Natural Disasters and Health Care

Impact of Natural Disasters on Health Care Submitted by – Dalton Divakaran MS Health Care Management University of Texas at Dallas Index Introduction Types of Disasters Effects of Disaster on Economy Effect of Disaster on Health Care Organization * Sudden Influx * Damage to Facilities * Inadequately Prepared * Specialty Treatment Availability Effects on the Population * Immediate Health Impact * Long-Term Impacts Steps in Disaster Management * Mitigation * Preparedness * Response * Recovery Real Incident Study * Background: * Immediate Response Considerations: * Evacuation: Special Immediate Concerns: * Recovery Process: * Facility Considerations: * Lessons Learned at This Point in Response/Recovery: * Takeaways from this incident: Conclusion References Introduction According to dictionary. com Disasters means “a calamitous event, especially one occurring suddenly and causing great loss of life, damage, or hardship, as a flood…” Disasters such as Earthquakes, tsunamis, floods, hurricanes, tornados, epidemic disease outbreaks and more can damage any population and have a tremendous effect on the health care organizations that respond.

Many health care organizations face major challenges during natural disasters. There are many different causes for those challenges. According to the International Federation of the Red Cross and Red Crescent Societies, in 2002, international disasters affected 608 million people and killed more than 24,000. The recent natural disaster in the United States for this year 2011(May 22, 2011) was the tornado Joplin in Missouri; 160 fatalities were reported in this natural disaster. Types of Disasters I. Natural disasters E. g. : Avalanches, Earthquakes, Volcanic eruptions. II. Hydrological disasters

E. g. : Floods, Tsunamis. III. Meteorological disasters E. g. : Blizzards, Cyclonic storms, Droughts, Hailstorms, Heat waves, Tornadoes, Fires. IV. Health disasters E. g. : Epidemics, Famines V. Space disasters E. g. : Impact events, Solar flares, Gamma ray burst. VI. Technological disasters: E. g. : Chemical spills. VII. Complex emergencies: E. g. : Civil wars and conflicts. Effects of Disaster on Economy Developing countries suffer more economic losses than developed countries. The common factor is that, the poor are the ones who suffer the most, in both developed and developing nations.

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Although the total economic loss in dollars is greater in developed countries, the percentage of losses relative to the gross national product in developing countries far exceeds that of developed nations. Technological disasters and complex emergencies are not easily predictable. The major source of disasters in the 21st century may be due to rapid increase of Technological hazards, unregulated industrialization of developing countries and the globalization of the chemical industry. Effect of Disaster on Health Care Organization Sudden Influx * The biggest challenge after an aftermath is to provide emergency treatment.

The sudden influx of patients to a facility and the need for emergency responders in many places at the same time puts a strain on the health care organizations in the local area. Outside sources like the Red Cross would pitch-in for help in rescue and relief operations in the following days of the incident. However, the responsibility of handling the initial emergency care lies with the local health care departments. Damage to Facilities * The other effects of natural disaster are the lossdegrading of equipment and facility due to sudden spurt in the patients handled at the same time.

The demand for all possible medical resources is the possibility that some of the resources may not be available because of direct damage from the natural disaster itself. For example floods may disrupt power supply required to run many equipments at the rescue center. Inadequately Prepared * Even though areas are more susceptible to certain natural disasters, such as earthquakes along a fault line or tornados in the South, they still strike with little or no warning. This throws the health care’s schedule out of the ordinary routine. The facility may not be completely prepared for what comes next.

Emergency preparedness plans improve the chances that the organization will be able to respond effectively in the event of a natural disaster, whatever said and done it is never a guarantee that when and what magnitude a calamity occurs. Specialty Treatment Availability * Some disasters are not common like the storms, earthquakes and tsunamis. Epidemic outbreaks of infectious disease are something which needs utmost care to stop them from spreading to the others. It is not just to take care of emergency relief but also to quickly and efficiently protect the rest of the population.

It is more challenging when there is no existing vaccine or known treatment. At this instance the role of health care organizations becomes even more important. These organizations must work to treat the patients and protect themselves while labs attempt to figure out a way to stop the infection from spreading. Effects on the Population A population’s vulnerability to all types of disasters depends on demographic growth, settlement in unsafe areas, environmental degradation, the pace of urbanization, unplanned development and climate change. Poverty thrives due to lack of access to healthy and safe environment.

