The effects of Hurricane Florence are beginning to be felt. Credit: Chip Somodevilla/Getty Images
Hurricane season is kicking into high gear. State and local governments in some areas are recommending that citizens evacuate certain areas. People are packing up. And hospitals are scrambling to prepare for both the storm itself and the influx of patients coming in the door.
The hard truth is that many hospitals are not as ready as they could be for a coming storm -- or other type of natural disaster for that matter -- but there are steps that leading institutions have taken, lessons learned, and resources that hospitals should know about whether they're in a storm's range or not.
Here's a look at available resources and hard-wrought frontline lessons from hospitals that survived natural disasters.
What to expect from Health and Human Services
HHS Secretary Alex Azar has declared public health emergencies in both North and South Carolina as Hurricane Florence barrels toward the eastern seaboard. The declarations give CMS beneficiaries and their healthcare providers and suppliers more flexibility in meeting emergency healthcare needs.
"These actions help ensure that Americans who rely on Medicare and Medicaid have continuous access to the care they need when the storm makes landfall," Secretary Azar said.
HHS has already positioned approximately 230 medical personnel from the National Disaster Medical System and medical equipment in North Carolina and Maryland for immediate availability to help state and local authorities respond to community medical needs. HHS staff from the Office of the Assistant Secretary for Preparedness and Response have activated a national contract making additional ambulances available to evacuate hospitals and nursing homes if needed and ASPR regional emergency coordinators are staffing operations centers to keep updated on potential public health and medical needs post-storm.
ASPR and CMS have also coordinated to provide information to North Carolina and South Carolina health officials on the number of Medicare beneficiaries relying on dialysis or other special medical equipment at home like oxygen concentrators in the potentially impacted areas.
"With this information, health and emergency management agencies can respond better, particularly after power outages, to save lives," HHS said.
Hurricane season: how prepared are hospitals?
Hurricane Florence is a force to be reckoned with, predicted to permanently mar the coastline. No doubt regional hospitals and providers are scrambling to prepare and a new survey reveals some of the things they should be working to put in place, or should already have implemented to minimize the impact to care and outcomes for patients.
According to DrFirst, an e-prescribing and medication management solution company, secure messaging and patient communications is a priority for most providers. Widespread dependence on non-HIPAA compliant disaster communications methods that fail to meet legal requirements for secure communications between medical teams, pharmacies, and patients is a problem. HIPAA dictates that a patient's private health information can only be shared with the patient or other providers via secure methods such as password-protected portals and secure messaging.
While the survey showed that the telephone is the most-used mode of communication for reaching out to various groups, followed by secure messaging and, in some cases, email, CMS stipulates that the use of phones for texting of patient health information is allowed only through a secure encrypted messaging platform. Encryption is also required when emailing patient health information.
Only 44 percent of respondents said HIPAA-compliant medical messaging is a key requirement of a disaster preparedness plan. Hospital-based respondents said the only thing more important than secure messaging was the installation of backup generators in case of power outages and the ordering and maintaining of extra inventory of supplies and medications.
What to prioritize now: telehealth, security
If you're not already prioritizing generators, security and supplies, then you should be. Telehealth could also prove useful in treating stranded patients, with 45 percent of respondents citing it as a valuable option, but connectivity and technical glitches thanks to impacted utilities could prove challenging.
Still, telehealth services are something to consider as a tool to reach patients to continue care on some level and there are providers who've made their services available free in disasters past.
For instance, Doctor On Demand and EpicMD offered Hurricane Harvey victims free telehealth consultations with board-certified physicians, psychiatrists and licensed psychologists 24/7 using smartphones or computers. Harvey victims were able to reach EpicMD clinicians for free telehealth services by phone, video, e-mail or text message.
LiveHealth Online was another telehealth vendor who jumped in to help victims of Hurricanes Irma and Harvey, offering consumers telehealth consultations with physicians and psychologists for non-emergency health conditions. It's very possible these vendors, or others, could be offering these services for those who face Florence and providers should be reaching out to them now.
Overall, while 72 percent of acute care respondents to the DrFirst study reported having a comprehensive disaster recovery plan in place "covering diverse scenarios and focusing both internally and externally," only 29 percent of specialty providers said the same, the survey said.
MD Anderson and Sutter Health survived natural disasters
One of the most successful hurricane-specific disaster responses was seen at MD Anderson during Hurricane Harvey. In their case, an ounce of prevention ended up being worth a ton of cure. True, they'd had heavy duty flood gates installed years prior after being badly battered by another hurricane, but they also took the lessons of that disaster and ran with them.
Emergency leaders built a comprehensive disaster response plan and team that did drills regularly, held roundtable discussions to refine operations and training, had an on-call team always ready and was in constant communication, and not just when they were awaiting disaster. It was a part of their regular routine and operation, and made all the difference.
If you haven't already engaged additional hospital security, it's important to call them in. Adequate security staffing was an issue during Harvey for many reasons, according to a recent Texas Hospital Association report. Some hospitals didn't have enough security, and those that did sequestered them. Then later, housing and feeding them along with patients proved challenging. Hospitals reported increased costs due to this issue.
"Hospitals reported eruptions of domestic violence amongst some of the individuals who had sought shelter. In addition, as more people relied on the hospital for shelter, and resources were stretched thin, stress and anxiety levels rose, creating tensions and the need for security personnel to maintain an orderly and calm environment," the report said.
When Sutter Health faced an unprecedented threat from a then-historic wildfire that laid siege to its northern California facilities, they seized on the flexibility, fluidity of staff and additional resources available to them because they were part of a large system. Staff were able to migrate to other hospitals and patients were evacuated, more supplies were available and shareable, and leaders were able to just do what needed to be done. If you are part of larger health system, be ready to harness that strength.
Other natural disaster problems to plan for
Displaced residents broke into a Beaumont hospital that had closed seeking shelter, and some hospitals reported break-ins by people looking for drugs. For hospitals that staff off-duty police officers as security, some officers were called to duty in neighborhoods. One hospital that happened to be treating ten prison inmates at the time got help from their accompanying prison guards, who stepped in to help with general security when they were off duty.
Supplies became scarce, not just because hospitals were flooded and inaccessible, but also because the facilities where the supplies were sitting were also inaccessible. So reach out while you can to establish contingency plans for getting them where they are needed.
Expect revenue and cash flow interruptions due to stalled billing and claims filing, business office closures and reduced hours, insurance and patient payment delays, decreased patient volume and canceled services.
Also, be prepared to deal with the emotional and mental toll these disasters can take on staff. Secure the help of chaplains and social workers to help staff cope with mounting stress, anxiety, burnout and separation from family, the report said.
Finally, maximize the capabilities of the larger system you belong to, if in fact you are part of one.