EMERGING TOPICS and DISASTER PREPAREDNESS Patricia C. Hunt, DO, MHA, CHCQM, FAOBIM, FAOCOPM How can I prepare myself? My Home My Practice/work Outline What are some emerging tools to prepare, predict, recover? How to think about preparedness Doomsday vs. back up planning A series of what if? scenarios NEVER say never Examples: What if the power goes out? What if evacuation is required? How can communication take place? Common Features Destruction (property) Harm (physical dangers) Fear (mental impact, exacerbation of preexisting medical conditions) A I M: The three steps to being psychologically prepared http://www.psychology.org.au/publications/tip_sheets/disasters/#s4 ANTICIPATE that you will be feeling worried or anxious and remember these are normal, although not always helpful, responses to a possible life threatening situation IDENTIFY what the specific physical feelings associated with anxiety are and whether you are having any frightening thoughts that are adding to the fear MANAGE your responses using controlled breathing and selftalk so that you stay as calm as possible and can focus on the practical tasks that need attention T-1
Damage to... Tra nsportation Structures Communication Systems Uti lities EXAMPLES Wa ter Service Fuel Supplies Fi nancial Services OF POSSIBLE IMPACT Possible Effects Inability to assess damage accurately Ambulances prevented from reaching victims Fi re departments prevented from getting to fires Fl ow of needed supplies (food, water,etc.) is interrupted Roa ds are closed and/or impassable Da maged critical facilities (e.g., hospitals, fire stations, police precincts, airports) unable to function normally Key points to communicate are: Pol ice prevented from reaching areas of civil unrest Increased risk of damage from falling debris Vi cti ms unable to call for help Coordination of services is hampered Fa milies and friends cannotcommunicate Los s of service IMPACT ON THE INFRASTRUCTURE Increased risk of fire or electrical shock OF DAMAGE ON INFRASTRUCTURE Li mited access to fuel, e.g., pumps that may not work Los s of contact between vi ctims and service providers Medical facilities hampered Increased risk to public health Increased risk of fire or explosion from fuel line rupture Ri sk of asphyxiation Inadequate water flow, which results in notice to boil water and ha mpered firefighting capabilities Location of the incident Type of incident Any hazards Approximate number of victims Type of assistance required http://www.cert-la.com/triage/start.htm ATM ma chines do not work Credi tcard systems i noperable T-2
Your household AND Your business T-3
Being Prepared Water http://emergency.cdc.gov/preparedness/kit/disasters/ MULTIPURPOSE TOOL SANITATION AND PERSONAL HYGIENE ITEMS COPIES OF PERSONAL DOCUMENTS (MEDICATION LIST AND PERTINENT MEDICAL INFORMATION, PROOF OF ADDRESS, DEED/LEASE TO HOME, PASSPORTS, BIRTH CERTIFICATES, INSURANCE POLICIES) CELL PHONE WITH CHARGERS EMERGENCY CONTACT INFORMATION EXTRA CASH EMERGENCY BLANKET MAP(S) OF THE AREA MEDICAL SUPPLIES (HEARING AIDS WITH EXTRA BATTERIES, GLASSES, CONTACT LENSES, SYRINGES, CANE) BABY SUPPLIES (BOTTLES, FORMULA, BABY FOOD, DIAPERS) GAMES AND ACTIVITIES FOR CHILDREN PET SUPPLIES (COLLAR, LEASH, ID, FOOD, CARRIER, BOWL) TWO WAY RADIOS MANUAL CAN OPENER WHISTLE N95 OR SURGICAL MASKS MATCHES RAIN GEAR TOWELS WORK GLOVES TOOLS/SUPPLIES FOR SECURING YOUR HOME EXTRA CLOTHING, HAT AND STURDY SHOES PLASTIC SHEETING DUCT TAPE SCISSORS HOUSEHOLD LIQUID BLEACH ENTERTAINMENT ITEMS BLANKETS OR SLEEPING BAGS SHUT OFF VALVE WRENCH CLEAN LARGE GARBAGE CAN STORE AT LEAST 1 GALLON PER PERSON AND PET PER DAY. STORE AT LEAST A 3-DAY SUPPLY OF WATER FOR EACH MEMBER OF YOUR FAMILY. IN AN EMERGENCY, DRINK AT LEAST 2 QUARTS OF WATER A DAY, OR 3 TO 4 QUARTS A DAY IF PREGNANT, SICK, A CHILD HOT CLIMATE Water (from uncertain sources). STRAINING IT. POUR THE WATER THROUGH PAPER TOWELS, A CLEAN CLOTH, OR A COFFEE FILTER TO REMOVE ANY SUSPENDED PARTICLES. DISTILLING IT. FILL A POT HALFWAY WITH WATER. TIE A CUP TO THE HANDLE ON THE POT'S LID SO THAT THE CUP WILL HANG RIGHT-SIDE-UP INSIDE THE POT WHEN THE LID IS UPSIDE-DOWN WITHOUT DANGLING INTO THE WATER. BOIL THE WATER FOR 20 MINUTES. THE WATER THAT DRIPS FROM THE LID INTO THE CUP IS DISTILLED. BOILING IT. IN A LARGE POT OR KETTLE, BRING WATER TO A ROLLING BOIL FOR 1 FULL MINUTE. COOL IT AND POUR IT BACK AND FORTH BETWEEN TWO CLEAN CONTAINERS TO IMPROVE ITS TASTE BEFORE DRINKING IT. FOOD NON-PERISHABLE EASY TO PREPARE ITEMS 3 DAY SUPPLY FOR EVACUATION 2 WEEK SUPPLY FOR HOME CHLORINATING IT. USING HOUSEHOLD LIQUID BLEACH THAT CONTAINS 5.25 TO 6.0 PERCENT SODIUM HYPOCHLORITE, ADD 16 DROPS (1/8 TEASPOON) PER GALLON TO WATER IN A LARGE POT OR KETTLE. STIR AND LET STAND FOR 30 MINUTES. IF THE WATER DOES NOT HAVE A SLIGHT BLEACH ODOR, REPEAT THE DOSAGE AND LET STAND ANOTHER 15 MINUTES. IF IT STILL DOES NOT SMELL OF CHLORINE, FIND ANOTHER SOURCE OF WATER AND START OVER. Obtaining ready access to the home phone numbers, e-mail addresses, pager numbers, and cell phone numbers of all staff members. Periodically update this information. This information should be stored off-site in a secure location since it may contain confidential