Addressing Natural Disaster Takes Cooperation, Preparation to Ensure Patient Health

Making sure that patients can receive health care is of vital importance when natural disaster is on the horizon. With hurricane season fast approaching the states bordering the Gulf of Mexico and Atlantic Ocean, health care professionals need to prepare for treating patients who may not be able to access health care for an indeterminate amount of time. Collaboration and preparation among multiple teams is of paramount importance to addressing natural disasters when it comes to health care.

The period from June through December is usually regarded as hurricane season in the Atlantic Ocean and acts as the primary natural disaster that affects the east and southeastern coasts. Hurricanes can leave residents stranded without means of receiving their health care due to flooding, structural damage to their home, or downed trees and cable lines that make streets dangerous to drive on, assuming the patient has a means of transportation at all. According to an article from Texas A&M, it is estimated that only 35% of people in South Carolina who were recommended to evacuate for Hurricane Matthew in 2016 actually left their home.¹ This can leave a significant number of people in vulnerable situations once a hurricane actually hits, and can lead to a greater number of fatalities.

With so many people likely to be vulnerable, not only to the after effects of the hurricane itself but also when it comes to getting the health care and treatments that they need, with a 33% higher death rate following a hurricane due to contributing factors,² it is important that health care officials, government, and health care facilities work together to figure out ways to address the needs of as many people as possible.

Oncology Practices’ Preparations

After Hurricane Helene moved through the Southeastern US in late September, bringing devastating flooding, Chris Elder, PharmD, BCOP, associate director of pharmacy clinical services at Florida Cancer Specialists & Research Institute, told The American Journal of Managed Care^® (AJMC®) that hurricanes can be hard to prepare for because even if staff know that the storm is coming, fear of the storm is something that both patients and staff have to overcome. Creating proper plans and preparing for the storm is the best form of overcoming that fear.

"That [emergency prep] team is getting together and meeting well in advance of a storm actually coming and walking through strategies and making sure teams are in place," said Elder. "Everyone has their roles established and what they're accountable for, really to help minimize an impact. So that's really our goal: protecting our patients, protecting our staff, as well as our assets, our buildings, and our medications we have stored on site."

Darrin Owen, pharmacy operations solutions manager at Florida Cancer Specialists & Research Institute, said that emergency operations plans start to form even before the 96-hour mark, as hurricanes can sometimes make unexpected turns that leave different parts of the state affected compared with what was planned. Generator clinics and battery backups act as assurance to keeping the stock within the clinics safe and prevent them from perishing.

"We have plans in place for our clinics that do not have generators to transfer their drugs to these locations so we know these drugs are safe during the storm," Owen told AJMC. "We won't delay patient care once we're able to assess damage and contact patients and get them back into the clinics."

Owen emphasized that oncology clinics, such as the one he works in, work together with multiple departments within their organization to get patients to their closest clinic to receive their treatment. The ability to move drugs from one place to another is also a beneficial practice in these situations.

"This past hurricane [Helene], we had a list of drugs that FedEx and UPS had a no-ship zip list so we knew where drugs weren't going to be able to be delivered," he said. "So in an event like that, we can always plan to have it delivered to a different zip code so that way we can get someone to go to that location, pick up the medication, and bring it to wherever we can get the patient."

Elder stated that, with Hurricane Helene, about 70% of clinics were open on Thursday and all returned to fully operational by Monday due to the preparation put in before each hurricane. However, Elder emphasized that they want to make sure patients are not putting themselves in danger when attempting to get to a clinic to get their treatment, stating that patients are often more fearful of the storm than they are about missing treatments.

"We need to empathize with that, recognize that fear that patients may have, and communicate effectively and appropriately to let them know that it's more important that they stay safe and may, at the very worst case, miss a day or so of treatment vs being placed in a dangerous scenario," said Elder. "We want to protect the patients, keep them safe, keep them on schedule as much as we can...but knowing if we need to move them a few days out, that's not going to impact their care."

Strategies for the Underserved

Federally qualified health centers (FQHCs) and other clinics that provide care throughout the country are an important resource when it comes to helping patients in low-income areas. FQHCs and other clinics can give extended supplies of medications to their patients to ensure that their patients have enough to last through the natural disaster, even providing methods of keeping perishable medications cool in case of a power outage.²

Other methods of making sure patients can maintain contact with their providers included distributing smartphones and remote monitoring tools for patients in the area to ensure the patient is able to request help if they need it. The clinics can also help serve patients that are not their own in case of flooding and other emergencies.

