In August and September 2017, Hurricanes Harvey, Irma, and Maria wrought torrential rain, powerful winds, and significant destruction across the southern United States and Puerto Rico. Hundreds have lost their lives; hundreds of thousands more have been displaced; and homes and businesses have been damaged or destroyed.
While recovery efforts are actively underway, rural areas are experiencing continued disruptions in access to power, clean water, food, and other key supplies, and critical medical care.
Neither Alarmist nor Insufficient
Hurricanes raise a variety of medical and public health concerns. Before a storm, vulnerable individuals and those who rely on special medical equipment and devices at key health centers, such as those on dialysis, may require additional considerations for evacuation. During and after a storm, flood waters can carry dangerous bacteria, and access to life-sustaining medication may be difficult. Hospitals are particularly challenged by many decisions, including whether to evacuate patients and how to endure the storm while maintaining effective care for patients. Although hospitals can do nothing to mitigate for force of hurricanes, they can prepare.
Hospitals also must prepare for a broad range of potential emergencies in addition to hurricanes. A variety of natural and man-made disasters can endanger the structure or overrun the capacity of hospitals, including fires, earthquakes, and pandemics.
Regarding the possibility of a pandemic, in particular, Mike Leavitt, former secretary of the U.S. Department of Health and Human Services, has commented on why preparation is difficult: “[A]nything we say now will seem alarmist. But if there is a pandemic, anything we say afterward will seem insufficient.” a
Indeed, it can be difficult for hospitals to strike the appropriate balance between being alarmist and having their response be insufficient.
The Importance of a Plan
The Joint Commission requires hospitals to have an emergency management plan. Moreover, in 2016, the Centers of Medicare & Medicaid Services (CMS) ruled that Medicare and Medicaid providers must have a disaster preparedness plan that complies with CMS regulations. b The recent hurricanes serve as a reminder for hospitals to not only revisit their emergency plans to ensure they are up-to-date and relevant for a variety of possible natural and man-made disasters, but also to incorporate routine trainings on that plan.
Weathering the Storm: Key Considerations for Hospitals
Based on challenges and lessons learned from past emergencies—including Hurricanes Katrina and Sandy and the Ebola threat—hospitals should address the following key points as they revisit their hospital emergency plans. Key takeaways are aggregated from several governmental and academic reports listed in the sidebar.
Self-sufficiency. Flooding and power outages can be particularly devastating during hurricanes. Hospitals must rely on their own sources for power, water, food, medication, and other supplies and consider how many weeks’ worth of those supplies are needed. Those supplies also must be kept safe—hospital leaders after both Hurricanes Katrina and Sandy discussed how supplies stored in the basement or on the first floor of the hospital were destroyed with flooding.
Moreover, supply chain automation has introduced more efficiency for hospitals by enabling them to reorder only those items in short supply. Relying on this type of automation, however, may leave a hospital short of needed items during a disaster. Potable water also is a concern and is essential not only for hydration and food preparation, but also for sanitation.
Communication. Clear communication should be a central element of emergency preparedness training to ensure every member of the hospital staff understands his or her role during a disaster. For example, based on its experience with Hurricane Katrina, one hospital recommends having a pre-established incident command center, rather than trying to set one up during an emergency. Those interviewed after previous hurricanes recommend developing strong positive relationships with local agencies—such as emergency medical services, police, and fire departments—and including those personnel in emergency plans and training. Another hospital leader recommends leveraging staff members’ extensive personal and professional networks to obtain needed supplies. A further key takeaway cited by hospital leaders is effectively tracking patients and communicating with other hospitals or healthcare professionals.
Reputation. Reputation is difficult to cultivate but easy to destroy. Leavitt asserts that “more reputational damage is done in the early stages of a crisis than at any other time.” c Hospitals should consider their plan for accurate messaging and public relations throughout a disaster, but especially in those initial, stressful, and chaotic moments.
Staff. Hospital staff and their families will, of course, also be deeply affected by the disaster, and plans for staff also must consider the needs of family members. Hospital staff are more likely to report to work if they know their families are safe. During Hurricane Katrina, one hospital allowed family members to accompany the hospital staff member, which eased the minds of the staff members but strained hospital supplies. Another hospital now requires staff members to submit for approval a family disaster plan. One physician shared his experience that employed providers, rather than those just affiliated with the hospital, were more likely to show up for work during disaster events.
Leadership. Strong, calm, and confident leadership is cited repeatedly as essential for a hospital’s successful weathering of a hurricane. Previous experience with a natural or man-made disaster is described as ideal. However, extensive preparation and analysis of other hospitals’ past mistakes is equally important. Hospital leaders must plan for the expected disaster—for example, the hurricane—and for the unexpected, such unanticipated flooding, longer periods without outside supplies, and even a second disaster. Individuals in leadership positions also should consider security, including locking up medications and locking down the building.
Finances. Emergencies have several stages. Initially, hospitals must ensure patients receive needed care, and they must combat immediate dangers such as lack of power, security risks, and a dearth of supplies. However, after the initial threat has abated, hospitals must contend with the later stages of enduring a disaster, including maintaining or recovering financial stability. Leavitt cautions that “if the average hospital has 100 days of cash on hand, a shutdown of its emergency department and severe disruption of normal admissions can drain those funds very quickly.” Emergency response plans should take into account the financial consequences of a natural or man-made disaster.
Mental health. Hurricanes Katrina and Sandy demonstrated the significant mental health toll on hospital staff. Five New Orleans physicians committed suicide following Hurricane Katrina, and many more staff members suffered from post-traumatic stress disorder. d Long shifts, limited supplies, lack of air-conditioning, patients clinging to life, worry over family members, and other elements weigh heavily on staff members during disasters. Incorporating a strategy for addressing staff members’ mental health is essential for preserving the health of the staff and the continued functioning of the hospital. When the adrenaline of the storm is over and the news cameras move on to the next story, staff members may continue to wrestle with their experiences.
Time to Reassess Disaster Preparedness
Experiences during Hurricanes Katrina and Sandy helped inform hospitals’ emergency plans and readiness for Hurricanes Harvey, Irma, and Maria. Today, hospital leaders have another opportunity to incorporate lessons learned from the three recent hurricanes into a hospital’s plan for any type of natural or man-made disaster. Indeed, every disaster that affects one or more U.S. hospitals will bring unique lessons and expose unforeseen vulnerabilities for the nation’s hospital industry at large. Such a disaster, therefore, will invariably present an important learning opportunity and a signal to hospital leaders that it is time reassess their organizations’ emergency plans and even organize routine hospitalwide trainings or re-trainings on the elements of those plans.
a. Miller, R., The News-Times (Danbury, Conn.), “State Preparing for Possibility of Bird Flu Pandemic,” chron.com, the website of the Houston Chronicle, Feb. 3, 2006.
b. CMS.gov, Emergency Preparedness Rule, page last modified, Oct. 10, 2017.
c. Leavitt, M. “Dallas’ Brush With Ebola Holds Lessons for Hospitals,” Modern Healthcare, Oct. 25, 2017.
d. Butterfield, S., “Hospitals and Hurricanes,” ACP Hospitalist, July 2016.