contact information. Securing pertinent contact information for government and emergency agencies. Developing a telephone message informing patients of why you have temporarily shut down, who they should call for medical emergencies and further contact information. Design a response plan. Review with each department the critical steps contained in the plan, then have each member sign a document indicating they understand how the plan will be implemented in the event of an emergency. Review the plan periodically and make updates when needed, such as when you expand or relocate your office space. Assume that you will have experience either temporary or permanent loss of access to: Patient charts and other key information; Medical information, such as specialty journals and textbooks; Support and clinical staff, such as nurses, administrative and billing personnel. How to contact employees and patients if phone lines are inaccessible; The length of time the practice can survive financially. The pharmaceuticals and other medical supplies that must be rapidly restocked; Your business insurance policy and how it addresses interruption in service; A new site where you can quickly set up and run your practice. T-4
Having copies of patient charts and other vital records off site (experts recommend that this is at least 50 miles away from your practice), even if most of your records are stored electronically. You should also keep extra copies of all the forms you use in your practice. Securing copies of loan applications, grant proposals, real estate records, advertising contracts or other agreements that are crucial for your business in a safe location. Sufficient insurance coverage Business interruption coverage? In many cases, when determining an alternate site for your practice, you may be able to form a mutual partnership with another practice, arranging for an emergency sharing of one another's facilities in case of disaster. Partner, if possible, with someone who is geographically far enough away to minimize the chances that you will both be affected by the same emergency situation or subsequent events. Your plan should also detail how you can communicate with vendors about where to deliver supplies, notify labs about your relocation, and inform other service people about how you are coping with your recovery. Plus, you should check with your vendors to see if they possess adequate business recovery plans. If they don't, urge them to put one together or find another vendor who is adequately prepared. Emerging tools Designate a trusted individual who can implement the recovery plan in case you are unavailable. Make sure your staff knows how to evacuate from your office in the event of a disaster. Periodically review and retrain staff about the location and proper use of available fire extinguishers. If your office is located in a building with other businesses and practices, coordinate your emergency plan with your neighbors New applications of technology Social media Others REMEMBER: Every new technology brings with it the capacity to screw things up in an entirely new way. http://www.computerworld.com/s/article/9221375/social_media_firestorms_a_first_ responder_s_guide Demonstrations http://www.earthzine.org/disastermanagement-theme/ http://www.ushahidi.com/ http://72hours.org/ http://www.ready.gov/today T-5
Helpful resources Photo Credits http://www.health.ny.gov/environmental/emergency/radiological_terroris m/radterr.pdf Title slide,be Prepared: http://www.gatech.edu/specialevents/blog/2012/03/27/be-prepared Photo 1 http://churchintoronto.blogspot.com/2012/02/do-trials-turn-people-to-god.html#!/2012/02/do-trials-turnpeople-to-god.html Photo 2 and 3 http://www.theatlantic.com/infocus/2012/10/hurricane-sandy-after- landfall/100396/ Anthrax letters, investigation: http://www.ph.ucla.edu/epi/bioter/detect/antdetect_letters_a.htm Subway during blackout: http://gothamist.com/2003/08/15/the_new_york_city_blackout_edition.php Satellite photo (blackout): http://bigpicture.typepad.com/writing/2003/08/open_the_pod_ba.html Flood in train station NYC: www.guardian.co.uk WTC 1993 shirt/move back logo: http://www.google.com/imgres?num=10&hl=en&tbo=d&biw=1093&bih=507&tbm=isch&tbnid=9owpomph-iolm:&imgrefurl=http://www.911memorial.org/blog/19-years-later-remembering-1993bombing-attack-wtc&docid=qno1z7uih3zom&imgurl=http://www.911memorial.org/sites/all/files/imagecache/blog_post_medium/blog /images/movebackjacketpicone.jpg&w=560&h=373&ei=5375up7ofzg50qghkyg4aw&zoom=1&iact=hc &vpx=726&vpy=179&dur=23&hovh=183&hovw=275&tx=88&ty=122&sig=106518176111928091341&pag e=4&tbnh=129&tbnw=188&start=54&ndsp=18&ved=1t:429,r:64,s:0,i:309 Avian Flu: http://www.nature.com/news/specials/mutantflu/index.html Japan s tsunami/radiation disaster: http://coastalcare.org/2011/03/japan-nuclear-plant-gets-help-fromus-robots/ http://www.health.ny.gov/publications/7001.pdf http://www.health.ny.gov/environmental/emergency/chemical_terrorism /chemical.htm http://www.nyc.gov/html/oem/html/ready/household_guide.shtml http://extension.missouri.edu/greene/documents/plansreports/using%20 social%20media%20in%20disasters.pdf http://wwwnc.cdc.gov/eid/ http://www.citizencorps.gov/cert/videos/ T-6