Outpatient Clinics Are Ideally Situated to Build Community's Resilience
It’s a routine day at the office when suddenly a deafening rumbling rises from the ground. Seconds later the floor shakes and rolls under your feet, knocking you to your knees. All around you glass shatters, and books, ceiling tiles, and supplies fly through the air.
Outside, a retaining wall fails and collapses into your building. Electricity, phones, and the Internet are all out. Water, gas, and sewer lines are broken.Your clinic is soon filled with injured people, most of them frightened and disoriented.
This past June’s “Cascadia Rising” exercise held throughout the region reminds us that we in the Northwest really are at risk for this kind of catastrophic event. Unfortunately, much of the media coverage promulgated the idea that FEMA, the National Guard, the Navy, the Red Cross, and other outside agencies will take care of us. As a result, our own medical community’s participation in the exercise was miniscule.
In reality, we must take care of ourselves.
Some experts, including various emergency managers, as well as Team Rubicon, a volunteer organization of veterans and first responders and medical professionals who provide disaster relief throughout the world, say it will take at least four days for outside help to arrive, and maybe more like two weeks, depending on the severity of the disaster.
Unless we have organized, practiced plans for disaster, we risk a marked increase in injuries, loss of life and property, and a prolonged, unsuccessful recovery.
Outpatient clinics are ideally situated to build our community’s resilience. If we encourage our patients to have extra medications, supplies, and plans for disasters, we can limit the surge of those needing medical care, prescriptions, and other supplies. Patients can become part of the solution instead of adding to the problem.
Building a disaster plan for our medical community can be broken down into four parts:
- The first building block is personal preparedness: our own, our staff’s, our patients.
- The second step is “MYN” or Mapping Your Neighborhood.” Neighbors helping neighbors. Having a neighborhood care center to watch over children, the elderly, or others who are vulnerable allows people to stay close to home, in familiar surroundings, which limits anxiety and displacement.
- Thirdly, medical facilities, including clinics, hospitals, nursing or assisted living homes, suppliers, and other businesses developing their own Disaster Response Plans (see “What Should Be in a Disaster Plan”) allowing them to stay in business, helping to care for the flood of injured people.
- Lastly, we coordinate our community:
- clinics working together, sharing supplies, working space, and staff,
- developing communication plans with staff, other clinics, hospitals, first responders, departments of public health and emergency management, and patients,
- planning how to put volunteers to work efficiently, and
- partnering with retirement and nursing homes, schools/universities, community organizations, churches, funeral homes, and other businesses.
This kind of planning will allow a robust response to any disaster and assist in a more rapid recovery.
In a recent survey of 64 local clinic administrators, one of the questions asked how many had disaster plans. Forty-three percent indicated they did have plans.
That’s a good start. But unfortunately, the numbers got worse. None of the clinics indicated they were asking patients about their personal disaster preparedness, and none were providing any education on this topic. In addition, none were ensuring that patients had an extra two weeks of their critical medications in a home disaster kit.
During a town hall meeting on disaster preparedness last fall, I was approached by numerous people asking how they could obtain an emergency supply of their medications. Physicians frequently don’t think about providing extra prescriptions for this purpose. And even if they do, insurance companies often are not willing to pay for extra medication without a tremendous amount of red tape. I suggest that physicians and their patients petition insurance companies to cover these needed medications. In addition, I advise patients who do have a backup supply to be diligent in making sure they monitor the dates so they aren’t storing expired prescriptions.
Disasters have a much greater impact on our most vulnerable patients: children; pregnant women (and women in general); the physically or mentally disabled; chemically dependent; elderly; cognitively, visually, and hearing impaired; and those with chronic illness. These also are most likely to be disadvantaged socioeconomically.
The psychological effects of disaster, especially anxiety and PTSD, tend to be greater in these patients as well. Therefore, I’d suggest identifying those at highest risk first and helping them to develop disaster plans, which can markedly improve their ability to cope. We could all learn from our nephrologist colleagues who routinely help their dialysis patients—for whom major disasters are life threatening—make disaster plans.
Children are more susceptible to chemical and radiation exposures, fire, dehydration, and other dangers. Their immaturity and lack of experience makes them more vulnerable to psychological trauma as well. Elderly patients are more likely to have chronic medical conditions and become confused and disoriented. Pregnant women require excellent nutrition and supplements and are at risk for disrupted prenatal care and preterm labor. Disabled patients have individualized, special needs. Obtaining disaster information and instruction for non-English-speaking patients is also a special challenge. Each of these groups requires unique planning.
To help with the planning, ask yourself and your staff the following questions:
- What extra supplies might be needed?
- How do we best communicate with our most vulnerable patients?
- Where can they go for help?
- Who will care for them?
Training patients what to do during earthquakes, fires, and other emergencies is critical to alleviate fear, injury, emotional trauma, and possible abuse. Our most vulnerable patients should be provided a written summary of their medical history, including medications, allergies, major medical problems, treatments, surgeries, etc. This is invaluable when power and electronic records are inaccessible, when dealing with communication or language barriers, and when there are hundreds of casualties at our doorstep.
Communication is key to a solid disaster response. The public needs to know what is happening, what to do, and where to go for help. This includes parents who ned to find their children in emergency situations. We need situational awareness and regular updates on conditions. It’s vital to know who is in charge, who can work, when and where, which cinics are still functional, where we can get extra supplies, and where to find extra staff, along with how to coordinate with hospitals, alternative care facilities, first responders, and emergency managers. Communications should be redundant: cell phones, texting, social media, hand-held phones, satellite phones, e eham radio, courier services, and poster boards are all options. Testing and practicing our communications befor disaster is critical..
All this planning may seem overwhelming, and finding time in your already hectic schedules may seem impossible. But fortunately, help is available. (See “Disaster Planning and
Response Community Resources”.)
Here are a few resources to get you and your staff started:
- In Kitsap County, emergency managers are developing a “train the trainer” program to help outpatient medical clinics become prepared for disasters, kitsapdem.org/preparedness.aspx.
- In Pierce/King County, the Northwest Healthcare Response Network, nwhrn.org, in Pierce/King County is developing modules for online clinic disaster planning.
- In South Snohomish County, the Disaster Medicine Project, facebook.com/DisasterMedicineProject, is hosting a Clinic Disaster Planning workshop on Tuesday, October 25, from 8:30–12 at Swedish Edmonds Hospital.
We can’t prevent disasters, but by participating in thorough coordinated disaster planning, we can be ready to serve everyone, including the most vulnerable, through robust response and recovery efforts.