With Florida still reeling from the effects of Hurricane Irma, a federal agency within the Department of Health and Human Services has issued draft guidance to help healthcare facilities with disaster planning and recovery for major hurricanes.
Based on lessons learned from Hurricanes Katrina, Sandy, Harvey and others, the document—from the Office of the Assistant Secretary for Preparedness and Response—provides an overview of the “potential significant public health and medical response and recovery needs facing hurricane- and severe storm-affected areas.” Among the topics in the draft are those covering health information management.
“During a disaster, patients may be separated from their ‘medical home’ and medical records,” states the draft. “Information technology systems may be damaged in the event, and access to the systems may be limited by physical barriers, access issues, power disruptions or other impacts.
“Patients being evacuated or moved from one healthcare facility to another need complete medical records transferred with them, but that is not always possible if the facility has experienced significant damage, and paper records are damaged or missing and electronic records are not accessible,” adds the document. “Redundant IT systems and back-up paper records with the critical information are ways to mitigate this issue.”
For those patients at home who are dependent on medical devices that require electricity, they are particularly vulnerable in major hurricanes. However, under the HHS emPOWER Program, the agency provides information to public health officials regarding Medicare beneficiaries who are dependent on electrical medical equipment and at risk from prolonged power outages because of hurricanes.
“Utilizing the emPOWER program, local authorities can identify Medicare patients who are dependent on durable medical equipment and other vulnerable diagnosis codes in order to target post emergency canvassing,” states the document. “The data includes information on beneficiary claims for ventilator, BiPAP, internal feeding, IV infusion pump, suction pump, at-home dialysis, electric wheelchair and electric bed equipment in the past 13 months; oxygen concentrator equipment in the past 36 months; and an implanted cardiac device (i.e., LVAD, RVAD, BIVAD, TAH) in the past five years.”
Although this information is made available as part of a pre-event planning operation, according to ASPR “just-in-time” coordination with the emPOWER program is also possible.
In addition, ASPR points out that healthcare facilities must have running potable water and power to continue operations during hurricanes and the resulting floods. “Rapid needs assessment of healthcare and residential care facilities and supplementation with external generators may be critical to preventing evacuation.”
According to the Florida Hospital Association, as of Monday, there were 54 hospitals statewide operating on backup generators.
When it comes to making the decision to evacuate a healthcare facility, the earlier the decision is made the better, according to ASPR.
“Anticipating the need to evacuate to avoid emergency evacuation is ideal,” states the document. “The longer a facility has to evacuate, the more orderly the process can be. Sheltering patients in place carries risk, though so does evacuation. These risks must be balanced and consideration for capacity of the region to transport, track and accommodate patients must also be considered. Healthcare coalitions and health systems can be excellent resources in making systematic decisions and supporting evacuation operations.”
Superstorm Sandy hit the New York and New Jersey coastline in October 2012, resulting in severe flooding from the storm surges for New York University (NYU) Langone Medical Center—a 725-bed tertiary care facility in New York City located one block from the East River—which was forced to evacuate more than 300 patients because of the loss of power.
“One of the early problems, when it became clear that NYU would have to move all the patients out, was that nobody had a list of all the bed vacancies in the city,” says Christine Kovner, the Mathey Mezey Professor of Geriatric Nursing at NYU Meyers. “That’s a big problem and was a big takeaway at the time.”
In the wake of Hurricane Harvey, Houston established a Catastrophic Medical Operations Center (CMOC) to help with disaster response coordination to support the resource needs of healthcare facilities. The center helped coordinate hospital closures, patient evacuations, placement and transport to other healthcare facilities based on capacity, as well as patient tracking and reporting. Among its functions, the CMOC received bed availability reports from more than 120 hospitals in a 25-county area.
In Florida this week, 36 hospitals were forced to close, casualties of Hurricane Irma’s destructive path. Nearly 12 percent of the state’s more than 300 hospitals decided to close thanks to Irma; in most cases, the closures were precautionary measures in advance of the hurricane’s arrival.
“Healthcare facilities can be forced to close during hurricanes due to damage or flooding, loss of utilities, or other physical issues and be ‘off-line’ for an indefinite amount of time,” according to ASPR. “If a healthcare facility was forced to close due to flooding or other damage sustained during the incident, that closure may trigger the requirement to be re-inspected prior to opening.”
While many healthcare facility closures or disruptions after a hurricane are temporary, and normal operations are able to resume relatively soon, inevitably there will be facilities that will not be able to quickly or easily re-open because of significant flooding or structural damage. ASPR references that the New Orleans metropolitan area had 4,083 hospital beds before Hurricane Katrina but only 1,971 beds were available one year later.
“Emergency planners must consider how to support these individual facilities in recovery and also plan to address the impact their loss will have on the overall delivery of healthcare to the community,” states the draft. “This impact involves all healthcare facilities, not just hospitals and nursing homes, but clinics, labs, outpatient offices, and individual physician practices.”
In the case of Superstorm Sandy and NYU Langone Medical Center in 2012, Kovner recounts that “not only was the hospital incapacitated but a lot of staff lost their houses or had massive flooding and had to live with family, neighbors or friends.”
The psychosocial toll of hurricanes on medical staff—who in addition to their professional duties must also care for loved ones—is a concern that ASPR addresses in its guidance in terms of staff fatigue and replenishment.
“In the first few days of a response, staff are focused on rescue and response operations and often can’t rest and remove themselves from operations or won’t. After a few days of nonstop operations, they begin to tire and can display signs of stress,” warns the document. “Cognitive abilities decline rapidly with fatigue, stress, and inadequate nutrition and hydration. Incident management should prioritize staffing planning, including adequate rest and replenishment cycles.”
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