November 2005 Volume 29 No. 10

According to the diligent record keeping of Julie Rex in the Medical Staff Office, this is Dr. Shuer's 100th Medical Staff Update column as chief of staff. Check the publication's online archives for many of Dr. Shuer's timely columns on a broad spectrum of subjects - ranging from current political issues to hospital practice to civility


Are We Ready for Our Disaster?

The tragedy stemming from this fall’s natural disasters are obvious. What is less clear is how to apply lessons from Hurricanes Katrina and Rita and the Southeast Asia earthquake to our own lives and practices. But the lessons are there, and we must heed them.

Although the hurricanes wrought some of the worst destruction, devastation and death in our nation’s history, the 7.6 magnitude earthquake a month later in the Kashmir region of India and Pakistan may - perhaps ironically - have struck closer to home. After all, an earthquake is the sort of disaster we ourselves will inevitably face here in Northern California.

Yet, it’s not the wind or flooding of hurricanes or the shaking and crumbling of earthquakes that offer us lessons now.

The human and economic toll following Katrina was greatly exacerbated by an abysmal absence of effective long-term planning - including the failure to replace a flawed levee system - as well as negligent short-term planning efforts, such as the egregious failure to do something as basic as deploy public buses to transport low income residents away from the impending storm. Instead, many residents were stranded - sometimes on the roofs of their own homes - while the buses themselves were stranded in floodwaters.

From anecdotes of friends and newscasts we have found plenty of harrowing stories about the difficulties faced by medical personnel and patients in hospitals in New Orleans during Katrina. For example, electric power was lost during the storms, and then some hospital generators failed in flooded basements. Even at hospitals with auxiliary power, generators became useless as fuel ran out - and ventilator - dependent patients had to be bagged hour after hour. Hospitals ran out of food and patients and medical personnel were given very strict, sparse rations. Patients had to be evacuated from makeshift helipads, and in some cases medical personnel were actually shot at while attempting to get out of their hospitals.

Sadly, such chaos on the Gulf Coast reminds us of a Third World disaster, and lack of planning stands out as a fatal flaw. But as health care professionals we can learn from the mistakes of the Gulf Coast hurricanes - just as I hope our colleagues in South Asia might be learning now from these mistakes.

I am troubled by colleagues who say that as intelligent people, we will be able to think our way through the problems that will arise in any new disasters, just as we think and plan our way through difficult cases in our examining rooms, hospital units, clinics or operating rooms. But such thinking fails to take into account our many years of training. We are able to adjust to the contingencies in our workplace every day because we have been taught how to react with skill and appropriate instinct under myriad conditions. But such training relates to our own professional specialties - not the discipline of disaster preparedness.
While no one can plan for every contingency, there is ample evidence that a solid disaster plan can create the necessary template - the appropriate mindset, instincts and flexible skills - to enable each of us to jump into action with the tools we need to do our jobs under highly unusual circumstances.

Such planning and preparations make a difference. While many factors were involved, it seems clear that Rita caused less chaos and disruption than Katrina at least in part because of better preparations.

Yet, I wonder what it takes to put disaster on our radar screen. It’s so easy to “go through the motions" when we have a disaster drill without really being as serious about the process as we should be. We keep hearing how we are due for the “big one," but yet most of us seem to live in denial just like those in New Orleans did prior to Katrina. Will we be prepared when our disaster occurs?
I must say that I for one will certainly view SHC disaster exercises from a different perspective in the future. Despite everything else we are responsible for doing each day, we must as individuals learn and develop strategies that will prevent our institution - and our medical practices and communities - from falling into chaos.

We think that as smart or even brilliant people we have the resources we need to respond to disasters in creative and innovative ways. We do have that potential. But we won’t be able to respond appropriately unless everyone is on the same page using the appropriate template. And we won’t get there until we become familiar with that template. Our disaster exercises breed that familiarity.

At SHC we do have an infrastructure. Last month I was heartened to read an insert placed in the Medical Staff Update that describes disaster preparations here at SHC. It was written by emergency medicine faculty member Eric Weiss, with the collaboration of Medical Staff President Kent Garman. We have the tools we need to work with our communities to bring more diligence and creativity to the mock disasters we simulate during our drills, and thus we become better prepared.

We have already seen positive signs that at Stanford we do wish to be involved. I want to acknowledge the outpouring of volunteerism from our physicians, nurses and other staff members who stood ready to travel to the Southeast to help those in need or who have volunteered to provide housing, supplies and money.

Our residency training programs have opened their arms to welcome at least three trainees who have been displaced because their hospitals have not been able to continue their training at least temporarily in the wake of the rebuilding efforts in the Southeast. I am in awe of our community’s generosity and altruism.

Since this is the November column and Thanksgiving Holiday is soon upon us, I wish to proclaim how thankful I am that we haven’t had to deal with the type of disasters first hand which others have this year. I am also thankful that we are surrounded by compassionate, giving people who are eager to reach out to those in need - and now hopefully also to assist in contingency planning here before an emergency hits home.