Every state is at risk for disaster, be it earthquakes, tornados, flash floods, or a pandemic. Last year, the hospital where I work as an ob/gyn hospitalist in the Pacific Northwest was put in a dire situation as wildfires surrounded and threatened to overtake our community. While the team was able to respond quickly and move patients to safety, it was a traumatic and emotional experience for both staff and patients.
As the West Coast currently faces a severe wildfire season and tropical storms threaten the East Coast, crisis management is absolutely critical. Several steps can help hospitals and staff prepare to manage these situations, not only in terms of helping patients affected by the disaster, but also in coordinating health care staff and facilities as they work to address the aftermath.
First, have an emergency plan that is evergreen. For major emergencies, evacuating the hospital can be a logistical nightmare. Our hospital had a protocol in place the last time we confronted a wildfire called “Ready, Set, Go!” to keep us ready with our things packed, set to leave at a moment’s notice, and finally, be equipped to go. Yet what compounded the difficulties was the fact that roadways were blocked by incoming fires and telecommunications were limited. With very little time to react, our health care staff had to remain nimble and quickly make plans on how to proceed in real time. This adaptability is particularly important for hospitalists that may be working at multiple hospitals in different geographies. Understanding and reviewing all evacuation routes on a regular basis, identifying possible scenarios that can arise as secondary disasters (e.g., downed power lines), and establishing alternative communication methods (including email, walkie talkie, text) are critical parts of a robust safety plan.
Second, understand patient risk. In a natural disaster, patients will be at varying levels of risk from exposure to the effects. For example, as an ob/gyn hospitalist, I know that pregnant patients are at increased risk for spontaneous miscarriage and preterm birth during wildfires and that prolonged exposure to wildfire smoke increases risk of high blood pressure, gestational diabetes, and premature birth. In addition to ensuring that an emergency plan accounts for evacuations, it also must take into account the potential risks to specific patient demographics and the equipment and care that will be required to treat an influx of patients, both from the immediate area and surrounding hospitals. A preparedness protocol should also include considerations for the various types of patients that may need to be evacuated and the essentials that need to be taken at a moment’s notice.
Finally, have a post-disaster plan. In the case of wildfires, it’s not just patients that are affected by disaster. During the Medford Fire, some of the hospital nursing staff found out that their homes had been lost while they were on shift, yet they could not leave their post. As health care providers, we are accustomed to putting patients first. However, the impact of catastrophic events in a community reaches those in the caretaker role as well. Staff members may be affected by their own loss, injury, or illness as a result of a natural disaster, or even from being in proximity with a large volume of patients affected by the same traumatic event. As part of preparedness efforts, health care leaders should assess resources that can help health care workers cope and recover following a traumatic event. For example, my hospital currently invests in an Employee Assistance Program that covers mental health services as well as creates opportunities for ob/gyn hospitalists to support one another through an internal program referred to as Clinician Assistance, Recovery, and Encouragement, which is especially important for those working through the psychological impacts of an adverse event. There are also a variety of online resources that can help with linking employees to postcrisis mental health assistance.
Disasters can occur at any time, with little warning. With National Preparedness Month in September, now is a perfect opportunity to look at how to improve upon existing emergency plans. By being prepared with an emergency plan that includes considerations for the hospital setting and patients with varying levels of risk, hospitalists can play an important role in preparing health care systems to build a more resilient community, mitigate risk, and ultimately, save lives.
Have you helped hospitals prepare for major emergencies or managed patient care in the midst of one? Share your experiences in the comment section.
Joy Anderson, MD, is an ob/gyn with the Ob Hospitalist Group. She is based in Medford, Oregon.
