Disasters can strike at any time, anywhere. So whether it’s a natural disaster, like an earthquake or hurricane, or a man-made one, like an Anthrax attack, your health care facility needs to be prepared. You can’t wait until the actual event. You need an all-hazards approach plan now.
When hurricane Katrina slammed the gulf coast, every American witnessed the devastation that occurs from lack of preparation and planning. Officials knew the storm was coming and they knew it was going to be big, but planning was almost non-existent. Although the officials ran a number of drills, allowed three days to evacuate, and identified which areas and residents would be most at risk, they failed to plan a designated time to leave, how they would evacuate residents, and how much time they would need to get everyone out safely.
But when hurricane Rita threatened Texas merely days after Katrina ravaged Louisiana and Missouri, the outcome was quite different. Each county in Texas plans and practices for disasters every year. So when meteorologists plotted Rita’s path, officials in Texas already knew who would be a part of their plan, they anticipated being overwhelmed, and they had identified who could support them. Although their evacuation looked chaotic when everyone ran out of gas on the road, they were able to accommodate the situation and they had a plan in action quickly after the fuel shortage took hold.
Due to standardized training, two rescuers who have never met and live in different parts of the country can perform C.P.R. together to resuscitate someone. After 9/11, it was determined that the same training model needed to apply to disaster medicine. Unfortunately, 9/11 illustrated that various organizations and responding agencies operate completely differently in response to the same problem. As a result, we saw a marked increase in the number of casualties. Similarly, while the mess with Katrina was still making headlines, Rita was much easier to deal with because the officials had a plan.
In response, The American Board of Physician Specialties (ABPS) determined that a new board of certification in disaster medicine should be an integral component of a national disaster preparedness strategy. Therefore, the ABPS organized and developed our nation’s first such certifying board, the American Board of Disaster Medicine. The goal of the American Board of Disaster Medicine is to foster, coordinate, build, and facilitate partnerships between disaster medicine specialists and all levels of government and the private sector. By certifying physicians educated in an “All-Hazards Approach” and a common shared skill set for all healthcare, the American Board of Disaster Medicine will integrate the best each medical specialty offers to improve disaster preparedness / response.
Dr. Maurice A. Ramirez, Chairperson of The American Board of Disaster Medicine and an expert on the topic of disaster preparedness and response has distilled the steps you need to become D.I.S.A.S.T.E.R. R.E.A.D.Y. and P.L.A.N. Each letter of these acronyms stands for a key item in your disaster preparation checklist. Go through each letter and take the necessary action. This is not something you will complete in an hour, but you do need to start now, long before any disaster is forecasted. When you can check all these items off your list, you will be as prepared as possible for any disaster that may come your way.
Let’s start with D.I.S.A.S.T.E.R.:
D is Detect
Detect that there is an event coming or that an event has occurred. Then activate the disaster plan. Make sure your plan is realistic.
I is Incident Command
Every community has one person in charge in case of a disaster. The “incident commander” is most often the emergency operations center commander, fire chief, EMS chief, or a law enforcement official. In any given health care facility, you also need your own “incident commander.” This person should not be the hospital CEO, head nurse, or the chief of staff physician. All those people should be providing healthcare or support during a disaster.
The definition of disaster in medicine is when need exceeds available resources. One of those resources is health care providers. Therefore, the incident commander should be someone who can answer to that outside person in charge of the disaster for the entire community.
During a disaster, the hospital CEO should be standing next to their media person, providing the community with a calm, confident, reassured face on their facility. If the CEO is there, the public will perceive that all is well. The person who is elected the instant command person should be inside delegating commands to healthcare professionals as well as non-healthcare support people. Choose the right person for the job.
S is Scene Safety
This is particularly important if the hospital or healthcare facility itself becomes part of the scene. Scene safety must be maintained by law enforcement workers, not healthcare providers. This is where pre-arrangements will come into play. In the event of a disaster, healthcare facilities become locked facilities—nobody in, nobody out unless they belong in or out. The decisions of those who decide who get treated first are final. Anyone who enters the facility must first be decontaminated. If there’s any chance of them bringing in manmade poisons, like Anthrax or Serin or other chemicals released during accidents, the contaminated people must be dealt with. If not, you run the risk of the whole hospital facility being contaminated and shut down. Also determine what impact the event had on the structure you are in. Is it safe to remain? If not, you must relocate.
