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or air mattresses on-site as well as on-site emergency storerooms. Given the enormous fuel access problems caused by Sandy, diesel fuel for generators, ambulances, and other key personnel vehicles should be added to any ‘critical supply’ list.”


Another saving grace: Plug local authori- ties into the process.


“From my own personal experience, every- thing can’t be mapped out in advance of an emergency so you need to be nimble, flexible and creative in keeping your supply lines open when the crisis happens,” Yokl noted. “With this said, I personally have found that the police can be of enormous assistance in any emer- gency. Once when there was a fire at a hospital where I worked that destroyed our outpatient department, I was able to coordinate with the police to secure and deliver all of the needed equipment that was required to clean up the debris and dry vacuum the flooded depart- ments caused by the fire. To this end, I would recommend that you develop a rapport with your local police chief or district commander to make sure they are there to assist you when a disaster strikes.” Frank Gerner, Director, Market Manage- ment, VHA East Coast Region, agreed. “Every hospital’s emergency plan should


be networked in to local, state, and federal resources to address a fire, tornado, flood or explosion- related emergency,” Gerner said. “Part of the issue to- day is hospitals maintain a just-in-time inventory with little or no surplus supplies. As part of preparedness planning, hospitals should establish and maintain relationships with local emergency preparedness teams, first responders, the National Guard and FEMA, and establish a plan or a framework that would allow them to deliver needed supplies to be delivered to the hospital. When a hospital becomes aware of an impending disaster, its supply chain leaders should alert suppliers to their urgent need for greater than normal supply orders.” That’s what Mercy and ROi learned post- tornado in Joplin, according to Greg Meier, Executive Director of Finance, ROi. “Coordination with local authorities is very important,” he indicated. “They understand the critical need for supplies to support medical services. As part of community response plan- ning, key communication channels and people must be identified so supplies can be delivered. In Joplin we worked with the local authorities and National Guard to clear paths and ensure delivery of not just supplies but also medical equipment, trailers and generators.” Added Nelson: “Being owned and operated by a healthcare provider undoubtedly made


Frank Gerner


this easier than it otherwise would have been. Advising marshals of anticipated incoming and outgoing delivery schedules and clearly marking vehicles so they are easily identified as supporting the healthcare facility allows this to go much smoother, particularly when curfews are imposed.” Electronic communication and data trans- mission during the storm posed another chal- lenge when power outages cramped cellular/ mobile telephone capabilities and computer functionality.


“From my experience, when a hospital’s electronic gear is down for any reason, hospi- tals must have manual backup systems to take their place,” Yokl advised. “As was reported during and after hurricane Sandy, almost nothing electronic worked for most of New York City for a week or two. Don’t depend on electronics of any kind to be available at your hospital either in an emergency. Make sure you have backup manual systems to take their place.”


During the aftermath of Katrina, for example, IMS had built a “safe command center” that housed satellite phones, generators and com- puters, Buisson acknowledged.


“Some of those systems can go on to emer- gency generators,” Gerner admitted. “VHA’s Mid-Atlantic region has established a disaster recovery arrangement with an outside ven- dor that member hospitals can participate in. Individual hospitals can establish that inde- pendently. Hospitals should check with their GPOs to determine availability of independent records storage programs.”


Without access to electronic health/medical


records, clinical research, billing and supply chain records — even if stored as a secure off- site data warehouse or “in the cloud” — when you have no functional computers and cellu- lar/mobile/WiFi communications, you have another disaster in the immediate aftermath of the disaster, according to Meier. “[But] availability of satellite based commu- nications can help this greatly,” he added. “The Missouri Disaster Medical Assistance Team (DMAT) had such an arrangement which we were able to take advantage of and was very helpful for the first few days. However, return- ing to paper is unavoidable without electronic communications. We were able to print medi- cal records out for current patients away from Joplin and then deliver where needed.”


Proact vs. react These recurring disasters beg the question whether it’s “easier” to plan for a disaster yet to happen or react to a disaster that already appeared.


“Planning problems are always easier to


solve because there is no stress or undue pres- sure during the planning exercises,” Yokl said. “Conversely, reacting in real time to a disaster


46 January 2013 • HEALTHCARE PURCHASING NEWS • www.hpnonline.com


that has already happened, with the fog of war setting in is unbelievably difficult; half of what you planned isn’t working and then you need to start all over to figure out how to solve your immediate challenges. Nothing can be more stressful and pressure filled than this.” Meier said he thinks reacting is easier. “You know the exact situation and the limitations and what has to be done,” he said. “When planning you have to think about a myriad of potential situations and imagine what is required and the potential limitations. This can be limitless.”


Nelson supported Meier’s logic. “Planning could be viewed as easier because it is only conceptual,” he said. “However, no amount of planning/drilling can simulate the real thing. For example, planning cannot prepare you for the human emotion and actions that accompany. Many of those who are reacting to the disaster will be impacted personally in addition to professionally, and the toll that takes is tremendous.”


For Buisson, reacting is easier “because you know what needs to be done” versus preparing for any scenario that may or may not happen, he added.


Gerner took the contrarian view in that planning for a disaster is easier than reacting to one, particularly on a personal level. “The hard part is when disaster strikes, employees who are working are devoted to taking care of their patients, but their own families may be in the disaster zone too, mak- ing employees eager to ascertain their safety,” he said. “Homes, too, can be affected, and employees are anxious to confirm that their property is safe. “Additionally, disaster preparedness plans often rely on the efforts of a fully staffed hos- pital,” Gerner continued. “When a disaster strikes, it is difficult to predict which staff members are working. The disaster could occur during a weekend or holiday when hospitals have a sparser staff, or when criti- cal task-owners in the plan are on vacation. To help reduce confusion about staff roles, hospitals should have several disaster plans — each with a different staffing component and contingency plan for accomplishing critical tasks.”


All told, O’Connor invoked a simple motto. “To the extent humanly possible, preplan and anticipate, with the understanding that one can never fully anticipate all scenarios,” he said. “Facilities should do SWOT (Strengths, Weaknesses, Opportunities and Threats) analyses and evaluate lessons learned, both large and small, from previous events, as well as learn from other states and regions that have experienced similar events.” HPN


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