Case Studies: Planning for the Known and Unknown

Elaine Porterfield

Disaster Preparation Is an Ongoing Project

You can prepare for disasters by consulting with experts, reviewing online and print resources, and participating in local, regional, or national events. But you can also learn from your peers how to be ready for a large-scale or even a small-scale incident.

Here are case studies from a regional hospital, a cancer clinic system, and a solo physician practice highlighting the preparations they made to be ready for any disaster, how they got back up and running when they faced challenging situations, and some lessons they learned along the way.

Windstorm Blows New Life into Disaster Planning for CCNW

When 100-foot-tall pine trees started swaying in a breeze, Adrianne Lara of Cancer Care Northwest knew they were in for trouble.

She was right: a devastating windstorm was sweeping through Spokane that would knock power out for days, shutting down patient care at several of Cancer Care’s sites. Although their organization had a limited disaster plan on hand, Lara, compliance officer for Cancer Care, concedes, “I don’t think anyone had dusted it off in a long time. We were more or less shooting from the hip. We didn’t have necessarily one big cohesive plan.”

From that windstorm on November 17, 2015, they learned a good many lessons to apply to disaster preparedness going forward, Lara says.


The first lesson was the importance of treating their disaster plan like a living document and updating it periodically, especially the emergency communications portion. When the windstorm hit, landlines went down, but cell phones still worked. It would have been helpful, she says, to have had an updated plan so staff knew instantly key cell numbers to call. That would have reduced duplicate calls and would have kept response efforts flowing as smoothly as possible.

“Communications were huge,” Lara says. “One of the things our employees really needed to have was an updated emergency phone tree to get the word out. We eventually designated one person to communicate with everyone.”


Access to cell phones meant they could send e-mails, text messages, and phone calls to keep the staff apprised of the constantly changing conditions in the region. That proved to be very valuable. “We sent one message from the top of the phone tree down, via cell-phone e-mail, to report on the status of our sites and situation,” Lara says. “We reassessed the status every hour and updated any information we were gathering for our staff. We were able to do that on a fairlyconsistent basis throughout the first day, and it was very helpful.”

They also learned the importance of an initial quick huddle to assess the situation. In their case, given that their employees work in eight separate locations in Eastern Washington and Idaho, their facilities manager proved to be one of the most important people on the job. He was able to stay on top of changing conditions at all their locations, Lara says, as well as interface with the authorities about emergency conditions regarding power and traffic. As it became clear no one knew when power would be restored to their darkened sites, the managers helped chart a course forward. “They congregated at seven o’clock the morning after to decide what to do and which locations to open,” Lara says.

“We decided to have skeleton crews with a nurse, a provider, and a receptionscheduler at all our sites, even the ones we had technically shut down because there was no electricity. Patients were showing up anyway. We tried our best to address their needs, whether it was medication—administering shots people needed, or whatever—and tried to get absolutely critical care taken care of right away.”


They also realized the importance of immediately going into triage mode at all sites, like an emergency department, for efficiency and patient safety. “We have a lot of fragile patients with multiple needs,” she says. “The skeleton crews addressed whatever problems they could and triaged the rest. One of major takeaways we had from the storm was the importance of triage. If someone absolutely needed treatment, we needed to do that and postpone or reschedule the rest. We went to paper documentation because of the lack of power. However, not all our sites were down, so the sites without power were able to partially access electronic medical records through the sites that were still online.”

Pharmacists were key as well. She says, "One of other things we immediately had to deal with were medications that must stay cold. We had some small generators on hand at our sites, and we were able to use them in our pharmacies for running refrigerators. We did have a backup plan for system outages, which was great, and the pharmacists and staff were able to kick that plan immediately into place.”

They also learned the importance of factoring in greatly increased travel times for staff. With the power out, intersections with downed trees and no traffic lights were clogged, posing yet another difficulty. Finally, they learned the importance of staff support. Many lacked power for days at their homes and had to scramble for child care—and food, since many grocery stores were closed. Lara herself was out of power for five days at home.

Checking on staff is hugely important to find out if they’re okay mentally and physically and have what they need to get through the emergency. “It’s important to be double-checking on staff,” she says. “That’s one of the things we talked about afterwards. People were traumatized by this. They had to be constantly thinking about how to warm themselves and their families at home, how to feed themselves and their families, or bathe. It was just so tiring and took a lot out of us. Checking on staff is hugely important to find out if they’re okay mentally and physically and have what they need to get through the emergency.”

A mass shooting at a school or a nightclub. Wildfires. Dust storms or blizzards leading to multiple pileups on a highway: all true-life scenarios that can impact hospitals anywhere. Trios Health in Kennewick, Washington, has recently revamped its emergency management plan to prepare for any such crisis that may come along. The idea is to train and drill for as many potential disasters as possible, so that the health-care facility is fully equipped to face the unthinkable, says Christy Kuhn, director of emergency management.

“The result of our emergency plan overhaul is a more interdisciplinary approach, very hands-on with frequent mini drills so we exceed all requirements,” says Kuhn. “Our focus is on engaging staff and increasing their competency, which in turn increases their confidence regarding all aspects of emergency management.”


The importance of being prepared hit home last spring when a computer failure halted all elevators for hours in a seven-story Trios building that houses, among other departments, oncology and interventional pain services.

