Apocalypse! Crisis! Disaster! Pestilence! Physicians Need to Know What to Do As Individuals and How to Work Within Their Healthcare System

Living in the San Diego area, disasters are an ever-present reality — from potential mudslides, fires, or earthquakes. Improving health system preparedness to deal with terrorism and mass casualty events can seem overwhelming, but it should be one of our highest priorities. Without adequate planning, practice, and preparation, the consequences to those afflicted can become horrific. As part of the national commitment to improve health systems in support of patient safety, physicians need to know what they can do as individuals as well as how to work within their healthcare system.

• Work with your local medical society, hospital, and other healthcare agencies involved in disaster preparation — accredited hospitals are required to plan and practice community-wide disaster drills based upon community-specific risks.
• Be aware of your responsibilities as a medical staff member at hospitals where you have privileges.
• Physicians and physician practices need to be involved with planning for the care of their patients to ensure critical services are not interrupted. This is especially true for patients with special needs, chronic diseases, the aged, and those with limited mobility.
• Patients who will need to be in a special medical needs shelter should be identified to the emergency operation center (EOC) so that early transportation and shelter availability is ensured.
• Check with the home health agencies that are caring for your patients and their plans to adequately provide services in the home.
• You may be called upon to be available to help staff shelters.

The physician plays a key role in community preparedness. You may be the first to identify that a biological attach is taking place, as was the case in Florida with the first anthrax case in 2001.

• Be familiar with the clinical manifestations, diagnostic tests, and treatment regimens for the major biological agents.
• Understand your hospital’s incident command structure.
  • Participate in hospital drills and community exercises.
• Maintain a relationship with the local health agency that is monitoring the health of the community and report suspected cases. The local health agency may be the primary source for treatment guidelines.

A disaster plan for your office, including plans for communicating with staff and patients and resuming full operations following a disaster, can reduce recovery time. The plan would include:

• Disaster planning checklist of items to consider as you plan to preserve assets and communicate with your staff and patients. It would be timed so that items are considered based upon priority and can be matched to weather-related information, such as in the case of hurricanes.
• Disaster recovery checklist with steps to follow upon your return from an evacuation.
• Full-circle call tree and instruction, which is a directional plan of who will contact whom in the event of a disaster.
• Instructions on setting up instant messaging groups at Yahoo.com to enable your staff to communicate when cells phones may not work.

During the aftermath of Hurricane Katrina, one of the most problematic areas of recovery was with medical records. Water, fire, and even disruptions in electricity can affect the recovery of medical records. Loss of records not only can disrupt care but can be compounded by the concerns about privacy issues and identify theft.

• One of the most effective ways to minimize medical record continuity gaps is through the use of an electronic medical record and office management system that is web-based and HIPAA-compliant.
• The Centers for Disease Control and Prevention have provided a method to provide patients with a personal medical information form that is a concise record patients can keep with them. This temporary record lists medical care and other health information and can be adapted. It is not intended to replace hardcopy or the EMR but is an interim communication tool. The tool — known as Keep It With You — is available at bt.cdc.gov/disasters/pdf/kiwy.pdf.
• You may want to consider having an attestation of medical record loss or destruction on file for documents that were partially or completely destroyed as a result of a disaster.

Planning for and responding to disasters are managed by multiple entities to include federal, state, and local governments; regional level, state, and local emergency management authorities (EMA); hospitals accredited by the Joint Commission; and volunteer organizations, such as the Red Cross and Salvation Army.

• Be familiar with your community. Ask the hospital you work in what your role is and how you fit into the plan. Accredited hospitals are required to work with the other agencies when developing their disaster preparedness plans and would be an excellent source of information.
• Emergency physicians and occupational health physicians frequently have local organizations with planning activities. You can talk to your peers about their roles and activities.
• Participate in the development of a community disaster plan and provide input into the state and local offices of emergency medical services and EMA.
• Ask yourself these questions:
  • Where should I go during a disaster?
  • How will I be notified if I am needed to respond to a disaster?
  • How will I be identified as a physician?
  • How will my patients be transferred or discharged?

Your actions during a disaster will be predicated on the disaster plan, thus the need for familiarity with the plan. Once the disaster is recognized, the physician should institute office and home disaster plans and participate in the community or hospital predesigned plan. You can provide your patients with an emergency supply checklist and home disaster plan to promote their safety.