Some of life’s best lessons are learned at the worst times. This is especially true for planners during times of disaster. Planning assumptions bear out to be too optimistic. Inventory consumed quicker than expected; supply chain proves remarkably undependable. Reliance on the good of human nature is replaced by shock and dismay. How we apply these lessons learned (or earned) strongly influences our response to future events. This simple axiom proved accurate after the May 22, 2011, EF5 multiple-vortex tornado that struck Joplin, Missouri, killing 162 people, devastating a hospital, 8,000 homes, 400 businesses, and 8 school buildings resulting in over $2.2 billion in damages.

Shortly after the devastating tornado, leaders from local hospitals gathered to share insights into their experience and assemble a list of lessons learned to be applied to future events. Their list was extensive and included many issues commonly reported after other types of disasters: complications resulting from loss of power; need for increased security; not enough flashlights; communication breakdowns and lack of interoperability; and challenges feeding and caring for patients and staff. The list also included a number of other valuable insights not often considered in emergency management planning:

• During a tornado alert, place a patient’s shoes on their bed so they are available in the event of an evacuation (to walk over glass and other debris).
• Create downtime kits with paper forms and pens/pencils for IT/IS and electrical outages.
• Have security available to ensure that when persons arrive to reclaim their automobiles on hospital grounds, that they are the true owner of the vehicle (several people tried to leave with cars, via tow trucks, that they didn’t own). Lockdown the facility until those procedures are established.
• ID badges need to be backed up with wallet identification cards for employees (who may have lost theirs as a result of the disaster).
• When you evacuate patients into the hallway during a tornado, convert all possible intravenous lines to a lock to avoid the use of IV poles; they become dangerous projectiles.
• During evacuation, place newborns in the arms of the fathers and focus evacuation efforts on the mothers.
• Beware of looting.  Physicians and staff experienced looting of their homes while they were at the hospital caring for others. Private physician offices were robbed of property and drugs during the recovery phase.
• Hospitals need the ability to install at least a six foot tall steel chain link fence around the perimeter of the facility as quickly as possible after the incident.
• Get portable toilets (and toilet/sanitary bags) to the site as soon as possible. Portable showers will also prove helpful.
• Always assume your facility is structurally unsound until proven otherwise by structural engineers.
• 96 hours of self-sustainability is a myth. The 96-hour cache of supplies was consumed in less than 4 hours.
• Store emergency supplies where you plan to use them. Make sure they are easily transportable; pallet jacks will not work in debris fields and stairwells.
• Establish “Scrub Racks” with many sizes to keep staff in suitable clothing.
• Lighting needs to be hands free to provide suitable clinical care.

These issues and others need to be addressed in emergency management planning. Drills that focus on processes and procedures for times of power failure, loss of utilities, and communication disruptions will reveal areas of improvement that need to be undertaken. Focused drills with clearly defined objectives will increase productivity and response capability. 

Contact DQE at info@dqeready.com to help develop and implement a drill or exercise or purchase needed disaster supplies at your facility.