Another aspect of care that the FQHCs specifically can address is the care of undocumented immigrants during these emergencies. Undocumented immigrants are less likely to go to clinics for care during emergencies due to a fear of deportation. FQHC staff can attempt travel to areas with the most need in order to encourage patients to get care and give care themselves in order to care for the patients as quickly and effectively as possible.²

Keeping Hospitals Safe

Hospitals also act as facilities that have to prepare for natural disaster. All hospitals require an emergency plan in case of disaster, approved by the hospital’s accrediting body.³ These plans are implemented before natural disasters such as hurricanes, with coordination occurring between local government, first responders, and patients. Decisions include deciding whether to evacuate the hospital or have staff remain the hospital throughout the storm. However, transferring patients can have health consequences so these decisions are not taken lightly and are done only in extreme emergencies.

Right before natural disasters, patients needing elective surgery will have to wait, as these surgeries are often shut down in favor of utilizing resources solely on disaster relief and taking care of patients already admitted to the hospital.³ This includes making sure that there are 2 teams of health care professionals available to treat patients and able to relieve each other of work.

Emergency plans for hurricanes include making sure that there is air conditioning for patient comfort, backup power for equipment keeping patients alive, and having enough food, water, and medicine in case of supply chain issues or difficulty in getting supplies to the hospital. This is vital when it comes to continuing to care for the patients within the care of the hospital.

"Knowing that [hurricanes] are eventually going to happen during hurricane season for us, it's always best to have a plan in place," said Owen. "We know, in most cases, health care providers and patients are most likely to be displaced after natural disaster, so it's in our best interest to be prepared for them and have a solution ready."

Looking Forward

An important factor when considering preparation in the future is the effect of climate change when it comes to both the extremity of the storms as well as the frequency of the storms. This can include the rising sea level or more frequent wildfires in some areas that can affect the way that residential patients live. Patients who are at a higher risk of being effected by extreme weather events were identified through a dashboard created in 2021.² This dashboard includes patients who have cancer, asthma, chronic obstructive pulmonary disease, dementia, and mental illness. The dashboard is able to indicate which regions are most at risk by assessing weather, climate, and air quality data in each region. This can allow for health centers and providers to narrow down who they need to target when it comes to preparation.

Hospitals, clinics, and health care workers prepare for hurricanes in advance to make sure all patients receive the care that they need | Image credit: Satoshi Kina - stock.adobe.com

Climate change is also likely to affect areas of low health equity, due to poorer air quality and lower funding in the area. Targeting these areas as regions to focus on during and outside of natural disasters should be a priority going forward, as reducing the disparities found in these areas could improve overall mortality and strain on health care resources during natural disasters.

Elder stated that making sure that all clinics in the state are prepared for the storm, regardless of whether they initially think the storm will affect them or not, is a way for them to keep vigilant and take all of the hurricanes seriously.

Owen addressed this by saying that, for them, the severity of the future hurricanes doesn't materially affect the way that they will prepare for hurricanes in the future. "We may have to pivot based off of different outliers with the storm...But I really feel that if we just continue moving forward with the plan that we have in place, in improving that plan, I think that's the most we can do," he said.

Elder said that there are aspects of emergency planning and disaster preparation that can help in day-to-day medical treatment, including effective communication, strategic planning, establishing accountability, and establishing clear roles and responsibilities.

"As we know, unfortunately we go through storm season every year and we just had Hurricane Helene. We're already on the lookout for the next storm coming. So any way that we can make improvements will be beneficial," said Elder. "So being able to take those processes and key strategies, we can apply those to the day to day operations to streamline care and be even more effective in delivering cancer care to our patients."

Improving on their plans, according to Owen, could involve doing more outreach in the days following a hurricane, specifically the idea of mobile units being dispatched that could help to administer medication. Pop-up areas around a community could be 1 such option. "If we could come across something like that in the future to help with this, I think it would definitely improve patient care...During times like this, FEMA goes out and they do their pop-up things for just regular assistance. I could see health care helping with something like that as well," he said.

Overall, a great deal of preparation is required to get the proper mechanizations in place to care for patients during a natural disaster. Preparing patients by giving them extra supplies of necessary medication, addressing patients who have stayed during a call for evacuation, and helping patients who live in particular areas of need are paramount in making sure that natural disasters do not worsen the health care of patients in affected areas.

References

1. Horney J. Why don’t more people evacuate before hurricanes? Texas A&M Today. October 19, 2016. Accessed September 25, 2024. https://today.tamu.edu/2016/10/19/why-dont-more-people-evacuate-before-hurricanes/
2. Hostetter M, Klein S. How health care organizations are preparing for climate shocks and protecting vulnerable patients. The Commonwealth Fund. October 20, 2022. Accessed September 25, 2024. https://www.commonwealthfund.org/publications/2022/oct/how-health-care-organizations-are-preparing-for-climate-shocks
3. Hess DB. How do hospitals prepare for hurricanes. CNN Health. September 2, 2019. Accessed September 25, 2024. https://www.cnn.com/2019/09/02/health/hurricane-hospital-prep-partner/index.html