EAST TENNESSEE (AP) — Patients and their caregivers sought shelter Friday on a Tennessee hospital’s roof after flooding caused by Hurricane Helene drove them from the building’s interior and conditions made rescue efforts difficult.

The dramatic scene at Unicoi County Hospital near the North Carolina border was one of several that played out across the southern U.S. in Helene’s wake, as flooding caused by its storm surge and rain sent thousands of police officers, firefighters, National Guard members and others on rescue missions. Hundreds were saved, but at least 40 died.

Unicoi County Hospital tried to evacuate 11 patients and 43 others Friday morning after the Nolichucky River overflowed its banks and flooded the facility, but the water was too treacherous for boats sent by the Tennessee Emergency Management Agency. The decision was made to take everyone to the roof.

“The water there simply came up faster with more debris than was safe to operate in the rafts to ferry from a dry point back to the hospital,” said Patrick Sheehan, Tennessee’s emergency operations director.

After other helicopters failed to reach the hospital because of the storm’s winds, a Virginia State Police helicopter was able to land on the roof. Three National Guard helicopters with hoist capabilities were on the way, officials said.

“We ask everyone to please pray for the people at Unicoi County Hospital, the first responders on-scene, the military leaders who are actively working to help, and our state leaders,” said Ballad Health, the hospital’s owner, on social media.