“It was an eye opener,” Kuhn says. “This incident really gave us the opportunity to improve our emergency plans even further.”

Kuhn is the author of the new 126-page emergency plan for Trios Health, and she’s glad she and Trios staff rethought just about every aspect of disaster preparedness. That includes going old-school with printed emergency manuals, useful in the event the computers go off-line. Pages are tabbed and laminated so employees can easily flip to the section pertaining to their department or to the emergency situation at hand.

But they realize simply finding and opening an emergency manual might take too long at the onset of a disaster, so they’ve made quick access to some crucial first steps even easier. She explains, “We have emergency numbers inside badge holders, as well as labor-pool locations to which staff members need to report.”


As part of their preparedness, Trios has sent staff to a free federal disaster drill held at a former military base in Alabama, and that’s really helped polish their overall emergency skills, Kuhn says. “Put on by FEMA and Homeland Security, it’s as close as you can get to an actual major emergency event. You get two days of classroom work and two days of disaster simulation with actors who take you through a myriad of events. They keep throwing things at you, such as an active shooter in the ER or a HAZMAT situation in one location, while a woman is delivering a baby in the hallway in another unit. The incident command center coordinates with frontline staff in the hospital as well as with community emergency services. This training program has really been essential in exposing our team to potential scenarios and how best to maneuver through the challenges each presents.”

One of the things they’ve stressed in preparing for an emergency is figuring out the best way to support employees so that they can provide care, Kuhn says. That includes helping them make their own personal emergency plans for their families and homes, such as designated meeting points, along with emergency kits and critical supplies to keep in cars, including bottled water, first-aid kits, and protein bars.

As for Trios itself, “We have a child-care provision as part of our emergency plan,” Kuhn says. “That includes a supervised area so our employees can drop off their own children and know where they are and that they’re safe.”

Additionally, Trios has thoroughly considered how best to support a variety of patient care staff, too.

“For example, if we’re not prepared because we don’t have enough gloves, and we have a flu epidemic, how can we provide patient care in a safe manner?” Kuhn asks. “Emergency preparedness is not just about having the clinicians well trained and prepared, but of equal importance is our support staff, whose role is just as vital. We need to think about how we’re going to feed people as time passes because our patients and staff will be tired and hungry. We have worked hard to ensure we have access to enough food and water to handle a crisis lasting up to 96 hours.”

On top of that, they’ve had to consider the fact they have the tallest building in the area, populated with many vulnerable and incapacitated patients, so Trios has tried to think of every possible scenario should there be a need to evacuate. Kuhn says, “We have assigned floor captains, each of whom have two-way radios, and we have stair chairs and practice how to use them in the event of an emergency.”

That helped when the elevator outage stranded many ill patients in the Trios building last spring, including a number on oxygen and with other mobility challenges, she says. But they realized during their response to the elevator failure that better equipment was required.

“We had to rely on two-way radios to communicate,” she says. “Currently, the ones we have work only within a certain range. It wasn’t far enough.”

The elevator incident, although unfortunate at the time, ended up being a great training situation that underscored the importance of teamwork and effective communication.

Trios consistently trains and drills regardless of what else is going on in a given unit or department, Kuhn says. “It’s always ongoing; you never stop. It’s just moving on to the next thing and then the next thing.”


Annette Seay, office manager for Grand Pediatrics in Spokane, lives in the countryside and takes weather warnings pretty seriously. So, when the weather service predicted a major windstorm last fall, Seay started to think about what might happen if the storm turned really bad,causing problems such as power outages for an extended period.

“We probably have a hundred thousand dollars’ worth of vaccines in our office at any given time that need to be kept cold,” she says. “I just knew we needed a generator.”

Joseph P. Kincaid, MD, is the sole pediatrician for the practice, working with two advanced registered nurse practitioners and a certified pediatric nurse practitioner. Concerned about the impending storm, Dr. Kincaid himself went to the hardware store. “I was able to buy the last remaining generator at Home Depot,” he says. “I felt really lucky we could get it.”

It was a good move. Late in the afternoon of November 17, 2015, the windstorm hit with ferocity, leaving behind power, phone, and utility outages that would last for weeks in some areas. At Grand Pediatrics, the office would remain dark for five days, three of them office days packed with a total of 250 appointments.

“The next day, the region looked like a battlefield,” Seay said. “There were so many trees lying in the middle of our roads. Huge trees. It was just horrible.”

But in her office, those vaccines would remain safely chilled, thanks to the generator. Dr. Kincaid came to the office every seven hours, day and night, to refuel it.

“We heard afterwards that a lot of practices lost their vaccines because they didn’t have a generator,” Seay says. “We did have a backup plan in place before the storm. In case we ever lost power we would take our vaccines to another medical office. But that wouldn’t have worked since all the other locations lost their power as well.”


What turned out to one of the most critical parts of their previously written emergency plan was a partnership with their Seattle software scheduling company to send patients and their families a prewritten message to let them know the practice was closed, Seay said. She was able to contact the software company via cell phone to deploy the message. Patients and their families then received the message by e-mail on their smart phones. She says that was a key takeaway from the storm: having an avenue to contact patients in case of an emergency.

“I give a lot of props to our software company for being able to help us by sending the message out,” she says. “We wouldn’t have been able to get hold of patients otherwise.”

Meanwhile, Dr. Kincaid says he’s pretty happy he owns a generator, now that fall storm season is here.