Poor education and awareness also poises risk to population. The effects of disaster on population can be broadly categorized into: 1. Immediate Health Impact 2. Long-Term Impacts These are explained below: Immediate Health Impact Short-term losses fall under three categories that have both direct and indirect effects: I. Disability, Illness, and Death; II. Direct losses in infrastructure; and III. Loss or disruption in health care delivery. Long-Term Impacts It is primarily a matter of building institutional ability and human resources, and includes: I.

Identifying vulnerability to natural hazards or other calamities; II. Building simple solutions for such occurrence in the future; III. Initiating a changedevelopment among the main factors to develop a basic plan that outlines the responsibilities of each factor in the health sector, identifying possible overlaps or gaps and building a consensus to create an effective healthcare system; IV. Maintaining close collaboration with these main factors; and V. Educating the first health responders and managers to face the special challenges of responding to disasters.

Steps in Disaster Management * Mitigation – To minimize the effects of disaster. Examples: Zoning; Vulnerability analyses; Public education. * Preparedness - Planning how to respond. Examples: Preparedness plans; Emergency exercises/training; Warning systems. * Response - Efforts in minimizing the hazards created by a disaster. Examples: Search and rescue; Emergency relief, Finding alternative sources for relief. * Recovery – Restore the community or organization to business as usual. Examples: Temporary housing; Grants; Medical care. Mitigation Preparedness Response Recovery

Fig: Phases of Disaster Management Mitigation Mitigation is to reduce the intensity of a risk. Mitigation activity decreases the probably of the same disaster reoccurring. It includes vulnerability analyses updates; zoning and land use management; building use regulations and safety codes; preventive health care; and public education. Preparedness Preparedness is to have the health care crew on toes during an emergency situation. It is to achieve a level of readiness to handle any emergency situations. Preparedness can take form of education of rescue
elief during emergencies.

This may include rehearsals as well. Also it helps to ensure an optimum reserve of medicine, food, water, equipments and other essentials maintained for emergencies. Like mitigation activities, preparedness actions also depend on the appropriate measures in national and regional development plans. Response Response is to react to emergency situations to maintain life, sustain injuries and support the morale of the affected. It also includes providing transport, temporary shelter and food for the affected. Charitable organizations often play a major role in this phase of the disaster management cycle.

Recovery Recovery is to bring back the affected population to normal life. Recovery measures both short and long term, include restoring life with minimum operating standard, temporary shelter, reconstruction and economic impact studies . This period brings many opportunities to boost prevention, increase vigilance and thus reducing helplessness. Real Incident Study August 2, 2011 Medical Response to Joplin Tornado May 22, 2011 Background: A tornado warning was issued by the National Weather Services on May 22, 2011 at 5:17 p. m. The tornado was rated an EF-5 with winds exceeding 200 mph.

It traveled from west to east along 32nd street cutting a path ? to 1 mile wide over 13. 8 miles. The tornado eye was approximately 300 yards wide. Mercy St. Johns Hospital took a direct hit, initial and secondary, on the west facade with duration of approximately 45 seconds. There was a pause as the eye passed through the facility. * 160 deaths in the community resulted from this storm. * 8000 structures were destroyed. 400 businesses destroyed, * 8 school buildings destroyed, * 18,000 vehicles destroyed and * 4,500 jobs displaced. When St.

Johns took the direct hit from the tornado initially the generators were destroyed, the roof was destroyed and most of which landed in the parking lots and on top of other facility equipment. All communications was immediately lost. The facility fire suppression sprinklers discharged and lines were broken. Several walls and floors were damaged. Doors were torn from their hinges, all of the glass was blown out of the building except the high impact shatter resistant glass in the psychiatric ward, gas lines were broken, sewer lines were destroyed with raw sewage projected throughout the facility, and 86 medical offices were destroyed.

The oxygen tank was severely damaged and discharged all of the liquid oxygen. There was a strong smell of natural gas throughout the building and all over the campus. Water discharged by the fire suppression system left the rooms and hallways with 3 to 6 inches of standing water. The air evacuation helicopter was destroyed. Typically the helicopter would have been moved to a local airport; however, the storm track did not predict impact to the hospital and there weather conditions prevented safe flight. All Hospital’s vehicles, except a John Deere tractor, were destroyed and the emergency trailer was found in pieces several blocks away.

