Losing utility power is always a concern in emergencies and disasters. “After 9/11 in New York City, lots of people flooded into emergency departments,” says Ann Waller, ScD, an associate professor in the Department of Emergency Medicine at the University of North Carolina at Chapel Hill and the UNC director for NC DETECT. (See “Disease Surveillance,” p. 20.)
“The emergency departments abandoned their electronic systems and went back to paper and pencil because it was faster to just do the bare minimum … and get them into each team than to enter all the information required,” she explains. “That was a real eye-opener for those of us who rely on electronic data.”
Preparing for crisis involves imagining the inaccessibility of all electronic communications and records, including data collection and surveillance, pharmacy, e-mail, and historical documentation and other medical records.
The general rule in disaster preparedness is to plan for 72-hour capacity: How and what do I need to exist for 72 hours? “And the standard is that you should try to do that for your average daily census plus 100 patients,” says Dr. Stucky.
Scheduling and staffing is another issue. “Be prepared to provide flex staffing and scheduling to provide surge capacity,” says Dr. Wilson.
Think on Your Feet: Training
If they are so inclined, hospitalists can become involved in disaster response, through disaster medical assistance teams, community emergency response teams, or through the Red Cross—to name a few. And there are plenty of ways to take advantage of free training, some of which provide CME.
Another important question to ask of your institution, says Dr. Stucky (who co-presented on the topic of disaster preparedness at this year’s SHM Annual Meeting) is whether they have run any mock disasters.
“You have to do that,” she says. “Half of disaster response is preparedness, but the other half is thinking on your feet. And there’s no way to do that without mocking a drill.”
While there can be value in computer-run mock-ups, “there’s nothing like doing it,” she says. “We learn at least 25 things every time we do it.” And though one drill does not a totally prepared institution make, “it does mean at least you have the right people in those strategic positions [and they] are people who can think on their feet.”
A valuable training resource from AHRQ is listed in the resources at the end of this article.5
With the vast amount of information on disaster preparedness available, one clear goal is to narrow it to avoid feeling overwhelmed.
“I think that is a real challenge,” says Dr. Cantrill, “but the first step is the motivation to at least look.”
Take for example the motivation of a flu pandemic. “It’s going to happen sooner or later, one of these days, but we know it this time,” says Waller. “We have the ability to be more prepared. … This is a huge opportunity to see it coming and to do as much as we can [correctly]. Which is not to say we can avoid everything, but at least we can be as prepared as we’ve ever been able to be.”
For hospitalists, there are several key techniques for individuals to be able to increase their readiness for disaster in the workplace. The first is to avoid relying initially or entirely on external help to supply a response, says Dr. Garrett: “You are the medical response, and there may be a delay until outside assistance is available.”