeritCare and Sanford Health.

Eventide Senior Living Communities, with about 450 residents to evacuate from two locations in Moorhead, faced a major challenge in finding beds.

“We had all hands on deck” to handle to logistical challenges of moving so many people on such short notice, said Jon Riewer, Eventide’s president and CEO. “We tried to put everybody within 100 miles.”

To place its last 24 residents, Eventide chartered a bus to beds in the Twin Cities.

Assisted-living or independent-living could safely stay in makeshift accommodations, including churches, but nursing home residents required skilled help.

“It’s almost a must that they have to be in a place with skilled nursing facilities,” Riewer said.

Luckily, Eventide was able to place nursing home residents in an empty nursing home in Detroit Lakes, Minn.

“To an organization and a person, everyone was very helpful,” Riewer said. “If it weren’t for the Midwestern hospitality, I don’t see how it would have worked.”

CHI Friendship, which operates group homes for disabled adults and assists disabled people in their homes, evacuated 75 residents to the Grafton Developmental Center, now called the Life Skills and Transition Center.

They made the trip in a caravan of chartered buses, and had to take back roads because Interstate 29 north of Fargo was flooded, as were some other roads.

“The beds were already there so they had everything ready for us when we arrived,” said Dori Leslie, CHI Friendship’s president. “It was a really good situation for us in Grafton. It was a really good location.”

The decision to uproot so many disabled adults was difficult, she said. “We knew we had to find a safe place,” and also a place that could offer activities.

More than 100 Bethany residents ended up at St. Leo’s Catholic Church in Casselton, N.D. “We just kind of took over St. Leo’s as a Bethany site,” Stuhaug said.

Memory care residents were housed in a large room at the church. “That way we could keep an eye on everybody,” he said.

Some Bethany residents were placed at an empty unit at St. Catherine’s Living Center in Wahpeton, N.D.

In total, Bethany evacuated 375 residents across 20 sites in 18 communities in North Dakota and northeastern South Dakota.

“All the facilities that weren’t in the flood path really stepped up,” Stuhaug said.

Altogether, 2,500 hospital patients, nursing home residents and vulnerable adults were evacuated from Fargo, and hundreds more from Moorhead, during the record 2009 flood.

Essentia Health, located farther from the river and on higher ground, did not have to evacuate any patients.

"With everything else that was happening in our community, we wanted to stay operational to serve our patients in the community," said Nicole Christensen, Essentia's chief nursing officer. "We had contingencies in place for food, water, power, supplies and linen," with necessary staff available in-house.

Essentia, which did not require sandbag protection, was available to accept patients from other hospitals.

Hospital and nursing home administrators learned many lessons from the mass evacuation. Communications have improved, including a database state health officials keep of available beds, and many procedures were refined, administrators said.

“A lot of good things came with that,” Stuhaug said.

Friendship’s Leslie agreed. “We definitely don’t want to repeat it, but we learned so many things.”

Much of the coordination for the evacuations was done behind the scenes by state and local public health officials. Officials had to act quickly to marshal resources and find beds for so many evacuees at once.

“Hectic is a kind word,” said Doug Murphy, emergency preparedness and response coordinator for Fargo Cass Public Health. “Evacuating a vulnerable population is a concern in any way, shape or form. That’s an emotional and stressful situation for those vulnerable populations.”

Because the 2009 flood fight was successful, however, Riewer worries it could cause complacency.

“I think everybody is proud of the work that has been done,” he said. “I worry that it’s going to create a false sense of confidence in our community. We’ve still got issues.”

Clay, Wilkin counties have new registry for vulnerable and at-risk populations

The Clay and Wilkin county public health departments encourage vulnerable and at-risk populations to register with their new emergency assistance request database.

During an emergency or disaster, the database will be used by emergency personnel to locate homes and prioritize first-responder services.

By identifying and engaging with at-risk and vulnerable populations in advance of a disaster, officials will be better able to assist.

Vulnerable and at-risk populations include those who are elderly, limited or non-English speaking, disabled as well as those who feel they cannot comfortably help themselves in a disaster.

County residents can find the registration database on their county website or can call their local public health department to register.

In Clay County, call 218-299-5220 or visit claycountymn.gov.

In Wilkin County, call 218-643-7122 or visit co.wilkin.mn.us.