How one practice adapted to the pressure of maintaining care during chaos.
With fierce winds, relentless rain and a cascade of falling trees and power lines, Hurricane Helene carved a path of devastation through the unique topography of western North Carolina. A hurricane in the mountains — following record-breaking rainfall — seemed unimaginable. Coupling the steep terrain with atmospheric factors and strong winds, Helene exposed the region’s vulnerabilities.
For the radiologists at ARA Health Specialists (ARAHS), the storm was more than a test of resilience; it was a masterclass in adapting under pressure. Located in Asheville, NC, and serving the area’s 18 counties, ARAHS provides interpretive services for most of the region’s healthcare systems.
The catastrophic breakdown of infrastructure from Helene brought workflows to a near standstill. With this disruption, the ARAHS team was forced to quickly rethink their operations and embrace new strategies to continue providing critical services.
Clinicians, unable to enter imaging orders into the electronic medical record system, found their usual workflows shattered. Without orders, systems couldn’t generate accession numbers, which meant radiologic technologists couldn’t link images to patients. Power outages and disrupted networks added to the chaos, preventing images from being sent to PACS. The radiologists, who usually worked with high-resolution monitors and advanced tools, read studies directly from scanners, recording preliminary findings on paper.
“Runners delivered the handwritten reports to the emergency department,” says ARAHS radiologist Marianne M. Ballisty, MD. “It felt like stepping back in time, but we had no choice.”
As hours turned to days, ARAHS began to realize additional impacts. PACS downtime compounded challenges, leaving radiologists without access to comparison studies or advanced imaging tools. Even though backup generators kept some systems live, the lack of internet and the downed cellular grid were major obstacles. Smaller regional hospitals, unable to send images to PACS, faced additional challenges.
Runners delivered the handwritten reports to the emergency department, it felt like stepping back in time, but we had no choice.
With the numerous and seemingly constant challenges, collaboration was key.
“Typically, we handle IR [interventional radiology] call from home,” says ARAHS interventional radiologist Trevor M. Downing, MD. “But without cell service, we had to have one IR doctor physically present in the hospital at all times. It was a challenge to coordinate, but we made it work.”
For many, just getting to the hospital was difficult. In some cases, radiologists were flown in by helicopter due to impassable roads to ensure continued patient care. Others arrived unannounced, simply because they felt they might be needed. Downing rode his bicycle through debris-strewn streets to get to work. “The roads were empty, and I didn’t have to worry about gas, which was impossible to come by, or blocked paths,” says Downing.
About 2.5 hours away in Charlotte, NC, ARAHS administrative leaders set up a command center to coordinate the crisis response. This center was a stable point of contact for physicians and hospitals, keeping lines of communication open amid sporadic mobile-phone coverage. They managed employee safety, matched available physicians to hospitals in need and ensured that critical radiology services could continue.
When internet service was disrupted at one location, staff were quickly dispatched to maintain continuity of care. In another instance, team members collaborated with emergency personnel to secure transportation to facilities in need, ensuring coverage during critical times. Hospital and ARAHS leadership efficiently worked within the evolving situation, reallocating personnel based on demand and scaling staffing to align with reduced inpatient and ER volumes.
In the absence of sterile processing capabilities, IR turned to disposable supplies to continue emergency procedures. However, overheated angiography equipment and lack of air conditioning in procedural rooms limited operations to the most critical cases. Diagnostic radiologists, meanwhile, faced the challenge of providing accurate interpretations without access to high-resolution monitors or prior studies.
“We were reading directly off the CT scanners, which aren’t designed for detailed interpretation,” Ballisty says. “It was far from ideal, but we had to trust our instincts and experience.”
Outpatient imaging centers became makeshift community hubs. Mission Hospital’s largest outpatient center in Asheville, NC, provided water and hot meals while other centers operated under ad hoc conditions. Bottled water was used for handwashing, and portable toilets were installed. Meanwhile, cross-trained mammography technologists took on roles in other modalities, demonstrating staff flexibility.
At the same time, administrative offices faced their own challenges. Internet providers were in crisis, and even when connectivity returned, systems were overwhelmed with backlogged data updates. The team turned to Starlink, a satellite internet service, for reliable access.
As the storm subsided and recovery began, the team reflected on what they had learned.
After 48 hours, PACS was restored and the backlog of preliminary studies began flooding the system. Radiologists faced the dual challenge of interpreting new studies while finalizing reports for the backlog. Staffing schedules, coordinated largely through word-of-mouth and in-person conversations, remained fluid as transportation and communication hurdles persisted.
Steve Thuahnai, MD, PhD, radiologist with ARAHS, reflects: “Reconciling handwritten notes with electronic records was painstaking. Even as systems came back online, the sheer workload was immense.”
As the skies cleared and recovery began, the storm left lasting lessons on radiology’s reliance on technology and the critical role of teamwork in maintaining patient care. “What stood out most,” says Thuahnai, “was the unparalleled teamwork — both within our staff and with our hospital partners.”
Article contributed by Steve Thuahnai, MD, PhD; Marianne Ballisty, MD; and Michelle Russell, ARA Health Specialists
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