Patient Safety Quarterly

Plan now for the disaster that is soon to come

Disasters bring unanticipated problems

A disaster is headed your way. The only question is what it will be and when it will hit. Plan now for the tornado, hurricane, earthquake, fire, or bomb, and eventually you'll be glad you did. Some type of major emergency is bound to hit your organization sooner or later. Health care administrators who have been through disasters offer these suggestions:

Make sure your agency’s disaster plan is up-to-date and that it reflects any changes made in your community’s emergency preparedness. "We’ve always had a disaster plan here from the beginning, but after Hurricane Andrew came and hit this area, we took another look at ours," says Nancy Bundy, RN, former director of professional services for Home Advantage Home Health Agency in Miami Beach, FL. The full-service agency, which is a department of Mount Sinai Medical Center, provides service to all of Dade County for Medicare patients.

As a result of the hurricane, the county changed its criteria for sending people to special-needs shelters. So Home Advantage had to adjust its policies. The agency now assesses each patient on admission as to whether they would need a special-needs shelter if a hurricane struck Miami. "If that’s the case, then right on the initiation visit, we start the paperwork to provide them transportation to a special-needs shelter," Bundy says.

Home Advantage also participates in an annual "call down," in which volunteers spend a day calling all of the people on the list for a special needs shelter to see if they still need to be on the list, says Silvia Arana, RN, BSN, MBA, director of community services. Arana participated in the program this past February. "We spent five hours calling hundreds of people, verifying that they still needed oxygen, and updating the file," she says.

Train staff how to handle the disaster personally and professionally. Experts say it’s a good idea to show employees how they can prepare their homes for a disaster by having disaster kits ready.

FL agency has mandatory one-hour inservice

One Jacksonville, FL, agency educates staff about disaster preparedness year round but holds a mandatory one-hour inservice in May. Hurri-cane season is between May and November. "The inservice was designed to help the staff personally prepare for a hurricane, to prepare their homes and their families," says Cindy Ehardt, RN, MSN, education coordinator for Baptist Home Healthcare of Jacksonville. The nonprofit, full-service agency serves five counties in northeastern Florida, from the Georgia border to St. Augustine.

"The gist of this inservice was to have the staff personally prepared so when they’re here helping us, they’re not worried about their families," Ehardt explains. "When Bertha came along, one of our key people was here biting her nails because she didn’t have a thing ready at home, and we had to let her go home."

The staff’s safety has to be the top concern, education managers insist. "Our employees were told not to attempt to get to a patient’s home during the storm, and they should wait until the roads were clear," says Ellen Cameron, MSW, CCSW, a director of regional operations and director of family and counseling services with the hospice. "They were not to risk their own lives or safety while we had trees down over roads, power lines down, and major problems with flooding," she adds.

Set priority lists of patients who will need the most help during an evacuation. An updated list of priority patients helped the staff of Southern Home Care of Jeffersonville, IN, locate patients quickly on the turbulent days after torrential rains sent the Ohio River over its banks. "Some of the patients didn’t want to leave their homes, so we had to tell them that we didn’t want them surrounded by water like an island, and if we thought they had critical needs we informed their families," recalls Marita Witten, a nursing secretary for the agency.

Every few months, Home Advantage employees review a roster of patients who need help with transportation during a hurricane. The patients’ names are color-coded according to whether they will need oxygen or electricity, Bundy says. When a hurricane watch is announced, the staff calls each patient to let them know that the nurses won’t be visiting their homes and to remind them to fill two extra weeks of prescriptions.

Baptist Home Healthcare has the nurses who admit patients go over emergency preparedness with each. "We ask them, What kind of plan do you have? Where are you prepared to go?’" Ehardt says. The agency has registered all of its patients with the Jacksonville emergency preparedness office by completing a form on each patient in which nurses set priorities for which patients will need assistance with evacuation to a special needs shelter, she adds.

The Lower Cape Fear Hospice, based in Wilmington, NC, was as prepared as an agency could be when Hurricane Fran swept the coast, but each disaster brings many unanticipated problems, and Fran was no exception. "We had plans as to who was going to do what," Cameron says. "But we didn’t know where the transportation problems would be, so we had to do a triage by telephone, calling the patients and families."

The agency kept a status board at its regional office so that nurses and other employees could check on their patients’ needs and plans. The board also listed the patients’ locations and their specific needs for medications, supplies, and equipment.

Make disaster preparation a major part of the educational program throughout the year. Ehardt teaches staff about disaster plans first in orientation as part of the safety section. Then she continues the education throughout the year, even encouraging nurses, aides, therapists, and social workers to become trained Red Cross volunteers. "About 75% of our home care patients would end up in Red Cross shelters, so we’ve had the American Red Cross in here training our staff to be volunteers," Ehardt states. "This training helps them understand what goes on in these shelters and what our patients will be facing."

Distribute disaster plan literature to your staff and patients. Jane Hoffmann, RN, MS, education coordinator for Columbia Homecare and Hospice in San Jose, CA, worked with several other California organizations on a disaster preparedness brochure for people who have special medical needs. It was funded by a grant from the American Red Cross of Washington, DC. Columbia Homecare will use the brochure when it’s finished, and it will be translated into Spanish and Vietnamese, she says. The American Red Cross also has a brochure called "Preparing for Emergencies, A Checklist for People with Mobility Problems."

Some agencies have created their own in-house brochures that list their policies and special instructions. The Lower Cape Fear Hospice has created its own five-page emergency operations policy that lists exactly which staff will be on the regional disaster team, how staff should prepare personally and professionally for a disaster, and other pertinent details.

For more disaster information, contact the following:

American Red Cross, 430 17th St. N.W., Washing-ton, DC 20006. The agency has various emergency brochures and booklets, including Your Family Disaster Supplies Kit, Preparing Your Home for a Hurricane, Emergency Preparedness Checklist, Your Family Disaster Plan, and Food and Water in an Emergency. To obtain copies, call a local office or (202) 737-8300. The disaster supplies kit brochure (order #379C) also can be ordered for 50 cents from the U.S. General Services Administration, by writing to R. Woods, Consumer Information Center — 6D, P.O. Box 100, Pueblo, CO 81002.

Metropolitan Life Insurance Co., One Madison Ave., New York, NY 10010. MetLife recently published a brochure called Preparing for Earthquakes that can be ordered free by calling (800) 638-5433, or through the Internet at