Five questions to ask your hospital before disaster strikes

Jun 20, 2006 4:01 PM, Contributed by Dr. Maurice A. Ramirez

Chlorine gas leaks after a train-car derailment. Radiation contaminates the community when an industrial accident occurs. A levee breaks, washing through every refinery and industrial plant and polluting all the water. Terrorists attack. Pandemic flu strikes.
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 anything.
For small 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, have led the Joint Commission on Accreditation of Health Care Organizations (JACHO) and the federal government to begin enforcing long-standing rules concerning disaster preparedness for hospital accreditation -- including 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? Ask the following five questions:
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 street.
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 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 disasters, 80 percent 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.
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.
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.
About the Author: Dr. Maurice A. Ramirez, DO, CNS, CMRO is founder of High Alert LLC, a Florida corporation dedicated to disaster preparedness, recognition, response and recovery education for businesses and communities nationally. Ramirez teaches all levels of Disaster Life Support to healthcare providers, emergency workers and governmental agencies.

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