By Cathryn Domrose
In the wake of Hurricane Katrina in 2005, disaster planners discovered the importance of creating an advance registry of emergency care providers, doing early evacuations and caring for peoples beloved pets. After a tornado struck St. Johns Regional Medical Center in Joplin, Mo., during the spring of 2011, nurses learned to put shoes on patients after weather warnings so they wouldnt have to walk barefoot through glass-strewn hallways.
In preparation for last years Hurricane Irene, health organizations in the Northeast improved methods of tracking evacuated patients and created ways for staff to spend the night at their facilities so they wouldnt have to brave high winds and water to get to work.
And after Superstorm Sandy? “Were going to have a big, long list,” said Shelly Raffle, manager of the emergency response system for the Visiting Nurse Service of New York. “If there is a silver lining to these events, its the opportunity to prepare afterward.”
Since the Sept. 11 terrorist attacks, emergency preparedness has gone from being something healthcare administrators wished they could do to a top priority, said Carrie Kotecki, RN, MSN, director of emergency services at Bronson Methodist Hospital in Kalamazoo, Mich., and an instructor at the Federal Emergency Management Agencys Center for Domestic Preparedness in Anniston, Ala. State and federal funds carry incentives to create and test emergency plans that meet certain standards. The Joint Commission requires accredited hospitals to have an emergency operations plan that includes preparations for situations in which a facility has no outside support for up to 96 hours.
After every disaster, organizations must re-evaluate and fine-tune their emergency plans. “I think there has been tremendous progress in the field of emergency preparedness and response,” said Andrew Stevermer, RN, MSN, acting deputy director of regional emergency coordination for the federal Office of Preparedness and Emergency Operations. Stevermer has been involved in the disaster preparedness field for 15 years. Nurses, he said, are playing increasingly important roles in emergency planning, both in the workplace and the community.
Stevermer and others have seen some major developments in disaster preparedness in the healthcare sector within the last 10 years:
• Partnerships among all players. Healthcare organizations, law enforcement, firefighters, utility companies and emergency responders have become better at coordinating efforts and assigning specific responsibilities, emergency planners said. Federal agencies are learning how to best support the efforts of state and local responders. “The importance of working together during a response cant be overemphasized,” Stevermer said.
• A structured, designated command center. The idea of a central command taking over in an emergency situation originated among California law enforcement agencies in the 1970s, Kotecki said. The Hospital Incident Command System, which many facilities use, designates roles for those involved in disaster response, including operations, planning and risk assessment.
• Established contingency plans. Hospitals should have accessible plans for specific situations, including power outages, relocation, evacuation and patient census surges. Kotecki said that at her hospital, every work station has a plastic flip book with menu-style listings, outlining plans for various emergencies. During the Joplin tornado, nurses said, numerous emergency drills prepared them to keep patients safe. “Because we do practice frequently, it was very seamless,” said Linda J. Knodel, RN, MHA, MSN, CPHQ, NE-BC, FACHE, vice president and CNO of Mercy Springfield Communities, a health system that includes St. Johns, which was destroyed in the tornado, and the newly opened Mercy Hospital Joplin.
Though Irene didnt do the damage many expected, it gave New York and New Jersey healthcare organizations a chance to work out kinks in their evacuation plans. As a result, two days before Sandy struck, Nassau University Medical Center on Long Island prepared to receive about 100 patients evacuated from Long Beach Medical Center and its affiliated nursing home, said Kathy Skarka, RN, MSN, CNA, NUMC senior vice president for patient care and CNO of the medical center. Everything went according to procedure, Skarka said. “We felt proud of ourselves. It went really smoothly. And then the hurricane came.”
Though they had prepared for the evacuation, administrators at the Nassau hospital did not realize how the powerful storm would affect their staff or how long many in the community would be without power or housing. While many workers spent the night at their facilities before Sandy hit, about 30% of the staff couldnt get to work in the days after the storm, Skarka said. “We found we were depending on the same people over and over, and we worried about them,” she said.
The hospitals normal daily census of about 360 patients rose to about 550, as people in shelters came to the ED when their oxygen tanks and medication supplies began to run out. People living without power brought generators or charcoal grills into their homes, inhaled poisonous fumes and needed to be treated in the hospitals hyperbaric chamber. A gasoline shortage kept staff from coming to work up to a week after the storm.
All the planning in the world wont stop a disaster from taking a toll, emergency preparedness experts said. Thats when nurses and emergency planners need to look beyond their plans and get creative, said Cheryl Peterson, RN, MSN, director of nursing practice and policy for the American Nurses Association.
After Sandy, healthcare workers exercised creativity. At the Visiting Nurse Service of New York, nurses rode bicycles, walked and took taxis to get to their patients. The agency set up trucks where staff could charge cell phones and used Facebook and Twitter to inform workers of open gas stations.
NUMC sent physicians to shelters with medications and oxygen tanks to help ease ED crowding, Skarka said. When it became clear the surge in patients would be protracted, hospital administrators contacted the federal government and got help from a Disaster Medical Assistance Team of 28 physicians, nurses and pharmacists. The hospital also worked with the county health commissioner to make sure discharged patients had safe shelter.
All these experiences will eventually be evaluated and incorporated into new disaster plans, Skarka said. “We never thought wed be doing this for a week. I think we will have a way better handle next time on how to do this [for a sustained period],” she said.
Since the Joplin tornado, Knodel said, her healthcare system keeps all the equipment for a mobile command center, such as phones and radios, in a storage unit separate from its hospitals and has made arrangements for an emergency day care center. Bronson Methodist has a contingency plan for staff pet and child care, Kotecki said.
Other major problems will take time to solve, emergency planners said, including how to care for people in the community who are elderly, frail, and homebound, and who may be reluctant to leave their homes. These people are the most vulnerable during a protracted power outage, Stevermer said. “Thats something we as a society have to think more about.”
Although emergency plans will always need fine-tuning and improvement, they have come a long way from a decade ago, when most medical facilities had nothing in place, Kotecki said. “Its gone from an attitude of, ‘This is not going to happen to me to ‘Its not a matter of if, but a matter of when.” •