Hospitalists can make a difference in disasters


When fire is eating entire neighborhoods, or a hurricane is smashing towns like toys, the hospitalist will invariably run right toward the disaster.

Lou Ferraro, Park South Photography

The prime directive during any emergency situation is communication, on both a microcosmic and a macrocosmic scale, said Dr. Mark Shapiro on Monday at HM19.

It sounds completely crazy, unless you’re a hospitalist, Mark Shapiro, MD, said during a Monday session. Or a hospitalist’s spouse.

As the Tubbs Fire raged across Northern California in October 2017, Dr. Shapiro fled with his 5-month-old son, his dog, and his wife. And then they had that conversation.

“After we got everyone settled, I said to my wife, ‘Honey, I need to go back.’ And she said, ‘Yes, of course you do.’ Having that clarity and support behind me was so important. I was able to return to the hospital and focus on my job.”

“Trust me,” said Dr. Shapiro, director of hospital medicine at Providence-St. Joseph Health Medical Group in Santa Rosa, Calif. “You will want to do your work.”

The Tubbs Fire opened a week of “extraordinary challenges” said Dr. Shapiro. His lecture, “A Survival Guide for Hospitalists: Emergency Preparedness for Hurricanes, Fires, Mass Casualties, and Other Emergencies,” drew on his personal experiences from that fire, his leadership during the emergency response, and the debriefings that inspired his colleagues and him to plan how to handle future emergencies.

“Over 1 week we struggled and suffered and learned a great deal about hospital operations and how to keep safe in an emergency situation,” he said in an interview.

The prime directive during any emergency situation is communication, on both a microcosmic and a macrocosmic scale.

“It pays to have these conversations with family and friends before a disaster happens, so that they understand you will have to go to work and that – importantly – you will want to go to work. Lay the groundwork so that when you say, ‘I love you,’ and leave, it’s not a surprise. It’s extremely important. You need to be able to do your work knowing that not only are they safe, but they’re also behind you on this.”

On a system-wide scale, emergency communications at work must be “redundant, flexible, and sustainable,” he added.

“You have to be able to communicate as a team, and that means knowing if your team is OK. Are they able to work? Are they hurt? Are they dead? We had to ask those questions at 3 a.m.”

Flexibility gives teams the option to switch communications modes on the fly – extremely important when standard modes may be endangered by natural disasters of all types.

“You don’t know how long one method will last, so your communication tools have to change. In our case, we lost cell communication but texting was intact. And we were lucky – we might not even have had that. What would you do if you lost that? Go to landlines? Pagers? It’s all very contextual.”

Another emergency preparedness must-do that Dr. Shapiro addressed in his presentation? It’s “Drill, drill, drill.”

“You have to understand what this is going to look like,” he said. Who’s going to go where, and when? What is the chain of command, and what happens when something disrupts those things, as will inevitably happen?

Cross-training is a big part of the picture, too. Not only do team members need to do their own job, they should be able to step in and at least competently do someone else’s job, as well.

“People need to be flexible, because ‘job X’ still needs to get done, no matter what.”

Dr. Shapiro’s interest in hospitalists responding to disaster extends even to his podcast, “Explore the Space,” which examines the interface between health care and society, with thought leaders from across the spectrum. Several podcasts in his series touch on disaster response and preparedness, including two from the fall of 2017, focusing specifically on the wildfire. [They can be downloaded for free at Stitcher or Apple Podcasts.]

Dr. Shapiro had no financial disclosures.

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