The Atlantic Hurricane season officially begins on June 1st and it is already predicted that 2021 will be more active than usual. Nineteen named storms and twelve hurricanes, four of which will be a category 3 or higher, are anticipated1. Regardless of whether there are 20 named storms or 10, it only takes one to have a catastrophic impact. Additionally, slow-moving, weak tropical storms should not be minimized as they have also been associating with massive flooding and devastating effects.
This is why it is paramount to review your hospital and departmental policies in preparation for natural disaster events. The American Society of Anesthesiologists and the Committee on Trauma and Emergency Preparedness has published a wealth of information with links to further resources to guide departmental and hospital leadership on various catastrophes, including weather-related disasters2. Part of emergency preparation is ensuring that staffing will be adequate. Medical professionals understand the sacrifices that are involved with their chosen profession: unpredictable hours, long days, weekend and holiday shifts. However, the obligation to patients, colleagues, and the hospital, compounded with the stress of preparing the home and family for an impending natural disaster can be overwhelming. Effective leadership and a plan that is clearly communicated in advance of its implementation will go far in easing anxiety and ensuring that your anesthesia work force is ready and mentally prepared for the challenges ahead.
The staffing preparation strategy in the following discussion is part of the “Harris Health System Emergency Management Hurricane, Tropical Storm, Flood Response Plan” and is just one version of how a major institution prepares and executes3. The Harris Health System serves over one million people and operates a renowned Level I trauma center with 444 licensed acute-care beds and a Level 3 trauma center with 207 licensed acute-care beds, distinguished for its neonatal intensive care and high-risk obstetric care.
When a storm or other weather-related event is anticipated, initial disaster preparations begin with a meeting between the CEO of the hospital and senior staff to determine operations over the coming days. All staff should report to work as scheduled and information disseminated as it becomes available. Staff should be reminded of their departmental-specific plans and should be aware of the location of emergency phones and power failure phone numbers. Within 48 hours of the predicted event, the Incident Command Center should be activated. The pre-determined Ride-out teams (personnel that will remain at the hospital during a major event) should be released from duty to make personal preparations and departmental directors should organize a rest/work rotation schedule for this team. The hospital, still functioning as usual, should begin cancelling appointments and upcoming procedures. The media should be updated on the hospital status and all employees should receive electronic weather-alert messages. At zero hour, or when emergency conditions begin, the Incident Command Center should take over all hospital operations, all outpatient appointments should be cancelled, and the Ride-out team should take over, releasing the Recovery staff (designated personnel who will relieve the Ride-out team when safely possible) to make their own preparations. The hospital should initiate a protective lockdown mode, restricting access to essential personnel only. During this entire time, a staffing and disaster information phone line and internet resources should be constantly updated and employees should monitor for emergency messaging by text, email, or voicemail. Once the hurricane or other natural disaster passes and conditions improve, damaged areas of the hospital should be secured and the cleanup and recovery process can commence. The Recovery team should be alerted to return to work to relieve the Ride-out team.
In order for this process to move smoothly and efficiently, it is imperative that Anesthesia Department Directors review hurricane plans and employee responsibilities with their staff before hurricane season. Contact information and telephone lists need to be updated and anesthesia staff need to be assigned to either the Ride-out or Recovery team in advance of the threat. Leaders can solicit volunteers for the teams or consider assigning those who live in closest proximity to the hospital to the Ride-out team. An alternate leader should also be assigned in the event that the Departmental Director is not able to lead.
Ensuring that your anesthesia personnel take the appropriate measures to personally prepare for a hurricane is critical to emergency planning and ensures that they are physically and mentally capable of caring for their patients. Gathering food, water, medications, and emergency supplies, in addition to securing the home and planning for the care of pets, children, and elderly family members should be done ahead of time. See Table 1, published by the ASA Committee on Trauma and Emergency Preparedness for an example of a family preparedness checklist. When assigned to a Ride-out team, personnel should be instructed to bring enough personal supplies enabling them to be self-reliant for up to 5 days. Please see Table 2 for a suggested checklist of recommended and prohibited items when reporting to work during an emergency.
Leading staff through a crisis does not necessarily end once conditions are safe and the hospital has begun to resume normal operations. Stressors may persist as staff may have sustained physical injuries or loss of property including vehicles and homes, or may have close friends and family that are in similar situations. Systems should be in place to assist staff in meeting their immediate needs by coordinating access to shelter and transportation, food and water, and mental healthcare. These can be in the form of partnerships with nearby schools and churches, coordination with the city and local fire department, and relationships with local businesses. If the immediate needs of your staff are met, they are more likely to return to work and provide high-level care for their patients4.
Hurricane season is upon us and no one can predict what 2021 will bring. The American Society of Anesthesiologists and the Committee on Trauma and Emergency Preparedness are great resources to assist in planning. Effective preparations, coupled with transparent and frequent communication are the best tools available to face the challenges of a natural disaster.
