By Don Sadler

Recent events have taught us that disasters can happen anywhere, at any time and under practically any circumstances. These include natural disasters like major storms, fires and earthquakes as well as man-made disasters like terrorism, cyber attacks and mass shootings.

So, it is critical that health care facilities conduct thorough disaster recovery planning. There’s often very little, if any, warning that a disaster is about to strike. Disaster preparation must occur long before events occur.

Experiencing Disaster First-Hand

Janet L. David-Lustina RN, MBA, BSN, BAP, the Director or Perioperative Services at the University Medical Center of Southern Nevada in Las Vegas, experienced a disaster first-hand in the form of a mass casualty event when a gunman opened fire on a crowd of concertgoers in Las Vegas on October 1, 2017.

“I truly believe that most facilities, both large and small, have come to realize that we all need to be prepared for both internal and external disasters,” she says. “When this attack occurred, it was an awakening that was felt throughout the nation and we started to question our vulnerabilities.”“As health care professionals, we asked ourselves valid questions about preparedness and recovery after a major disaster,” David-Lustina adds. “It would be remiss for any health care facility to think they will not at some point be affected by a disaster of some kind.”

According to Byron L. Burlingame, MS, RN, BSN, CNOR, Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN), larger health systems and facilities have been developing disaster plans and conducting readiness drills for years.

“They are more prepared for disasters now than they used to be,” says Burlingame. “But for smaller facilities like surgery centers, there is work to be done in order for them to support their community’s disaster plans.”

During her travels to speak at events in the U.S. and internationally, Sherry L. Buxton, MBA, BSN, RN, NEA-BC, Chief Surgical Services Officer, AHG Administration at ORMC/Orlando Health, says she encounters many hospitals and health care organizations that do not have a disaster recovery plan.

“Or, if they do have a plan, it hasn’t been updated or exercised,” Buxton adds. “And, some facilities can’t get executive support for their plan. As more mass casualty events occur, hospitals are starting to reach out for direction when it comes to disaster recovery planning.”

“With mass casualty events taking place more often, there is increased discussion about planning for such events,” adds Wilton C. Levine, Medical Director, Perioperative Services at Massachusetts General Hospital in Boston. Levin was in the hospital when victims of the Boston Marathon bombing that occurred in 2013 began arriving.

Disaster Recovery Plan Components

Levine lists a number of components that should be part of a health care facility’s disaster recovery plan: leadership involvement, clear communication, broad training, knowledge of resources, security, and downtime procedures.

David-Lustina concurs: “Strong administrative leadership that is involved and engaged is especially critical,” she says. “So is facility-wide engagement, role play, mock code and debriefing of strengths and weaknesses of the plan.”

Buxton stress the importance of continuity of operations in the event of a disaster. “Or in other words, ensuring that you can continue to function and provide health care services to the community you serve,” she says. “Your plan needs to emphasize people, systems, resources and facilities.”

Burlingame notes that AORN members can obtain a toolkit on emergency preparedness that provides resources for creating a disaster plan. “This includes both mass-casualty events and non-utility based events,” he says.

Simulation and training are critical when it comes to disaster planning, says Levine.

“We conduct disaster drills throughout the year,” he says. “These range in scale from small table top drills to unit-based drills, hospital-wide drills and regionally coordinated multi-hospital drills.”

“A table top drill is an effective method for evaluating your plan,” adds Burlingame. “This drill would include an assessment of the facility’s utilities and an evaluation as to how they would stand up to potential disasters.”

Mock disaster code and debriefing, meanwhile, are a good way to evaluate the effectiveness of your disaster plan before a disaster strikes.

“Each mock code should involve different team members from their respective departments so different perspectives and perceived challenges are addressed,” says David-Lustina. “The more perspective and feedback you obtain, the better.”

Shortcomings of Disaster Plans

One problem that Buxton sees with some health care facilities’ disaster recovery plans is how “spider-webbed” their computer systems are and how systems are reliant on one another. “If one goes down, this can affect all the others and negatively impact patient care,” she says.

Meanwhile, Burlingame says it’s not uncommon for facilities to have small plans for various situations while lacking an overarching plan that would cover multiple scenarios with specific steps for each one.

“Facilities need to be sure their plan is thorough, with clear measures for each type of failure, and then provide education and perform competency verification on the entire perioperative team,” says Burlingame. “All team members have roles to perform during a disaster.”

Buxton places communication at the top of her disaster planning priority list. “You’ve got to have a way to communicate with your staff at all times, both day and night,” she says.

“Disaster plans are fluid and ever-changing based on lessons learned from real incidents and disaster drills,” Buxton adds. “Every disaster is different – no two incidents are the same – and there are always lessons to be learned and areas for improvement.”

Inside the Las Vegas Shooting

In Las Vegas on the night of October 1, 2017, David-Lustina says the first University Medical Center trauma activation alert notification for a “full trauma activation for GSW” went out just two minutes after the last shots were fired.

“This tells me that the Las Vegas disaster communication plan was intact and effective in notifying key stakeholders that a disaster had occurred,” David-Lustina says. “Upon activation of the disaster code, we were ready when patients started arriving – there was no delay in providing immediate care.”

“Physicians, residents, attendings, military partners, nursing and ancillary staff were all readily available,” David-Lustina adds. “And more were either arriving or calling in to see if their assistance was needed. Administrative team members also arrived, rounded on all units and provided assistance as needed.”

Patient flow, tracking and identification were among the biggest challenges at UMC during this disaster. “The faster patients arrived, the harder it was to keep track of everyone,” she says.

As families started calling looking for loved ones, hospital personnel had to make sure they were not violating patient privacy. “We were fortunate in that we had a designated public speaker for the facility,” says David-Lustina.

“We also had a patient advocate who tightly managed patient privacy and ensured that the correct patients were paired with the correct family members,” she adds. “All in all, we were well-prepared for this event considering it was our first and hopefully our last disaster of this magnitude.”

Take Disaster Planning Seriously

Buxton’s advice to hospitals and health care facilities when it comes to disaster planning? “Take it seriously and start to plan now,” she says.

“For example, what are you going to do if 15 patients from a disaster urgently need to get into ORs in the middle of the night?” she asks. “Who is going to staff the ORs and do you have enough supplies for this type of incident?”

David-Lustina urges hospitals to recognize that doctors, surgeons, nurses and other health care providers are deeply affected by disasters and may need help coping with the ongoing physical, emotional and physiological effects.

“During the event we’re running on adrenaline and endorphins but afterward we often crash,” she says. “Sometimes we’re unable to shut our brains off or sleep, which can take a toll both mentally and physically.

“Therefore, health care facilities need to provide support resources to their employees,” David-Lustina adds. “And when the event is over, health care workers need to know that they’ve done the best job they can and provide ongoing support for each other.”