We all do our best to be prepared in an emergency; however, there are always things we don’t expect that may come up. We often take medical care for granted when disaster hits. The hospitals and physicians are usually there when we need them, but what happens when the hospital has been destroyed by a natural or manmade disaster? Remember Joplin, Missouri, in 2011 when an F5 tornado destroyed the hospital there? How about Hurricane Maria in 2017 that rendered 65 of 67 hospitals in Puerto Rico non-operational in the first few days after the disaster? There were 3.5-million people seeking help with only two functioning hospitals on the island. One month after the hurricane, less than half of those 67 facilities were operational. Are you prepared for that scenario? Do you have a plan?
I asked three experts in their respective fields what advice they’d give in a situation where disaster has destroyed medical facilities. Mark Linderman is a crisis risk manager for the CDC and takes a community approach to preparation. Kerry Davis is a former medic and nurse, and is the CEO of Dark Angel Medical. He focuses on teaching individuals skill sets and developing a plan to survive. J.R. Grounds is the leader of the Civilian Crisis Response Team and agrees with both Mark and Kerry in that individual skill sets are important; however, being flexible and working together are just as important.
Why is it important to be medically prepared for a disaster?
ML: There is a misconception that if something happens, the federal government will come in and save everybody. Depending on how widespread that disaster is, the government may not be able to help. A disaster happens locally first. The feds may be too busy helping elsewhere, and it may be some time before they can get to a smaller community. Communities need to understand what resources they have, how they’re allocated, and how to respond if something happens. We need to care for ourselves first before the feds come in.
JRG: One of the problems is that before the outside help comes in, you can imagine that the staff at the hospital is being affected by the disaster. Maybe they can’t even make it to the hospital. The local service providers are also compromised by the disaster. They may have emergencies at home as well. A hospital may be stocked with backup medical supplies and generators in preparation for a major catastrophe; however, the staff is a major resource that may not be able to get to the hospital.
KD: No one is coming to save you, so it’s up to you.
When disaster strikes, what is the mindset for those going through the initial stages of the disaster recovery?
ML: Obviously, there is fear. Denial is also a huge factor in a disaster. A lot of people have to overcome that denial. Bitterness could play a huge role.
JRG: It’s mass panic. Complete chaos.
KD: You have to remember the basic tenets of survival: fire, water, food, and shelter. Most importantly, have a plan. If you don’t have a plan, then you are already behind the eight ball. Having a plan is being in the proper mindset. If you have a plan and know how to implement the plan, that will eliminate a lot of confusion.
What can people do prior to the disaster to help improve their situation during a disaster?
ML: It’s contingent upon the type of disaster. The biggest thing is that people should be sure they are up to date on the Tdap (tetanus vaccine). People should have a basic knowledge of first aid to help themselves or others. If the hospital is decimated, there should be protocols in place to address the situation with other agencies.
JRG: People have got to take more responsibility to deal with their current medical issues. Make sure they have medications, supplies, etc. They also need to be able to provide the short-term lower-level emergency care for themselves (e.g. bandages, antiseptics, splints).
KD: I think people are trying to become more self-reliant. I think if they know some basic medical stuff that will go a long way. Basic wound care is a big deal. Immunizations are important. Make sure your tetanus is up to date. Dental health is important (see RECOIL OFFGRID Issue 27). Get an emergency dental kit. Have a reference library of books. Look at home remedies, because a lot of it works. Bioenvironmental stuff … how to make clean water. How to use bleach. How to boil water. Basic field hygiene. In a prolonged disaster where people are dying, how are they going to dispose of the bodies? We may see the diseases of the dark ages — how are you going to prepare for that?
What medical supplies do you keep handy?
KD: We have analgesics, basic antibiotics (Azithromycin, Ciprofloxacin, and Metronidazole). If you have these medications, make sure they aren’t beyond their expiration dates. Lots of bandages, basic wound care, and dental care items (toothpaste, dental floss). Trash bags, toilet paper, feminine products, condoms, hydrogen peroxide, rubbing alcohol, basic suturing kits, skin staplers. If you know how to suture or staple, that’s important too. Acetaminophen, Ibuprofen, and having pediatric doses of those medications are also helpful.
How often are you going through your med kit to know it’s up to date?
KD: We do a quarterly inventory to make sure things aren’t out of date. If something expires in that quarter, I will pull that and purchase an update for the inventory.
How many days of supplies should people have on hand?
ML: FEMA really tries to educate people that a three-day supply is adequate, but a disaster on a larger magnitude may require a much longer supply. Three days is a good start, but a more realistic view is that two to three weeks of supplies is needed.