Everyone in the facility panicked that they were going to die, nurses evacuated patients to the hallways per their procedures and at the time of impact nurses covered patients with their bodies to offer as much protection as possible. IV’s were ripped from patients’ arms, the IV poles became projectiles, and several patients were bleeding as a result. The ceilings collapsed, electrical, IT, and HVAC equipment dropped and littered the hallways. All emergency lights and exit signs were ripped from their mounts and were useless. Both incident command centers were destroyed and Emergency Operations Plans (EOP) lost in the debris.

The facility was filled with hazardous waste and the radioactive material was unsecured. Outside debris was mixed and power lines were down. Note: If the tornado had moved just two blocks south Freeman would also have been destroyed. Freeman did suffer some physical damage that resulted in internal evacuation of at least 6 patient rooms. Immediate Response Considerations: There were many immediate considerations that had to be made. If the generators were started, then there was an extremely high probability of electrocution and possible explosion from natural gas.

Various ways for communication should be arranged. Communications is not yet interoperable. Security forces and public safety could not communicate with each other due to variation is radio systems. Ambulance radios became the communication infrastructure during the initial response. Staff management is vital. Sufficient staff should be available for relief. Drug dispensing machines are useless in this type of a disaster. Staff had to break into the machines to gain access to life saving drugs. ID badges need to be backed up with wallet identification cards for employees.

Several staff members lost their homes and automobiles and the badges went with them in many cases. National Guard troops refused to allow staff into the area because of no identification. Pharmacies need to be guarded with armed security. Have strong security so that people won’t run away with cars they do not own. The hospital needs access to several utility terrain vehicles (UTV) for equipment and patient transport. Same uniform, common identification and common radio frequencies are required for the security team for easy identity. Remember that even the staffs require food, water and rest.

Evacuation: Within a few hours St. Johns evacuated 183 patients, completed one surgical case while the storm was in progress, had 1 patient in the PACU, 24 ED patients and 28 critical care patients were among the evacuees. Evacuation was a tough job. This rescue team used what is described as the reverse START process found in our evacuation plan. The team discharged most of the patients they could. Some had no home to go to and opted to stay in the health care system as long as possible. Patient tracking was a nightmare. It took about 4 days to positively locate all of the evacuated patients.

Many were sent to hospitals a great distance from St. Johns. The usage of heliport was not practicable and two temporary heliports were constructed in the parking lot. Anything that could be used to move a patient was used. Hospital evacuation sleds, mattresses, doors, wheelchairs, and mattresses were used to move patients down 9 flights of stairs that were dark and littered with debris. The Hospital had three predetermined collection points (muster stations) to evacuate to. This helped them to identify the patients and giving accountability for staff. Special Immediate Concerns:

Staffs and physician homes were looted while they were trying to save other. There were attempts to loot property and drugs from the hospital and physicians’ offices. Hospitals need deployable incident command centers rather than fixed. Intra-operation communications was an immediate and continuing concern. Security forces could not be identified since they came in variety of uniforms. There was no common identification and no common radio frequency. Hospitals need the ability to install at least a 6’ steel chain link fence around the perimeter as soon as possible following the initial event.

Know your staff was personally affected by the storm, many lost family members and homes. Many were not prepared to see the level of trauma and had difficulty dealing with the reality of this event. Nearly all required debriefing and employee support services. Special equipments are required for immediate rescue. Know whom your local, state, and federal response partners are and have an established relationship with them prior to any event. In an event of this magnitude, if you try to survive in your facility you cannot do it. You will need to evacuate the facility as soon as safe to do so.

Everyone should be included during the planning process. It is important to acknowledge that although a given natural disaster may last for only a short period; survivors can be involved with the disaster aftermath for months or even years. Recovery Process: The first step is security of the facility and campus. The next morning after the event the mass evacuation was complete and the facility was cleared. As stated earlier, contracted security forces need to be in the same uniform and on the same radio frequencies as the Hospital security forces so that the recovery process goes smooth.

