Engaging the Private-Sector Health Care System in Building Capacity to Respond to Threats to the Public's Health and National Security Proceedings of a Workshop (2018) / Chapter Skim
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3 Learning from Experience
3 Learning from Experience
Pages 25-42
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From page 25... ...
In that same 10-year period, Ascension will go through about 1,500 disasters. "Last year," he noted, "we had 96 incident command activations, and it is this experience that leads the way health care systems respond to disasters." In fact, added Cormier, he has asked the American Public Health Association to bring the large health systems together to pool 25
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From page 26... ...
Ascension has 12 hospitals in Texas, mostly located in the Austin area, and while there was some flooding and water damage during Hurricane Harvey, those hospitals served as receiving facilities for people evacuated from southeastern Texas. He noted that he was in contact with his friend and colleague Michael Wargo from HCA throughout Hurricane Harvey to make sure the two systems coordinated their activities.
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From page 27... ...
"When you are the holder of the truth, that is what you need to do." Cormier noted that the federal government was extremely helpful during Hurricane Irma by supplying platelets, which enabled Ascension's three Jacksonville hospitals to keep its surgical facilities open and operational. ASPR held daily conference calls during each of the national emergencies in 2017 through the Health Care and Public Health Sector Coordinating Council.1 Cormier stressed the importance of being a member of the council.
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From page 28... ...
In the months after Hurricane Katrina, health care officials in New Orleans began thinking about how to build a more resilient system. One realization was that New Orleans had a very centralized health care system, said DeSalvo, with about 30 percent of the city's population receiving care at the city's Charity Hospital, which was also the city's level one trauma center, a major training ground for providers in the community, and an important source for outpatient care (DeSalvo, 2006)
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From page 29... ...
"There is an old adage in internal medicine that discharge planning begins at admission," said DeSalvo, and New Orleans adopted that philosophy when it came to rebuilding its health care infrastructure and making it more resilient by design, which included making the entire community more resilient in the face of disaster. One important lesson learned from the Gulf Coast's experience with Hurricane Katrina, and one DeSalvo said was reinforced during the 2017 hurricane season, was that the social determinants of health, which are often affected severely in a disaster, have a disproportionately negative effect on communities of color, people with low income, and seniors.
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From page 30... ...
While the coalition was arranging to transfer patients, senior leadership in HCA's Gulf Coast Division was already at work on a reunification plan that would detail how to transfer those patients back into the city once the flooding had cleared. She noted that throughout the hurricane, business went on as emergency operations and preparedness drills became real life and plans were enacted for getting personnel and material resources to where they needed to be, with help from HCA's Nashville Emergency Operations Center, the Coalition's Catastrophic Medical Operations Center (CMOC)
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From page 31... ...
In the end, she added, no patients, employees, or visitors were harmed. Lessons from the Las Vegas Mass Shooting Sunrise Hospital, said chief executive officer Todd Sklamberg, is the largest acute care hospital in Nevada, a regional tertiary center, and a level two trauma center.
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From page 32... ...
One issue that arose was that the hospital ran out of mass casualty tags, so the trauma teams resorted to the old-fashioned procedure of writing vital signs on patients' foreheads with Sharpies. An Ambulance Service Perspective Forty-six years ago, with a degree in communications engineering, Richard Zuschlag founded Acadian Ambulance Service.
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From page 33... ...
His concern going forward, with so much of the communication infrastructure moving to the Internet, is that a hacker could take down a big piece of the region's emergency communication systems. He credited FEMA's National Emergency Management Information System with doing a good job with training and developing protocols that have aligned public safety agencies, volunteer organizations, and public and private health care systems for disaster response.
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From page 34... ...
In Texas, the regional advisory councils have done an excellent job organizing the response to mass casualty events and disasters, and their involvement during Hurricane Harvey was an immense help. One challenge that did arise was finding the right kind of watercraft to rescue patients.
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From page 35... ...
John Hick asked Erb and DeSalvo to talk about the role of health care coalitions during the recovery phase and the opportunities for coalitions to engage in community planning for the recovery stage. Erb said that from the Gulf Coast perspective, HCA could have been better coordinated with the coalitions to understand what she and her team would be looking at after the storm and what the plan was for setting up makeshift triage tents, for example, in the emergency department parking lot or for serving dialysis patients who cannot get to their usual dialysis center.
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From page 36... ...
During Hurricane Katrina, someone from New Orleans Charity Hospital called the emergency operations center requesting evacuation for its patients when the facility started flooding and losing power. Charity Hospital was told to move its patients to lower floors and be ready to be evacuated.
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From page 37... ...
DeSalvo replied that one thing DoD brings to disaster response is that it does not have an agenda in the community and so it is not trying to vie for territory and be in charge, which she said is one of the ugly parts of disaster response. During Hurricane Katrina, the military's agenda was to do whatever was needed in terms of providing security and helping in whatever way it was needed.
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From page 38... ...
Keeping with that theme, Sklamberg remarked that his institution could not have handled the Las Vegas shooting situation without assistance from the entire community, which meant sharing resources, sharing assets, and communicating where the best care for certain patients was. "If there had been discussion about doing this ourselves, we would not have survived," said Sklamberg, who again stressed the need for real-time coordination when disaster occurs.
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From page 39... ...
Mahshid Abir of the University of Michigan Medical School asked the panelists if they encountered any particular challenges during Hurricane Harvey in emergency care or inpatient care for pediatric patients. Martinez replied that his hospital had 30 children in his emergency department after a carbon monoxide event at a local school, pointing to the need to have the capabilities to treat multiple children during that kind of everyday emergency.
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From page 40... ...
This initiative is working with law enforcement to bring individuals straight to psychiatric hospitals, rather than to the emergency department, and using software to track social determinants of health and match patients with resources in the community. His question for the panelists was whether organizations dealing with social determinants of health, including EMS and acute care, should be involved in the health care coalitions.
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From page 41... ...
"Part of being a leader is providing hope and information, and even if it was not definitive information, giving folks updates on a regular basis is important," added Sklamberg. Erb recalled how at one point during Hurricane Harvey, when multiple voices were arguing for different courses of action, the division president shut the door to the command center, muted the phone lines, and had a real discussion with the senior leadership team about needing to make decisions to do the right thing for its patients and for the health of the affected divisions.
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From page 42... ...
42 ENGAGING THE PRIVATE-SECTOR HEALTH CARE SYSTEM moments" that kept those in the field apprised of what was going on across the system. Cormier said this is a struggle every day for clinicians in the emergency department who are scared to discharge a mental health patient or not prescribe an antibiotic.
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