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. Every county in Texas plans and practices for disaster 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.
Consider the facts: One third of businesses that are unprepared for a disaster will never reopen after cleanup is over. To avoid being part of that statistic, plan ahead and be disaster ready. 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.
Detect your own vulnerabilities and those of your community. You have geographic vulnerabilities and competitive vulnerabilities. For example, if you live in a flood-prone area, you are vulnerable. If your business is in a low-lying building, a flood will affect you first. But if you are positioned up on top of a hill, you can be fairly certain you won’t need to be the first to pack sand bags around your office. You have now detected a competitive advantage.
Detect your community’s needs too. Consider how your business can help. If you run a gas station, police and emergency vehicles and generators will need to be refueled. How can you help them? Do you have generators to allow you to pump the fuel out from underground? If so, you’ve just detected a unique advantage you can offer to the community in the event of an emergency.
I is Incident Command
Every community has one person in command in case of a disaster. That person, the “incident commander,” has a set of responsibilities to delegate that filters down through an established structure. The “incident commander” is most often the emergency operations center commander, fire chief, EMS chief, or a law enforcement official. The definition of disaster is when need exceeds available resources. Find out who is in that incident command position now and ask how you could help become a part of that structure. For example, if you are a provider of heavy equipment, you can make arrangements for your trucks, cranes, and earth movers to be at the county’s disposal to help with cleanup—you have now become part of the emergency team. If you wait until disaster strikes, your offers of help may be too late. Do it now.
S is Scene Safety
Know where your safety vulnerabilities are. If you were to lose power or cellular phone service, how will that affect your business? Be prepared. If you own a jewelry store and your alarms malfunction, you will be a target for looters. Let local law enforcement know that if the power is off, your business will be vulnerable. Ask them to do an extra pass in front of your business in the event of a disaster. To encourage them to keep an extra close eye on your business, offer your services now—let them park their cruisers in your parking lot or use your restroom facilities when they are out on patrol.
This is particularly important if your facility itself becomes part of the scene. Scene safety must be maintained by law enforcement workers, not your employees, or you. This is where pre-arrangements will come into play. In the event of a disaster, your 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. 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—either your current one or the potential one during a disaster. If keeping your business open is not safe, or if your employees have urgent personal or family needs during a crisis, you need to take responsibility for that and be realistic. Assess whether it is safe to continue to be open and ask yourself if your employees have needs that are outside of the business. If so, make allowances for those. You don’t have to stay open 24/7 or put yourself or your employees at risk. Letting your employees know that their personal needs are important will gain you their trust and loyalty.
S is Support
Support works both ways. The easiest way to get support during an emergency situation is to give it as part of the support team. All emergency response managers are taught to reach in their community and make pre-arrangements for the resources they need. These are called mutual aid agreements. Approach the emergency response manager and say, “I can provide you the following things. Will that be of help?” You will most likely get a yes, especially if you do this ahead of time. You will be written into the county’s plan. Be prepared to deliver whatever you promise. An advantage to you is that when you have a need, you are already known to the people with the power. And since you’ve already detected what kind of support you’ll need, you can ask for it in advance.
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
Triage means to do the most good for the most people with limited resources. Even if you’ve been the best person and the most helpful to your community, if your needs are minor you will have to wait longer than someone whose needs are greater. The person with the greatest need will get help first—no matter when they ask. Adopt the same principle with your business resources. If your business supplies something that will be in great demand—like plywood, or gasoline, or drinking water—you may have to ration based on the greatest need. Even though it may be a hard decision to make, you are really benefiting the community.
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 your employee, who are going to have to be assessed regularly as to whether they need a break. Also consider your available space.
E is Evacuate
If you are called to evacuate, go. Orders to evacuate usually come in stages. When they tell the group you belong to that it’s time to evacuate, heed the warning—it’s unsafe to stay. Rest assured that businesses that are prepared and forced to evacuate in most cases will reopen when it’s safe to do so.
R is Recovery
Recovery begins with your recovery plan—long before the event occurs. Before the forecasted event, move your computers and set your supplies aside. Continue to do business. Have a cashbox and receipt book in case your register goes down. Have a sign that doesn’t require electricity to run that says “Open.” When the disaster is over and people venture out into their community, they will see your sign. Even if they don’t buy something from you right then, they will remember that you stayed open or reopened quickly after the disaster. Have these items on hand “just in case” as part of your recovery plan.
And now for R.E.A.D.Y.
R is for Rely
After you develop a disaster plan, you need to be ready within your own business. 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 business 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? How do you collect payment? Cash or a trust system? 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. They’ll take comfort in knowing what procedures to follow in the event of an emergency. The community leaders also need to know the plan within your facility.
A is for Appreciate / Anticipate / Adapt
Appreciate your employees every day. Not only will you experience a more pleasant workplace, but in a time of crisis your employees will pay you back with their loyalty. In the face of a natural disaster, continue to appreciate your employees—particularly the ones who came back. But still appreciate the ones who couldn’t come back. Some people will have more pressing personal responsibilities than others.
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. Anticipate that events will not unfold as planned. Be flexible. Adapt to the unexpected.
Remember: “Sempier Gumby” – “Always Flexible”
D is for Drill, Drill, Drill
Have dry runs. Just as you have a routine procedure for a fire drill, so should you for a disaster drill. Any drill needs to realistically recreate what your facility can do. If you don’t, panic will set in and your mind will shut down. You will revert to what is familiar—the day-to-day routine you’ve always done—not what you should be doing in a disaster. 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. Dedicate yourself to the entire process and practice.
Y is for You
For businesses, it comes down to you—each individual and each employer. 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.
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 natural disaster. With proper planning, however, your business 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. Plan ahead. Educate your employees on what they need to do, appreciate those that help you run your business, hold practice drills regularly and take responsibility for your actions. 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. When you are dedicated to your employees, your business, and your community before, during, and after a disaster, you will be rewarded with a business that remains open and profitable for years to come.