I don’t want to alarm anyone out there, but I think that someone has ticked off Mother Nature. The evidence is pretty clear.
I’d like to use the cliché “unless you’ve been living under a rock” to talk about how much media attention the unprecedented natural disasters have been getting lately, but I won’t—because choosing to live under a rock seems fairly prudent these days. This has been an active season with severe costs in terms of damage, injuries and loss-of-life. This season will have lasting repercussions on our country, our economy and our citizens for decades to come. And it’s not over yet. June 1 marked the start of the 2011 Atlantic hurricane season.
Some of my current career endeavors allow me to join in the response to disaster relief operations across the country, usually for an extended period of time. In this capacity, I’ve had the opportunity to directly work with people who have been affected by some of the worst disasters, and I consider myself lucky to respond and assist. Through this, I’ve seen the strength and resilience of some amazing people and their wider communities. I’ve also gotten to observe the response efforts firsthand and learn from what I’ve seen.
I had a conversation the other day with a lady who had been greatly affected by a tornado that came close to her house and devastated her neighborhood. She told me about how she used her personal stockpile of food, water and clothing to support not only her family and extended family, but also her friends and neighbors during the days following the storm. She told me how she had had followed the advice of the disaster preparedness information before the disaster because she lived in rural tornado country. Her family and friends who had teased her about her obsession with being prepared weren’t laughing anymore.
Honestly, that’s the first story I’ve ever heard from someone who truly prepared to be self-sufficient after a disaster. I was impressed. This got me thinking. Numerous resources exist with information about how individuals and families can prepare for a disaster situation. There’s information for small-business disaster preparedness as well. However, I’ve found some information to be lacking.
How should your ambulance service prepare for a disaster?
I’m not talking about mass casualty incident (MCI) response, because there’s plenty of literature available on that topic, and I’m hardly an expert. I’m talking about continuity of operations procedures (COOP) planning and disaster preparedness for EMS and other public safety agencies. We need to come up with our own plans to meet our needs following disasters.
So much effort is put into response plans and other emergency management activities, but little time has been devoted to the topic of how we can take care of our EMS extended families in time of disaster. We need to start this … now. We must think outside the box because disasters can and will strike without warning. EMS agencies must meet the challenges and continue to meet their community’s needs. It’s our responsibility, and it lies with the individual agency.
Lessons from Katrina
I was fortunate enough to respond to Mississippi for the recovery effort following hurricane Katrina in 2005. I spent 7 months on the ground taking care of people. I had the chance to work one-on-one with hundreds—if not thousands—of people in a humanitarian capacity. I talked with them about their experiences and remember a great many of them clearly. Their experiences were profound. They were haunting, stark, raw and incredible. The hurricane took everything and spared little. It even obliterated pharmacies, which were needed for medication refills and over-the-counter meds.
Such large-scale disasters take their toll on more things than we think about. Sure, you may be able to charge your heart monitor from the inverter in your ambulance, but will you want to use the diesel to make sure you can defibrillate when needed? How will you get the diesel fuel for the ambulances if your gas pumps are destroyed? How will you upload run reports from your computer system, keep flashlights charged or keep oxygen in your tanks? How will you feed your crews, who will undoubtedly be running themselves ragged in the field? Will they have enough water, insect repellent, sun-screen and spare uniforms for extended deployment? Who will be taking care of their families while they’re out taking care of the community?
Ambulance services need to plan for their needs beyond the business of responding to the MCIs caused by disasters. For example, call volumes following the incident invariably skyrocket as people injure themselves living amongst and cleaning up the wreckage.
I’ve come up with some things I think ambulance services should focus on when creating a disaster plan.
Our people are truly our most valuable resource. In a disaster, EMS is a community’s best resource. Your staff will be stressed—as they cover the increased demand under horrible circumstances. They’ll need extra support. All your staff will want to help, and you may not have ambulances for them to staff. You’ll need to develop a rotational plan to allow staff members to get adequate rest, take care of their families and their property, and have time to decompress. Your personnel are going to be torn between caring for their families and working when their community needs them most. Ambulance services must prepare for this and help meet those needs by doing the following:
- Store food, water and extra uniforms at the station in a hardened area for use after a disaster;
- Anticipate sheltering needs for employees and their families who might be left homeless after a storm.
- Assign non-operational staff members to check on employees’ families. An EMT who doesn’t know that their own loved ones are safe will not be an effective responder.
- Ensure staff members are provided with bug repellent, sunscreen and other necessities for working extended periods in the weather conditions;
- Think of unconventional assignments if you have a surplus of employees without ambulances. You may want to assign EMS personnel to other teams, mass-shelters or search-and-rescue operations. Your local hospitals may need support as well. Limit shift length by policy. EMS providers tend to work too many hours at the onset of a disaster and burn themselves out. Ensure everyone gets some rest.
