In a disaster, will your hospital be ready?

Posted Nov. 07, 2013, at 11:23 a.m.
Erik Steele
Contributed photo
Erik Steele

There were many who died at the hands of Hurricane Katrina and shouldn’t have. There was also something that should have died and did not — the inadequate readiness of many American hospitals for disasters.

Years after the retreating waters of the Gulf Coast left the wreckage of inadequate disaster planning at several New Orleans hospitals exposed, Hurricane Sandy did the same along the New York and New Jersey coasts. Similar disasters elsewhere have done the same since in other communities.

In a disaster of disaster planning, patients at some New Orleans hospitals paid with their lives for that lack of preparation. The stories of 16 who were essentially euthanized at Memorial Hospital by desperate physicians and nurses largely for lack of effective hospital and community disaster plans are detailed in a new book — “Five Days at Memorial” by Pulitzer Prize-winning physician and journalist Dr. Sheri Fink, M.D.

Among the many disaster planning lessons of Katrina and Sandy that can be learned studying those storms and reading Dr. Fink’s book are three that stand out.

First, that a disaster will happen some day to your hospital. It’s not a matter of if, it’s just a matter of when and what. It may not be half an ocean surging up over the landscape and into the hospital basement where back-up generators, crucial electrical circuits and water pumps are stored, but some day, some surge of some kind (epidemic influenza, earthquake, devastating ice storms, hurricane winds, toxic chemicals from a train wreck, etc.) will roll over the place where your community relies for care and your mother may be recovering from pneumonia.

Second, most hospitals have disaster plans that assume America will come quickly to their rescue. Diesel fuel and medical supplies necessary to run the hospital when the power goes out and re-supply is cut off are usually enough to last only five to seven days, based on what hurricane and earthquakes have proven is an erroneous assumption that help will certainly arrive within that time frame. This is America, after all. So too few hospitals have preparations that include enough critical supplies to take care of patients for long enough — enough diesel fuel to run the generators that keep life-sustaining equipment such as ventilators, for example. Then, too few have good guidelines for staff who must decide how to determine who lives and dies if supplies run short.

Many existing disaster plans are designed primarily for response to more common, large scale events that end quickly and do not damage either hospital or community infrastructure, events such as mass bombings or passenger train crashes. Hospitals in Boston responded magnificently to one such event, the Boston Marathon bombing.

Sandy, Katrina, the New England and Canadian maritime provinces ice storm of 1998, earthquakes, etc. are the kind of massive regional paralytic disaster for which hospitals are often less well prepared.

Third, and related, those plans assume other community services — fire and rescue, ambulances, area evacuation centers, hospitals to which your hospital should be able to transfer its patients in a crisis, etc. — will be working and able to help hospitals with stranded patients. Often, however, those community resources will not be able to respond to the hospital because they are overwhelmed by the same disaster, or they are unable to get to your hospital to help it take care of patients through the disaster.

Reasons for this lack of adequate preparation for big, paralyzing disasters is multi-factorial. Real preparedness costs money at a time when there is little to spare and every penny spent on real preparedness will mean not doing something else important. Emergency preparedness is not medically “sexy,” like a new surgical robot, but rather like putting money into a new basement no one sees and is nothing you can market to patients.

“Come to the world’s best hospital because we have better emergency preparedness than our competitors” will never be seen on a marketing billboard. Effective planning and training takes expertise and training that too few hospitals have been willing to support, often because it is difficult to convince hospital leaders to spend precious dollars on something everyone hopes and thinks will never happen. Community, regional and national preparedness is required for an individual hospital to be truly prepared, and preparedness in those sectors is beyond a hospital’s control.

None of that, however, amounts to enough of a reason for an individual hospital not to plan and prepare effectively. To do so in spite of those and other barriers requires driven hospital leadership. That’s why “Five Days at Memorial” should be required reading for any American interested in whether their hospital is ready for its disaster, and especially required reading for those who lead those hospitals — board members, administrators, leading physicians and nurses, etc. Plans need to assume help is not coming in five days, and how to decide which patients will not continue getting care if resources to care for them run out, etc.

The lesson of “Five Days at Memorial” is that lack of effective emergency preparedness now in even large, sophisticated hospitals in the middle of great American cities will kill patients later. We need to act now as though their deaths would be on our heads, because they otherwise probably will be.

Erik Steele is the former chief medical officer of Eastern Maine Healthcare Systems. He now works at Summa Health System in Akron, Ohio.

 

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