After the poorly planned evacuation for Hurricane Rita in 2005, many health care systems in the Houston area updated the disaster plans they would implement in the event of a major disaster. In September 2008, Texas health care systems in the Houston-Galveston area had the opportunity to execute those plans when Hurricane Ike made landfall. Despite hours of hurricane preparation at the Texas Orthopedic Hospital in Houston, TX, before the storm, we found that there were still lessons to be learned from Hurricane Ike that can be used by other health care systems to prepare for disaster.