- Track every employee hour and expense for possible assistance and/or reimbursement after the disaster; and
- Make it your policy that staff members respond to the station or designated area after the danger has passed. Don’t let your employees drive to the station during storm conditions. Have them remain in a sheltered place until danger has passed.
Our ambulances and vehicles run hard every day under normal circumstances, but the additional stress of a disaster can cause them to fail. Increased call volume will take its toll, as will the damaged roads and debris. If fuel is scare, you may want to ration it. You’ll need to develop a disaster fleet operational plan considering these needs:
- Tires: When driving over debris and damaged roads, tires take a beating. They’ll need to be repaired and replaced. During a disaster, always have a maintenance person on-duty who can attend to tire-related issues and have some extra tires on-hand.
- Fuel: You’ll need to manage fuel consumption because fuel may become scarce, or your fueling point may be destroyed. It’s good practice to determine more than one hardened fueling point and ensure access for your vehicles and power generation equipment.
- Develop a plan for when severe weather or a disaster is anticipated. Make it policy that all units obtain full tanks of fuel just prior to an anticipated incident. Keep reserve trucks with full tanks at all times.
- Have an additional method of payment for fuel available in your trucks, such as a fleet credit card, that can be used anywhere.
- Keep idling to a minimum to conserve fuel.
- Fuel your trucks before they return if your trucks must transfer patients to an outside area.
- Stage units at different areas and ensure those areas have shelter for your personnel when severe weather is anticipated. That way, if a unit is destroyed, not every unit will be. Ensure you have a hardened shelter for personnel to ride out the storm; don’t leave them sitting in the ambulance.
- Miscellaneous: Place water, bug-spray, sun-screen, rain-gear and additional flashlights in each unit.
The disaster may damage your facilities and stations. It may disrupt your operations and destroy your administrative or dispatch centers. Harden these areas and ensure that personnel at the stations have shelter available from storms, such as tornadoes. If your station is a steel building with no basement, plan on having a storm shelter available. Harden your informational technology systems and servers for your patient care reporting (PCR) system and have a backup PCR system in place for disaster needs.
Purchase and install a good backup generator and have extra fuel on hand for it. Store enough food and water to support your normal staffing needs, plus at least 50% for three days. MREs make great food storage. You may also need to set up new facilities to continue operations after your station has been destroyed. Also consider the following:
- Electricity: Purchase a backup generator and have it installed to local code. Ensure it can power your operations, as well as charge medical equipment that runs on battery power.
- Shelter: It cannot be stressed enough that your personnel will need a safe place to take refuge from the storm. A lot of stations aren’t storm-resistant, so have a shelter planned for providers.
- Doors: Ensure your overhead doors have a backup system so they can be opened following a storm and interruption of power.
The means of communications we depend on could be destroyed. Radio towers may be taken down, cell-phone towers may topple and radios won’t work without power. You may not be able to page out for assistance. Plan on redundant, hardened means of communications and make procedures for crews to follow post-incident to ensure critical information flows freely.
Also, make a communications “go bag,” which includes spare radios, a list of all critical dispatch information and phone numbers, and contact methods for personnel and their families. Take it to a safe location or the location of a temporary communications center. Have a method of communicating information to on-duty and off-duty employees. Request resources early and pre-plan methods of restoring communications as early as possible following an incident. Make use of social media to communicate needed information to the public in a rapid fashion.
Medical supplies may be in short supply, and your trucks may not have the ability to restock. This may require your service to anticipate needs by keeping more than minimal levels of equipment on the trucks. Anticipate where you can add these extra supplies and where your needs may be. You may consider hardening your store of medical supplies or keeping them in more than one location. You cannot rely on mutual aid if more than just your community has been hit. Add the following to your plan to be self sufficient:
- Oxygen: Will you have enough oxygen on hand to meet your needs? Will you have an adequate oxygen supply available if your supplier or stores have been destroyed?;
- Backboards: They may become scarce. Their use may need to become triaged and dependent on selective spinal immobilization criteria. You may want to ask transport units from other areas taking patients to other hospitals to leave some of their backboards with your service or your local hospital. You can return them later.; and
- Replacements: Contact your equipment suppliers soon after an incident and ask if they can send an emergency shipment to replace your stores and support increased demands following the incident. Reach out to neighboring or out-of-area services to see if they can spare equipment or assistance. They’ll want to help; you just need to ask.
Disasters always bring forth unanticipated challenges. You may find your agency becoming the focal point for your community and providing assistance with all sorts of unanticipated needs. You may support sheltering operations, coordinate volunteers or warehouses and distribute supplies. Track every expense, and ensure information flows freely and is documented. Disaster preparedness takes a lot of free thinking and adapting to unanticipated needs. With a few plans in place beyond your MCI response, your agency can care for its community and its personnel. Plan now. Think outside the box and do the work before you have to.
And could someone buy Mother Nature a box of chocolates or something? Sheesh.