Questions to Ask Your Hospital Before Disaster
By Maurice A. Ramirez
gas leaks after a train-car derailment. Radiation contaminates the
community when an industrial accident occurs. A levy breaks, washing
through every refinery and industrial plant and polluting all the
water. Terrorists attack. Pandemic flu strikes.
numbers of people in your community are very sick, the last thing you
want is for your hospital to be incapacitated as well. In America, any hospital or emergency room is considered a “first receiver.”
That is, in the event of any kind of a healthcare disaster or mass
casualty event, they would be the first to receive patients.
Therefore, hospitals must be able to work as health care providers
and, to some degree, as hazardous materials (hazmat) operators. But
setting up hazmat operations can cost up to $2 million, training
decontamination teams can cost up to $250,000 in the first year, and
running the required disaster drills twice a year, every year, can run
anywhere from $125,000 - $250,000. Federal funding for these efforts
has been scarce. So most private institutions have been left with two
choices: Paying for equipment and training out of pocket, or not doing
and rural hospitals, spending this kind of money for disaster
preparedness has been difficult. But poor hospital response to
Hurricane Katrina and other disasters, and the specter of pandemic flu
on the horizon in the next 3-6 years, lead the Joint Commission on
Accreditation of Health Care Organizations (JACHO) and the federal
government to begin enforcing longstanding rules about disaster
preparedness for hospital accreditation. These rules include twice
yearly disaster drills and the ability to be a first receiver.
How do you
know if your local hospital
is up to snuff as a first-receiver facility? Every individual citizen
needs to ask the following five questions of their community’s
Question #1: What has been done to prepare? If your community is in
an area where a natural disaster or an industrial accident could
occur, is your hospital conducting live disaster drills? Nothing
substitutes for what is called in disaster parlance, “getting cold
and wet.” Full-scale scenarios with wet, “contaminated”
patients, and front-line first receivers in bio-hazard gear will show
hospital staff if they can properly cope with an influx of extra
patients who need to be decontaminated. The best way to learn is by
combining the familiar (the environment of the facility) with the
unfamiliar (a disaster scenario of some type).
Question #2: Who’s grading the drills? If your local hospital is
holding drills, who’s grading them? A hospital grading its own
performance is like asking a 10-year-old to grade his own final exam.
Of course they’ll give themselves good marks, because they aren’t
qualified to assess their own performance. Even though they’ll be
paid by the hospital, independent experts will offer a realistic, less
biased assessment and will be capable of comparing the hospital to
other similar facilities. An independent evaluator will be able to
offer real recommendations to improve.
Question #3: Does the ER door lock? And can people get past it
without any difficulty? An episode of the television show ER pointed out this danger. Following a very realistic disaster
scenario—a ruptured tank at a chemical plant—three victims arrived
in the ER completely soaked and non-decontaminated. And because the ER
doors didn’t lock, they were able to walk straight in from the
emergency rooms have equally easy access, so the ER and every person
in it can easily be contaminated. If the decontamination and first
responder teams are in the ER at the time a contaminated individual or
group wanders in, in effect the whole hospital is rendered useless and
no longer has any ability to respond.
Question #4: Who is being trained? Many hospitals make the mistake of training only those in the emergency
room for disaster response. And if their ER becomes contaminated, a
disaster quickly turns into a catastrophe. Trained providers have the
people and the ability to respond, but run out of needed resources. In
a catastrophe, needs exceed the ability to respond. So trained people
must be spread throughout the hospital: front desk, custodial staff,
administration, and every other department. In the event that one team
is lost, another team can quickly fill in.
Question #5: What decontamination facilities are available? In
studies of every disaster, 80% of the victims arrive at the hospital
by some means other than an ambulance, which means they show up
contaminated or potentially contaminated. Is your local hospital set
up with the equipment to offer decontamination? Or they may rely on
their local fire department and hazmat team; this can be problematic,
though, since those first responders will head to the site of the
disaster, not to the hospital to spray down patients.
What can you do? These
five questions are tough ones that a lot of hospital administrators
don’t want to answer because they know they will get failing marks.
But when people in their own community ask, “Where do we stand?”
they can be compelled to answer and to fill in the gaps in their
disaster preparedness. Therefore:
Every time you go to the hospital for something as
simple as a blood test, you’ll get a satisfaction survey. At the
bottom is a space to make a comment, so ask these questions every time
you get such a survey.
If your community’s media haven’t asked these
questions of local healthcare administrators, then the public should
be telling them to. Make phone calls to reporters at local papers and
radio and television stations.
Attend county commission and city government meetings on
disaster planning and ask these questions. Almost every community now
has at least one a year, if only to keep the Homeland Security dollars
Every city, county, and state level of government has a
website where you can ask these questions, as does every hospital.
When you find the space where you’re asked what they can do to make
things better for the community, this is the answer.
Ready or Not…Here We Come: Fortunately, Hurricane Katrina-sized
disasters and pandemic flus don’t happen every year. But the sad
truth is that, sooner rather than later, there will be another New Orleans, another
Charity Hospital, and another total system failure if local communities don’t take
care of themselves.
hospitals now are private businesses,
completely driven by public perception, and the opinion of the
loudest voices wins. So one person speaking out can make a difference,
and a group of people calling out can make a huge
difference. If a hospital consultant makes a recommendation, a CEO is
likely to say, “Sure, but you’re not the one paying for it.” But
if 50 or 100 or 1,000 hospital customers make the statement, that CEO
will listen or will risk not being CEO anymore. When informed citizens
in every county, every parish, and every city ask “Are we ready?”
first receivers will be compelled to do what it takes to get the
equipment, the people, and the training to keep everyone safe in the
event of a disaster.
Read other articles and learn more about
Dr. Maurice Ramirez.
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