Arrangement for vehicles and fuel should be done and agreements must be in place to have them delivered from locations outside the affected area. The types of vehicles needed should be predetermined. The delivery mechanism should be established very effectively to even work without any phone service. Tent operations became the first means of providing medical services followed by portable facilities. Facility Considerations: During Disasters even emergency power outlets may not operate. Assuming you can use a power generator, consider the following facilities: * Camera’s intended for security purpose should be on power generator. Lighting on emergency power needs to be evaluated. * Exit signs, stairs should be marked with photo luminescent tape or paint. * Knowledge on how to shut down utilities and medical gases quickly and establish a protocol for this procedure. * Proper lightning should be maintained in parking lots and facility areas during recovery phase. * The facility should be considered unstable until cleared by structural engineers. * Secure wiring, HVAC components, piping and light fixtures correctly above ceilings. * Plan for rapid deployment and connection trailer mounted equipment, portable buildings, and portable equipment. Debris removal is lengthy and complex. Lessons Learned at This Point in Response/Recovery: * Intra department communication is a must. If the Hospital and response partners are not on common frequencies then effective communication will not be possible. * Purchase solar charging stations for cellular phones and radio batteries. * Social networks or texting services may not be available during disaster. Effective alternative ways to communicate should be taught to the staffs. * Telephone landlines and support from IT are vital. Electronic Medical Records were essential to the continuum of patient care and for identification of practitioners who were in the facility at the time of impact. * Know that your reserve supplies will be inadequate or may be lost. A 96 hour cache of supplies may last as few as 4 hours because of the unanticipated demand. * If the generators operated the potential exists for several deaths by electrocution or explosion. * Stairwell lighting will be lost. JCMH egress lighting is all generator fed with no battery emergency lighting. * Manage staff and provide staff support, including mental health services.

This will help them in taking quick decision. * Security of the building is critical. You have to protect your resources. * Badges will be lost during this type of event. Have wallet identification cards for your staff. Takeaways from this incident: * What you practice is what you do. * Knowledge of response partners, local, state, and federal. * Rehearsals with your community partners for rescue related activities. * Add patient slippers/shoes to your weather plan. Have on bed during Code Grey Level I. * Warehousing emergency supplies and to make it easily accessible even without transport facility. Have emergency kits throughout the facility with pens, pencils, paper, and medical record forms. Also include gloves, masks, flashlights, and batteries. * Develop a common triage tag and process. It is best to have a standard triage system. Share and follow it with all of the hospitals in your region. * You need to develop a rapid response team for security and a component of the security team will need to be armed. * Staff adequately during such events. * Efficient disbursement of supplies (Medicines, food etc) among staff for patient care and personal use. Consider staff physical and psychological needs – shift relief, food, rest, and debriefing. * Many storms usually have a follow- up storm and to be ready to minimize damage caused to structure and building (eg: Glass debris)during such events.. * The Joint Commission will arrive on site to assist with reestablishment of services and they proved to be a valuable resource. * Establish “Scrub Racks” with many sizes of scrubs to keep staff in suitable clothing. Conclusion Natural disasters are crisis situations. However, with planning, costly and ineffective interventions can be avoided.

Improvisation and rush inevitably come with a high price, and there are many things health officials ought to avoid— preferential use of expatriate health professionals; emergency procurement and airlifting of food, water, and supplies that often are available locally or that remain in storage for long periods of time; the tendency to adopt dramatic measures— all contribute to making disaster relief one of the least cost effective health activities. . The occurrence of a major disaster can be the initial catalyst that helps health authorities recognize that disasters are a public health risk that must be addressed in an organized manner.

Yet, preparedness cannot wait. A continual effort is needed to reduce possibility, by decreasing weakness through elimination and minimization and by increasing potential through ability methods. There needs to be a continuum between normal development, preparedness, and disaster response activities. Disasters are not likely to decrease in the foreseeable future. A sustained effort is needed to minimize risk, by reducing vulnerability through prevention and mitigation and by increasing capacity through preparedness measures.

Disasters need to be addressed on a long-term and institutionalized basis through an established ministry of health program or department for prevention, mitigation, preparedness, and response for all types of disasters. References * Environmental health in emergencies and disasters: A practical guide. WHO, 2002. * Disaster Help, US Department of Homeland Security. * Green Paper on Disaster Management, Department of Provincial and Local Government, South Africa * http://www. ehow. com/list_6847852_effects-disasters-health-care-organizations. tml#ixzz1epfIqgRL * Guide to Emergency Management Planning in Health CareBy Joint Commission Resources, Inc * http://www. scsrc. org/wp-content/uploads/2011/08/Joplin_Tornado_Trip_Report. pdf * http://www. himss. org/content/files/ambulatorydocs/BridgeheadWhitePaper_HealthcareDisasterRecovery. pdf * http://www. healthcaredisasterplanning. org/ * http://www. sans. org/reading_room/whitepapers/hipaa/disaster-recovery-healthcare-organizations-impact-hipaa-security_1336 * http://pandemic. wisconsin. gov/docview. asp? docid=14447 * http://www. dcp2. org/file/121/

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