If a disaster strikes and medical services are not immediately available, would there be any medical resources or facilities that would make sense as alternatives?
JRG: In Houston during Hurricane Harvey, the local hospital moved all of their critical patients to other facilities. We set up a tent with the National Guard infantry units and they didn’t have necessary medical and decon staff. In a large-scale disaster like Harvey, there was a large geographic area to have the National Guard cover. Those units were being triaged themselves to areas where they could do the most good. The problem then was that the smaller areas were left to fend for themselves. The small hospital was getting ready to go under water and their supplies were going to be compromised. They backed up a truck and loaded it with all kinds of medical supplies to take to the tent. We loaded stuff that we thought was important — bandages, insulin, diabetic supplies, nebulizers. We had a lot of resources, but the resources get triaged just like patients. If the resource is 10 miles away, but there is no way to get to it because of the flooding, it might as well be on the other end of the globe. The makeshift hospital that may be in a parking lot somewhere has to draw a line about who they might see because of the massive influx of patients. So when the secondary providers start getting that overflow of patients it can be very overwhelming.
ML: Emergency departments can be quickly over-whelmed during a disaster. There is a certain capacity that an emergency department can handle. If a hospital has been decimated, there are other resources available. Whether that is the Red Cross, churches, or universities, there are opportunities for assistance. Some universities can have nursing programs that can be valuable in a disaster situation. We have PODs (Places of Disbursement): open POD where people come to a location where, say, the health department has set up to care for people. There are closed PODs where universities that have nursing programs can help. These relationships are pre-established prior to the disaster. The urgent care center is also an option. Senior housing developments are a potential option, because they have nurses and medications that may be useful. Medical reserve corps (MRCs) should also be established before the disaster. These consist of volunteers from the medical community who are important to establish.
Many people will want to help when a disaster strikes. Where should they go to be most helpful?
ML: You want to check with the local emergency management agency. You can also check with Red Cross, local churches, and walk-in clinics. Hospital and public health agencies get some degree of assistance and are required to have volunteer programs.
JRG: There will be some sort of incident command post that you can look for. If you see a tent in a parking lot, somebody in there will be in charge. Let them know what experience you have and what your credentials are, so that they can figure out how you can best be used. The other thing I would say is don’t get your feelings hurt if that person doesn’t immediately pay attention to you or put you right to work. They have to figure out how to incorporate you into the plan in a safe manner.
What about the surge of volunteers that shows up to help?
ML: Agencies have the best intentions, but their intentions convolute the process of response recovery. When we go down trying to help and it’s not a part of the coordinated effort, there are now more people to feed, more places for people to stay. This diverts the efforts from people who actually need the help to people who are there to help. Now healthcare has to help people affected from the disaster, but also the people who are there to help.
JRG: There are so many volunteers who just show up, and there isn’t really a way to know what their experiences are or what equipment they have. So it becomes a situation where the volunteers can actually overwhelm the system. The person who’s in charge on scene has to be responsible for the people affected by the disaster as well as the volunteers aiding in the disaster. The last thing they want is to need to take care of the volunteer as well. It’s not that help isn’t needed, but the chaos has to be managed. Also, find an organization that has experience in dealing with disaster services. Volunteer with them and get some experience.
Any final thoughts?
ML: The nature of a disaster is that it catches us off-guard so we have to be ready as a community. The community is the glue that holds us together and we have to remember that we are a national community as much as we are a local community.
JRG: You have to be able to take care of yourself. If you have a medical condition, you need to understand how your body will respond in that setting. You have to stay in the game to help as many people as you can.
KD: The biggest thing is having a plan, but be flexible. Don’t be so rigid you can’t think outside the box. There are a lot of gray areas. Plan ahead. Practice carrying your gear so you know if it’s feasible to carry around. At least you are ahead of the guy who didn’t plan. It’s better to be proactive than reactive.
When a natural or manmade disaster strikes, it may be a prolonged period of time before help arrives. Be prepared to fend for yourself. That means taking classes, developing skill sets, and formulating a plan for surviving the disaster aftermath. Make sure that you know what you are capable of doing in various conditions and train with your gear. Understand the emotional components after the disaster strikes and how you personally manage those within yourself and others.
Maintain flexibility in your thinking as someone trying to survive the disaster as well as a responder trying to help others. As Kerry Davis said, “No one is coming to save you,” and it’s our responsibility to prepare and plan before disaster strikes.
David L. Miller, DO, FACOI is an internist in private practice for 20 years. His experiences away from the office have included time as a fight doctor in regional MMA events and as a team physician for 10 years at a mid-major university in the Midwest. Currently, he serves as the lead medical instructor for the Civilian Crisis Response team based out of Indianapolis.