A is Assess
Assess your situation—and reassess it again and again—as you act and before you act. Know what you’re getting yourself into. How are you going to get in and get out? How long are you going to be there? What else do you need? Once you’ve assessed your situation, your resources, and your needs, then you can act.
S is Support
Support works both ways. You need to negotiate to be part of pre-arranged mutual aid agreements. If you are an executive in a healthcare company or an insurance company, have these things done months or years before you need them. Regularly check that everyone is still in agreement. The time to be arranging your support and your help is not when the disaster occurs; it’s now.
Remember, the Disaster Medical teams don’t come until 24-48 hours. FEMA doesn’t come for days. The National Guard can’t come until a disaster is called, and then it usually takes another 24 hours. All of those outside supports are late events. For the first 24-48 hours you’ll be on your own. If you haven’t set up your support systems, you are going to run out of manpower and supplies.
T is Triage and Treatment
This is true medical military triage. This is not a situation where we are looking for maximum customer satisfaction or to move the least injured patient the fastest. It’s doing the most good for the most people with limited resources. Sickest come first, and the most likely to survive come before the least likely to survive. Those who are minimally injured may be delayed in their treatment for an extended period of time.
Use your resources as wisely as possible, including the health care providers, who are going to have to be assessed regularly as to whether they need a break. Also consider your available space. If you fill the ER with patients who have bumps and bruises because you think you can move them fast, you will have no space for people who are finally taken out of a collapsed building and need care the most.
E is Evacuate
You may be told you need to evacuate the building you’re in. When you get the order, get out. Another part of the evacuation plan is knowing how you going to move patients. If you are the closest hospital to the scene of the disaster, patients will end up at your hospital first. If patients need to be moved somewhere else, how will you do it?
R is Recovery
Recovery begins with your recovery plan—long before the event occurs. Healthcare officials that have large facilities at their disposal need to be part of the process beforehand. The community will look to them for help. When people are hurt and in the days that follow, as the sick run out of medication, as the elderly run out of oxygen, as diabetics run out of the proper type of food they need, people will need to know how to access those needed resources.
And now for R.E.A.D.Y.
R is for Rely
What do you count on to continue to operate? Is it dependent on a single person or a single system? If so, you need to create redundancy. What do you rely on? Do you have key procedures that only exist in your employees’ heads? Write them down now. Keep a copy at your facility and another off-site at a safe location. Those processes are important. Back up your computer files and store them off-site. If your building were to be demolished, would you be able to quickly duplicate your processes in another location?
E is for Educate
If you become part of your community response, you will need to know how to access people and they will need to know how to access you. How are they going to identify themselves? Develop a written procedure. Make sure your staff knows exactly what they should do. It’s not good enough to write a plan and sit it on a shelf to collect dust. It has to be brought off the shelf, dusted off, and everyone needs to know the plan—even the volunteers. They need to be oriented to the plan you have and the plan your community has. The community leaders also need to know the plan within your facility.
A is for Appreciate
Appreciate the needs of your employees. Appreciate them being there, away from their families. Appreciate them for drilling and educating themselves on this beforehand. Appreciate your healthcare workers or they will move on or leave this profession entirely. Remember, the best way to inspire loyalty is to lead humbly.
D is for Drill, Drill, Drill
Have dry runs. Any drill needs to realistically recreate what your facility can do. Consider at what point you’d have to declare an internal disaster on top of an external disaster—when the needs within your facility have exceeded your ability to meet the public’s needs.
Y is for You
For healthcare facilities, it comes down to you—each individual—from the janitor to the CEO, from the incident commander to the triage nurse to the registration clerk. Take responsibility for all your actions. Plan ahead and be part of the recovery solution.
Finally, let’s P.L.A.N.
P is for People
The first step in making your plan is to take an inventory of who will be participating. If you are making a plan for your family, consider who will be with you and how to prepare each person for the disaster. If you have small children, you may need to talk to them about what is happening, and reassure them that everything will be all right.
Also, what tasks will each person perform? If you’re facing a hurricane, who will board up the windows? Who will make sure the dog gets into the car if you evacuate? Each person should have a function in ensuring the safety and security of everyone else. Even children can participate. A small task might make a child feel more purposeful, like a critical part of the plan, rather than a helpless bystander. So if your children are old enough to take part, put them in charge of the extra batteries or have them fill the water bottles.
