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Before Hurricane Katrina hit in 2005, the board at St. Tammany Parish Hospital, a 300-bed facility in Covington, LA, on the north side of Lake Pontchartrain, was quite pleased with its 10-year strategic plan. The hospital was just about to complete a $55 million expansion, the finishing touches were being put on a quick-care clinic in their ED, and the board was beginning the process of improving the relationship between the hospital and its physicians. Then the storm came-and after the storm, thousands of displaced persons. There was no room in the ED; every bed was full. In one day, the carefully crafted long-term plan was tossed out the window. Survival of the hospital and its patients depended on quick thinking and risky decision-making.