Disaster Preparedness: Are Physicians Prepared?

EVEN A CASUAL glance at the news illustrates why disaster preparedness is a crucial field in which healthcare professionals need to understand and participate. Public health emergencies of many kinds happen regularly, and they can occur at any time and in any place. And, while the public often views physicians as all-knowing and extremely prepared professionals, doctors are sometimes the least equipped when it comes to disaster readiness. A 2015 study published in Disaster Medicine and Public Health Preparedness indicates fewer than half of the 1,603 practicing physicians interviewed felt ready to handle a natural disaster. Beyond this, less than a third of those interviewed had signed up to receive mobile alerts of emergencies and disasters from local and federal agencies.¹

Healthcare professionals need to ask themselves: Is our practice prepared to face a situation such as a wildfire, hazardous chemical spill, terrorism attack, mass shooting or an epidemic? Could we effectively organize resources and staff should infrastructure be damaged and inoperative indefinitely — including clinics, roads and vehicles? Could we seamlessly work with other healthcare professionals and professionals from other fields to secure an area, transport patients, garner supplies or perform unusual yet crucial tasks necessary to ensure people’s well-being? And, could we do all of these things under potentially stressful conditions?

Whether healthcare workers serve in rural or major metropolitan areas, they are wise to prepare in advance to respond efficiently and effectively in the face of worst-case scenarios. They must have a specific plan of response for virtually any dangerous situation that is in place prior to a hazardous event. Only then will they best protect their patients, the general public and themselves, depending on the nature and scope of the emergency. They should also train together as a team and with teams of other professionals, including those from law enforcement and other local, state and federal agencies that could be involved should an entire region be affected by a crisis situation.

Taking the necessary steps to successfully anticipate and navigate large-scale emergencies can seem daunting — especially since disaster preparedness is an emergent and developing field. But, today, there are clear steps physicians can take to become better equipped.

What Is Preparedness?

Disaster medical science is a comprehensive new field involving many practices and types of workers, and understanding a few of its fundamental principles is crucial.

Disaster. Kristi L. Koenig, MD, FACEP, FIFEM, FAEMS, emergency medical services medical director of San Diego County and professor emeritus of emergency medicine and public health at the University of California, Irvine, says, “A common question surrounding disaster preparedness is, ‘Are we ready?’ The tempting retort is: ‘Ready for what?’” This is a valid question considering descriptions of a disaster can be contradictory or even vague. “On a conceptual level, a ‘disaster event’ can be defined as a condition or situation (with or without casualties) for which the available resources are inadequate at a given point in time,” explains Dr. Koenig.² She uses the fitting acronym “PICE” for any type of potential injury/illness creating event, since it is a concise, all-encompassing term that eliminates the descriptors of “manmade” or “natural.”

Incident command/management system (ICS). Another principle is ICS, which is functionally based and depends on positions rather than people. The Federal Emergency Management Agency (FEMA) defines ICS as “a management system designed to enable effective and efficient domestic incident management by integrating a combination of facilities, equipment, personnel, procedures and communications operating within a common organizational structure.” Such a command center typically oversees and organizes five major areas: command, operations, planning, logistics, intelligence and investigations, and finance and administration.³

Surge capacity. Surge capacity is any medical system’s ability to manage a sudden influx of patients when patient care needs exceed available resources. To have adequate surge capacity requires a well-functioning ICS, enough space to accommodate extra patients, adequate supplies and the flexibility to manage special situations, including the presence of contaminated or contagious patients.⁴

Dr. Koenig defines surge capacity as “the components necessary to care for a sudden, unexpected increase in patient volume that exceeds current capacity.”⁵ She further explains surge capacity with the “3S concept”: staff (personnel), stuff (supplies and medications) and structure (physical location for patient care and management structure).² Without an understanding of the concept of surge capacity, and the resultant preparation needed, even the most well-meaning clinic or hospital will be severely challenged when faced with an influx of patients during a large-scale disaster.

Comprehensive emergency management (CEM). CEM involves four phases of disaster management that address all aspects of disaster management: ^6,7

• Mitigation: Efforts to limit loss of life by decreasing the impact of disasters
• Preparedness: Garnering and developing resources to limit the impacts of disasters
• Response: Efforts/activities to prevent or manage the disaster and its effects
• Recovery: Short- and long-term restoration of the resources and capabilities affected by disasters

Dr. Koenig believes all four phases should be more thoroughly embraced rather than merely “focusing only on the highly visible ‘response’ phase,”² which tends to get the most media coverage and resources. Understanding and anticipating all four phases ensures management of a disaster throughout its life cycle. Understanding CEM ensures resources will remain available and patient care and safety will continue after a disaster occurs.

Community resilience. When considering how best to prepare for a disaster, the community in which the healthcare practice is located must also be considered. Community resilience involves how well people adapt to and recover from trauma. It involves both emotional and physical resources, including socioeconomic status, education, mental health and behavioral factors, and previous traumas, among other factors. Physicians must assess their community’s resources in these areas to determine how a disaster plan needs to be adapted to meet their particular needs.⁷

Preparedness Is Fluid, Not Static

Contrary to popular misconception, disaster preparedness is not an unchanging, one-time event for which a single plan of response is needed. Preparedness must be ever-changing with teams of medical professionals and first responders training together regularly since resources, current events and even weather change often. And, because a disaster could affect an entire community or region, medical teams must work in conjunction with law enforcement, public health and other local, state and federal agencies.

Preparedness should also be strategic and flexible enough to cover all types of disasters. This is why all-hazard preparedness is crucial. Rather than preparing for a specific event such as an earthquake or flood, being prepared for all hazards means developing an emergency management system that is flexible and ready to manage any event, even if it is unusual. For example, in California, where physicians very likely expect a wildfire and are prepared for it, they would not necessarily expect a hurricane even though one could occur.

Questions to Ask

As physicians navigate disaster medicine for their practices, the following questions should be asked:

1. Is our plan adequate? To answer this seemingly simple yet complicated question, the Joint Commission, FEMA and other organizations have guidelines in placeto guide physicians. Although these plans are not necessarily comprehensive or tailor-made for specific circumstances, they can be helpful.
2. How will the disaster be managed? Who has authority to activate the ICS? Are personnel trained in their roles? Which personalities and skills on the team best fit these roles?
3. What are the practice’s resources, and how will they be managed? How will additional necessary resources be identified and obtained?
4. Is the disaster plan well-documented and adequately shared for all involved to understand it and have access to it?
5. Is there a list of all hazardous materials within the facility, as well as health information about each?
6. How would the practice withstand a disaster? There are six critical elements to maintain a practice’s operations: physical plant, personnel, supervision, supplies and equipment, communication and transportation.⁸ How are these elements best protected?
7. Is every team member in agreement regarding the disaster preparedness effort? If not, how can they be encouraged to be onboard?
8. If regular communications systems are disrupted, what backup options are available? For example, will handheld radios or ham radios be needed? Would a bullhorn be helpful?
9. Is there a plan for document recovery should records get lost? For instance, is the cloud available for storage? Does the practice have a subscription service that maintains documents online?

While these are merely a few possible questions, they are a good place to begin the discussion and thought processes necessary to prepare a team physically, mentally and emotionally to respond well in the face of a large-scale disaster.

Helpful Resources

When a disaster strikes, physicians will be relied upon to provide medical care to those in need. To prepare them, a number of helpful texts on disaster preparedness are available, including Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practices in which well-researched and exhaustive information is presented on a variety of disaster management topics. Dr. Koenig is an expert in the field of disaster preparedness, and she encourages physicians to do their part to help protect public safety.