#hsem

I had the opportunity to attend the International Disaster Conference and Expo in New Orleans about 6 weeks ago and something I had suspected about emergency preparedness activities was strongly reinforced: that we plan well for scenarios that are easy to address and tend to ignore or plan less well for those that are difficult. One of the sessions I attended was a presentation outlining the process and outcome of developing a particular state’s public health department’s plans for medical sheltering during a disaster. While the plans were sound and certainly had their purpose, I couldn’t help but think that they only addressed a high-impact, low probability event producing mass casualties. What about more likely scenarios, such as natural disasters – wildfires, earthquakes, hurricanes – that would require the sheltering of large numbers of people who aren’t acutely injured or ill? How much knowledge did they have of preexisting medical conditions in the community and what plans were made around those individuals? I asked the question of the presenter and the somewhat expected response was, “That wasn’t part of our planning.” Yikes.

The state’s plan calls for the activation of medical shelters in the event of an incident producing mass casualties or illness. Non-medical shelters are just that – places where “healthy” people go during an evacuation. Healthy people go to non-medical shelters, sick people go to hospitals or medical shelters, if they’ve been stood up, and never the twain shall meet. I was left puzzled.

In fairness, we are all really good at planning what’s easy to plan for. Not to make light of or oversimplify things, but a man-made disaster producing mass injury is relatively easy to address: enough properly-trained staff, bandages, IV catheters and fluids, blood products, resources to move victims to a health care facility, and surge capacity plans for the hospital. They’re easy to plan for because the event itself is what determines the condition of the victims – explosions, chemical exposure, mass shootings – the injuries (and therefore the treatment) are easy to anticipate.

What isn’t so easy to anticipate and plan for is tens or even hundreds of thousands people requiring emergency sheltering as the result of a hurricane, wildfire, earthquake, or other natural event. They likely weren’t injured, but they bring with them all of their preexisting medical conditions, some of which may have been exacerbated by power outages, stress, or the evacuation itself. These are arguably just as high-impact and unquestionably more probable than their man-made, terrorist-focused counterparts (in fact, by most accounts, 2011 was the costliest year ever for disasters, all of which were naturally-occurring).These scenarios present with a far greater number of potential treatment scenarios than do incidents producing large numbers of traumatic injuries. As a result, it seems our planning is rather strong around the latter and relatively weak around the former. 

What if emergency management, public health, and healthcare officials and practitioners could have advanced knowledge of the maladies that exist in the community before the disaster? Would their planning around transportation and shelter needs change if they knew there were 100 ventilator-dependent residents in their county? I would think so. Where will the 620 renal dialysis patients receive treatment if weather conditions make travel to their outpatient dialysis centers impossible or electricity is interrupted for an extended period of time? As an emergency manager, how can I expect my community to willingly evacuate their homes and take advantage of the shelters I have established, if I haven’t made arrangements for sheltering the 2,042 cats and dogs that are their pets? How many wheelchair-bound individuals live in my city and are my shelters able to accommodate them? So on and so forth.

I have been faced with a few of these dilemmas myself, notably during the blackout in New York City in 2003 and a particularly bad ice storm in metro Atlanta in 2011 that shut the roads down for nearly 5 days. In New York City, it was a hot August afternoon when the power went out. Anyone on an electrically-powered medical device became a 9-1-1 call. Add to that group of patients, those with any condition exacerbated by extreme temperatures, in this case heat. The cascading effect was as follows: EMS call volume went through the roof; on scene times increased significantly because crews were faced with having to climb stairs and carry patients because the elevators were out; and, because hospitals were overwhelmed, ambulances were prevented from quickly returning to service due to a lack of space for their patients in the emergency rooms. To say that it was a mess would be an understatement, and if there was any knowledge of or planning around these special populations by city officials, it certainly wasn’t relayed to the hospital I worked for or my EMS crews in the field.

During the recent ice storm in Atlanta, we flat-out got lucky. The city I worked for did far better than most with keeping our primary and a few of our secondary roads passable and we staffed additional police, fire and EMS units; however, many of our residents were stuck in their homes or neighborhoods for nearly 5 days. By about day 3 or 4, I started becoming concerned about the unknown number of patients in our city of 97,000 residents who relied on dialysis, supplemental oxygen, or in-home medical care. Dialysis centers were all closed, oxygen deliveries weren’t being made (but fortunately deliveries of enough oxygen for a week were made right before the storm), and visiting nurses couldn’t make their rounds. I am convinced that had transportation been impacted by another day or two, or we had lost power, our regional public safety and healthcare infrastructure would have been brought to its knees. The most troubling thing about this is that we would have had no knowledge of the magnitude of the problem until we were faced with it. That’s simply unacceptable to the public and should be to us as public safety and health officials.

Why do I point out all of this? Well, we’re previewing a new solution at EMS Today / International Conference on Disaster & Terrorism Preparedness this week in Baltimore, and the first customers will begin utilizing it next month. We’ve received excellent feedback from emergency managers and public health officials from across the country about the solution and I am hopeful that it will provide critical and actionable information to close the gaps in the scenarios previously mentioned and many that were not.

Specifically, we anticipate that SmartPrepare will help address various challenges around vulnerable populations / whole community preparedness by providing:

Automation of citizen data collection, validation, and geocoding

More effective preparedness around community needs

Rapid identification & visualization of vulnerable populations

More efficient response to those in greatest need of assistance

Facilitated interoperable regional reporting

Every good emergency manager knows that the time to prepare for and make the necessary relationships for successful response is long before the disaster occurs. We hope that SmartPrepare will arm public officials with the knowledge necessary for determining their community’s specific needs, so that the most beneficial plans and relationships can be established before they are needed.