Likewise, if you are making a plan for your business, consider who will participate and what role each person will fill. If you plan to close, you need to know who will be involved in the closing decision, and how you will secure the premises. If you decide to stay open, your plan is even more important because you will be responsible for the safety of your employees.
Other people in your plan include contacts outside the disaster zone. You need someone to serve as a message board for communication. Then everyone involved in your plan can call in and let the centralized person know they are safe and their location. If you decide to leave, you need someone out of state whom you can stay with.
Finally, consider what outside facilities you are going to rely on. If you have unanticipated emergencies, who are you going to call? Are they going to be able to get to you? If your entire plan is to call 911 and get assistance, you need to realize that in a disaster situation they probably won’t be able to assist you for seventy-two hours. In this case, you will need to reassess your plan.
L is for Leave
Next, consider leaving the disaster zone. When and how will you leave (evacuate)? Where will you go and how will you get there? Will your family or fellow evacuees meet before you leave or when you arrive at your destination? The decision to leave makes communication and your contacts outside the disaster zone critically important. How will you communicate while you evacuate and after you arrive at your destination? What are you going to do if you get separated? Operate on a buddy system; no one should be left alone. When you and your family or business associates become mobile, make sure everyone knows the plan. Then, if your plan fails, you need an alternative.
If you are not leaving, consider where will you stay and how will you stay safe. Will you all stay together or shelter in the place you are when the disaster strikes? Will you send some of your family to your evacuation destination while others stay? All these factors need careful consideration and planning.
A is for Anticipate / Adapt
Unfortunately, in a disaster situation, nothing always goes as planned. So anticipate plan failures and plan for the “what ifs.” This is a chance to brainstorm. Make a list of all the possible failures. What if the phone lines go down? What if your basement floods? What if you get caught in traffic? No “what if” is too extreme to consider. The only possibility that you can’t plan for is the one you didn’t think of.
Once you’ve brainstormed possible failures, you need to adapt to each one with an alternate plan. If the phone lines go down, can you use your cell phone? If your basement floods, can you seek shelter with a neighbor or in some other nearby location? If you get caught in traffic, will you have enough gas to evacuate successfully?
What if something happens that you didn’t anticipate? If you go through this process enough times and really work on your plan, then you will be able to adapt to the failure. You’re mind will be primed and you’ll be ready to think of alternatives, even if the failure isn’t anticipated beforehand. Anticipate that events will not unfold as planned. Be flexible. Adapt to the unexpected.
Remember: “Sempier Gumby” – “Always Flexible”
N is for Needs
In any disaster situation, you must be ready to go for seventy-two hours without assistance. Those first seventy-two hours are critical because emergency relief will be overwhelmed during that time. Fire departments, police, and medical personnel won’t have the resources to get to everyone.
After hurricane Katrina, many people died simply because they ran out of food and water in those critical three days. However, four days before Rita hit Texas, the community leaders were on the television warning people that if they decided to stay, they needed to be prepared for seventy-two hours because no one would be able to help them.
When working on your plan, make sure you account for all your needs for seventy-two hours. Be prepared to be self-sufficient during this time. Each one of your family members must have personal identification and photos of all others in your plan, two quarts (liters) of drinking water, seventy-two hours of food, seventy-two hours of clothes, two weeks of medications, two weeks of toiletries, a supply of cash (credit/debit cards can’t be verified if phone lines go down), a flashlight, a portable radio, batteries, a signal whistle, white/silver duct tape, a first aid kit, prepaid calling card, and a list of emergency phone numbers.
These needs should be kept in a rolling backpack that stays with the owner. Keep this bag, your Disaster Pack, readily accessible. And if a disaster is imminent, keep the Disaster Pack with you at all times.
Are You Ready?
Once you have taken an inventory of your family, made arrangements for evacuation, anticipated and accommodated failures, and gathered all your needs for seventy-two hours, you need to review and practice your plan each year.
Hurricane situations are timely because of what happened on the gulf coast, but regardless of what disaster situation you face you must have a plan. In a tornado, tsunami, terrorist attack, or whatever, you can use these steps to make your disaster plan and ensure the safety of your family and your business.
Nothing you do can prevent a disaster. With proper planning, however, your healthcare facility can become “D.I.S.A.S.T.E.R. R.E.A.D.Y.” and “P.L.A.N.” Identify your strengths and weaknesses. If the worst happens, don’t panic. You already know the drill and what is expected of you. Be ready to do your best and activate your plan at the drop of a hat, ready to help those with the greatest need.