Texas hospitals are running out of water. Some facilities are now evacuating patients for their safety.

Health systems are reporting hundreds of their employees sleeping overnight because of perilous road conditions. Many patients who are ready for discharge are stuck because they have no power at home. And many others are showing up at hospitals in search of a warm place to sleep or to keep lifesaving medical equipment powered.

"For Texas hospitals, this is an emergency on top of a pandemic," Carrie Williams of the Texas Hospital Association said in an email. "They have been on the front lines now with broken pipes, dwindling supplies and water restrictions."

Hospitals are going to great lengths to protect their water supplies, including in Austin where staff used trash bags to remove feces from toilets, a nurse told KVUE. A hospital in Houston relied on buckets of rain water from the roof to flush toilets. Elsewhere, staff are cleaning themselves with hand sanitizer instead of soap and water.

Some hospitals said the situation improved Thursday as temperatures warmed and water trucks arrived. But authorities fear more pipes will burst, heating systems will fail and water pressure will plunge at hospitals as temperatures dip below freezing for the next several nights.

In a stretch of Southeast Texas from Houston to Corpus Christi, 45 of roughly 100 hospitals declared an "internal disaster" status Wednesday night to dissuade emergency medical crews from taking patients to them. The area is home to about 8 million people. While Texas is no stranger to hurricane seasons - including Hurricane Harvey, which flooded Houston in 2017 - health care leaders say the strain on hospitals is particularly acute this year with a natural disaster impacting the entire state during a pandemic.

"For me, this is worse than Harvey because of the enormous swath of Texas that this has covered," said Darrell Pile, chief executive of the Southeast Texas Regional Advisory Council, who oversees preparations for and management of medical crises for the 25-county region. "We have never had this many hospitals impacted simultaneously."

Some are now moving patients to other facilities for their safety - if they can find anywhere with the ability to take them.

"No one hospital currently has the capacity to accept transport of a large number of patients," David Huffstutler, CEO of St. David's HealthCare, which operates four hospitals in the Austin area, said in a statement.

St. David's hospital in Austin lost water pressure Wednesday, which also meant losing heat because water feeds the boiler. The entire city is under a boil water advisory that could last days. Patients washed their hands with jugs of water and staff emptied toilets with bags as a result. The hospital also transported about 30 of 300 patients elsewhere.

Huffstutler said the hospital restored heat after bringing in water trucks to create a closed-loop warming system. While water trucks were working to recharge water pressure, another Austin facility lost water pressure and a third continues to experience low pressure. Other hospitals in Austin, as well as hospitals in Arlington and San Antonio, also had low water pressure issues.

"One of our biggest challenges has been the inability to discharge patients due to mobility and transportation issues, as well as power and water outages at their homes, and limited access to shelters in the area," Huffstutler wrote. "Fortunately, so far, we have been able to manage through that, and things should get better over the next couple of days."

In Houston, which is also under a boil water notice, Mayor Sylvester Turner, a Democrat, pleaded with residents to stop running water to prevent pipes from freezing to help conserve resources for hospitals. Pipes have already burst at multiple Houston Methodist hospitals, and at least two facilities are operating without water

The lack of water forced some quick thinking, said Roberta Schwartz, executive vice president and chief innovation officer at Houston Methodist. She described a swiftly rigged system to sluice rainwater from the roof into a large laundry bin, then used to fill buckets and flush toilets.

Across the seven-hospital system, emergency rooms were inundated with patients who, in addition to typical medical emergencies, slipped on ice, needed batteries for medical appliances and sought dialysis treatments after their usual centers closed. One large emergency room treated nearly twice the usual 110 daily patients.

Ben Saldana, the medical director for the Houston Methodist's emergency departments, said the threat of coronavirus complicated an already fraught situation. Each patient had to be evaluated to see whether they might be suffering from the virus.

"We were teasing it out," Saldana said. "Is it also covid?"

Turner, who has already dipped into a water supply bookmarked for irrigating parks, has instructed grocery store chains to send whatever available water they can spare to hospitals. He also said the city parks and recreation department delivered water to hospitals Wednesday night. The Houston Fire Department has separately sent water to at least one facility, Lyndon B. Johnson Hospital.

Rural health care providers with far fewer resources than big-city hospitals faced especially tough challenges trying to deliver care in the storm-battered state.

"We have not had power outages at our clinics like this before that have kept us from seeing patients," said Lynn Falcone, CEO of Cuero Regional Hospital, a rural system with five clinics based about a hundred miles south of Austin.

The clinics shut down Monday after losing power and water and are not expected to reopen until next Monday. One requires significant repair after burst pipes left two to three inches of water on the floor.

The main 49-bed hospital is still operational with staff sleeping overnight, Falcone said, but has struggled to find others willing to accept patients with more complicated cases. One patient traveled four hours to Laredo because roads were safer. A mother and her newborn stayed an extra night because they lacked water and power at home.

Ari Espinosa, 18 of San Antonio, spent about four hours trying to find a doctor after suffering an allergic reaction Wednesday morning. He had no WiFi or data on his phone to look up options.

He and his mother first drove to a nearby urgent care clinic where the lights were off and parking lot empty. They braved slippery roads with reckless drivers to try another two clinics before regaining connection to the Internet and discovering most were closed. They tried a large hospital where the parking lot was so overrun that staff allowed patients to park illegally.

"It was completely packed, and there were really really sick people," Espinosa recalled. "Someone was vomiting and moaning in the corner. Some guy walked in and his hand was bleeding all over the place."

He finally saw a doctor at the fifth facility they tried, capping off a treacherous search.

As routine medical care goes interrupted, ongoing coronavirus vaccine drives have ground to a halt too.

"This is as challenging of a weather situation in our area than I've ever seen," said George Roberts, CEO of the Northeast Texas Public Health District, which canceled vaccinations until next week. "We have a generational weather event associated with a generational pandemic."