Emergency

Preparedness
Jacob Persily, Shweta Patro, Andrea DAgostino, Drashti
Patel, Fred Weiss
February 23, 2014

Superstorm Sandy
October 29, 2012
157 fatalities
$68 billion in damages
Effects Still felt today
90% of hospitals felt Substantial Challenges

Principle Issues
1.Hospital Infrastructure
2.Patient Surge
3.Communication
4.Staffing
5.Recovery

Hospital Infrastructure
Damage to hospital infrastructure can
compromise health and safety of patients and
strain the hospitals ability to provide quality
care during a disaster
About half the hospitals (83 of 172) in the declared
disaster areas reported challenges with facility
infrastructure when responding to Sandy

Specific Infrastructure Problems

Flooding due to the storm
Impacted generators, water supply, caused structural
damage

Specific Infrastructure Problems

Widespread power outages
Reliance on backup generators and alternative
procedures for patient care
Impacted access to patient medical records

Fuel Bucket Line

during Sandy

Infrastructure Related Solutions

Planning for emergencies of longer duration and more
clearly defining staff roles during the emergency
A pre-storm checklist for each department, including
administration, clinical laboratory, and facilities
Routine testing of utility systems such as generators
Improving emergency planning in terms of conducting
adequate emergency drills
Address deficiencies regarding fire safety, obstruction,
and signage

Patient Surge
A surge describes the ability to provide adequate medical
evaluation and care during events that exceed the limits
of the normal medical infrastructure.
It includes the ability of HCOs to survive a hazard impact
and maintain or recover operations that were
compromised.

Patient Surge
In these situations HCOs must:
Identify the medical need
Identify the resources to address the needs efficiently
Move the resources quickly to locations of patient
need
Manage and support the resources to their maximum
capacity

Patient Surge
HCOs can expect for increases in patient number due to:
Cold temperatures and lack of power yielding higher incidence of
pneumonia/illness
Potential lack of access to medication sending patients to ED as last
resort
Lack of access to food or clean water causing dehydration
Delay in medical care worsening injury creating need for more urgent
medical attention
Homeless populations or those affected by the storm seeking refuge
Cases of extreme anxiety caused by stress from the storm

Patient Surge Action Steps

Securing Transportation
Securing Emergency Transportation in case evacuation or
emergency situation

Stocking Supplies Prior to Storm

Preparing medications, Food/Water, Clean linens, and all needs
to remain operational

Rescheduling Elective Surgeries

Keeping OR available for potential emergencies

Prohibiting Patient Visitation

Keeping the number not seeking care at a minimum to prevent
overcrowding

Patient Surge
Emergency Preparedness
NY/NJ had put in place a well thought out surge plan to
be able to handle and control an increase in patient
volume
This plan allowed for immediate and swift action to be
taken in circumstances that warranted evacuation
In contrast, when Hurricane Katrina hit, New Orleans
hospitals did not have a surge plan to prepare to
evacuate or receive patients after the storm

Communication
One-third of hospitals in the declared disaster
areas (59 of 172) reported that communication
was a challenge during the storm, including
contacting staff, officials, and other hospitals

Communication
Infrastructure Failures
Compromised cell phone towers
Flooded telephone switching stations
Damaged telephone utility poles

Communication
A Solution for Infrastructure Failures: Redundancy
Cellular and landline telephone technology was
damaged but other devices could be used in place
Satellite telephones
Two way VHF/UHF radio
Amateur (HAM) radio

Communication
A Solution for
Infrastructure Failures:
Interoperable
Communications
Vertical
Horizontal

Communication
Recommendations for Improving
Communication:
Compliance with National Health Security Strategy
guidelines
Redundancy
Redundancy
Interoperability
Social Media Management
Telemedicine Infrastructure and Processes

Community Collaboration problems

47 facilities with collaboration challenges with
other entities
Problems with distributing and sharing fuel
transportation, hospital beds, and space in public
shelters, all of which affected the capability of
hospitals to care for patients

The Importance of Staffing in Emergency

Scenarios
The NPHHI survey indicates that the number of licensed
(i.e., theoretically available) beds exceeds the number of
operational (i.e., staffed) beds at members facilities by
an average of 100 beds. This makes staffing the
essential factor in transforming possible into realized
capabilities and illustrates how nurse and emergency
physician shortages profoundly affect a hospitals ability
to manage surge capacity. Research Brief, NPHHI 2007

Staffing Issues
Getting staff in place for an extended period of
limited travel
Staffing to handle increased patient flow
Distribution of staff from non-functional
hospitals
Adequate supply of specialists
Provider burnout during disaster
Emotional distress after disaster

Sandy-Specific Issues
Evacuation needs-Provide patient care while
moving patients

6 Common Sense Solutions to Emergency

Staffing Issues
1.
2.
3.
4.
5.

Prepare at Home and the Workplace

Plan for Early Arrival
Plan to deploy staff in unconventional ways
Invest in state-of-the-art communications technology
Establish mandatory brainstorming sessions with
senior hospital leadership throughout the year.
6. Activate the Emergency Command Process Early

Recovery
The recovery of a Hospital after a major
disaster is crucial to the community
Lessons learned in the aftermath of Hurricane Katrina
in New Orleans can be applied to the health care
systems affected by Hurricane Sandy

Recovery
The first aspect of recovering from a major
disaster in a healthcare setting is assuring
that the staff and personnel are being offered
proper coaching and assistance to deal with
the mental strain of the situation.

Recovery
Helping staff recover:
Offer counseling and mental assistance after major
disaster
Consolidate and discuss procedures to see how to
improve going forward
Keep staff informed of plans throughout duration of
recovery
Allow for staff to home life in order to better prepare
them for reentry to work life

Recovery
Infrastructure of health care facility need to be
addressed:
Make sure any sort of power failure can be resolved
by facilities available.
Prepare as though hospitals will be stranded for long
periods of time.
Allow for proper inspections to be made before
readmitting patients.

Any Questions?

References
http://essentialhospitals.org/wp-content/uploads/2014/10/May2007_Research_Brief.pdf
http://www.beckershospitalreview.com/quality/lessons-learned-from-hurricane-sandy-6-steps-every-hospital-should-implement-before-disaster-strikes.html
https://oig.hhs.gov/oei/reports/oei-06-13-00260.pdf
http://www.slate.com/articles/news_and_politics/gallery/2012/11/hurricane_sandy_s_aftermath_is_worse_than_you_think_photos_of_the_devastation.htm
l
http://www.slate.com/content/dam/slate/articles/news_and_politics/gallery/2012/11/hurricane_sandy_s_aftermath_is_worse_than_you_think_photos_of_t
he_devastation/155063532.jpg.CROP.article920-large.jpg
http://assets.nydailynews.com/polopoly_fs/1.1200357!/img/httpImage/image.jpg_gen/derivatives/article_970/hosp12n-2-web.jpg
http://www.prlog.org/12016252-stay-conne
http://www.phe.gov/preparedness/planning/hpp/reports/documents/capabilities.pdf
http://www.phe.gov/Preparedness/planning/hpp/meetings/Documents/capability6-20130812.pdf