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When a Disaster Hits: How Neurologists Can Prepare

Avitzur, Orly, MD

doi: 10.1097/01.NT.0000403267.46951.61
AERIAL VIEW OF ST. JOHN‘S Regional Medical Center in Joplin, MO, one day after the May 22 tornado.

AERIAL VIEW OF ST. JOHN‘S Regional Medical Center in Joplin, MO, one day after the May 22 tornado.

This past year has brought a record number of tornadoes and severe storms, unprecedented flooding, mudslides, landslides, wildfires, earthquakes, hazardous volcanic eruptions, and a devastating tsunami in Japan. At press time, the Federal Emergency Management Agency (FEMA) listed 47 major disasters in the United States alone this year, exceeding in less than six months the average of 34 per year. And if disaster declarations continue at this rate, they will set a record for the worst year since the list was first published in 1953.

Few of us in small and medium-sized practices have given consideration to such a catastrophic event — much less developed a disaster preparedness plan. But as neurologists who have experienced natural disasters first-hand can attest, there are measures that can make a difference when it comes to picking up the pieces in the wake of a catastrophe.

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Neurohospitalist Daniel L. Dagen, MD, was working his usual Thursday-to-Monday shift at St. John‘s Regional Medical Center in Joplin, MO, on May 22 when a “condition gray” — the warning of an impending tornado — was sounded through the hospital loudspeaker. All 18 neurology patients on the sixth floor were moved to the interior hallways, recalled Dr. Dagen, who first saw the exterior walls cave in, followed by the interior walls and ceilings. He felt the entire steel-reinforced concrete building oscillate for over three minutes, and when the winds stopped, debris was everywhere around him. His ward had sustained some of the worst of the damage.



Having survived a prior tornado that decimated his home and neighboring houses three years earlier, Dr. Dagen was aware that there would be no assistance for at least an hour. No one had predicted that the hospital, built to be hurricane-resistant, would be unable to withstand the storm, and so he improvised an evacuation plan. He had patients placed into wheelchairs; groups of four carried them down seven flights of dark stairwells to exit the hospital, and returned to get more. Everyone — patients, all the nurses, and he, himself — had sustained abrasions and contusions, and some people had suffered puncture injuries. His patients were the last to be evacuated as they were the sickest and least ambulatory on the upper level floors, but they all made it out. “It was a miracle that no one died,” he said.

Taylor C. Bear, MD, had taken refuge in his home‘s basement when the tornado hit Joplin. After it passed, he made his way to St. John‘s where he worked as the only full-time neurologist. Dr. Bear and others who arrived at the scene to help were not allowed inside due to fear of gas leaks. So they made their way to the local community center, Memorial Hall, and assisted in triage and basic first aid for the gathering number of walking wounded.

The next day, he returned to his office and found that only one week after it had been remodeled, the building next to the hospital was also badly damaged and had been declared a health hazard. His immediate concern was his baclofen pump patients. “I knew that many pharmacies were damaged and that my patients would soon be in withdrawal, so I went in, grabbed the flash drive where I store my data, all the baclofen I could take, and my programming equipment,” he said. The information enabled him to check which patients were due for refills and to make house calls before telephone lines were re-established.

Dr. Bear, who has been working in a temporary clinic since the disaster and seeing neurologic patients in a field hospital, now calls their new electronic health record (EHR) a blessing. Although many physicians grumbled when it went live only three weeks earlier, it became a lifesaver in the aftermath of the disaster. Nearby hospitals that had assumed the care of evacuated patients were able to access their records from the remote server, and physicians, like Dr. Bear, were able to see the records of patients who had been hospitalized. In contrast, they were still weeks short of making the switch to EHR in his outpatient practice. Consequently, those physicians have yet to lay hands on those paper records, which now have to undergo a laborious decontamination and scanning process.

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Dr. Dagen recommends that doctors think about the most likely event to impact their area and prepare for it in advance. He had made a storm shelter only six months before he survived the May 10, 2008 tornado that caused the deaths of four neighbors and left two severely injured. “If you live near a nuclear power plant, an airport or railroad track, or near an earthquake fault line, develop an emergency plan,” he advised.

Neurologist Maximo C. Kiok, MD, who works at Trinity Medical Group in Minot, ND, attributes the organized response to the recent flooding that affected more than 4,000 homes in his city to thoughtful planning and the benefit of advance warnings. “The hospital itself was not damaged, but its nursing home and psychiatric hospital were evacuated ahead of the flood, and [at press time] they are currently partially flooded,” he said.

Because it was anticipated that the dam would not hold up against the rains and snowmelt, patients had been transferred out about a week earlier. At the suggestion of house staff, who anticipated that the roads would close to the North Hill part of the city, the hospital had established a satellite ER across the river there, along with a helicopter service, available 24/7, to transport patients to the main hospital if needed. Indeed, when the floods came, road transportation became critically impaired, but the doctors and nurses who lived near the North Hill medical unit, were able to get to work.

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Most local hospitals have a written disaster plan and even engage in regular drills. Get a copy and become familiar with the plan, and meet with your staff or other physicians in your building to discuss how you can best be prepared.

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After interviewing neurologists whose lives were turned upside down by Hurricane Katrina for Neurology Today, I made triplicate copies of all my critical office documents — everything from birth certificates, medical licenses, insurance cards, and diplomas, and financial data — and stored them in other locations. You can also scan them into an electronic file and keep on a server or USB drive. Many New Orleans neurologists lost diplomas and licenses and had difficulty tracking down essential insurance information. It delayed them from getting the help they needed to rebuild their practices or relocate elsewhere. Indeed, after I heard from the New Orleans neurologists how difficult it was to practice in the states where they had to relocate, I decided to get a medical license in another state nearby.

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Read your business owner‘s policy to review your coverage for fire, theft, flooding or other disasters. Equipment, computers and chart damage can be costly to replace. Although it‘s understandable to want to skimp on insurance during these tough economic times, it‘s best to avoid the temptation to make this cut. “Many of my colleagues, whose homes were destroyed in the floods, were uninsured,” said Bahram A. Kordlar, MD, another Minot neurologist at Trinity. Following the last major flood in 1969, residents had felt reassured that sufficient steps had been taken to prevent flooding and most had chosen to forgo flood insurance.

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Drs. Dagen and Bear agreed that neurologists are ill-equipped to serve as first responders at a disaster site. Dr. Dagen had been an emergency medicine physician prior to going into neurology, and that training served him well, but Dr. Bear admits that he felt out of his element at the emergency center created to care for the wounded. They recommend that physicians take a class in emergency preparedness to help prepare them for the first-responder triage that will be needed, for example, wound-dressing, setting bones, and even clearing airways.

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Although St. John‘s emergency preparedness plan was able to protect the vast majority of patients and hospital workers, it did not anticipate the loss of power. The twister‘s 200 mile per hour winds had sucked out the medical center‘s backup generator, leaving the hospital in the dark, and causing five patients on respirators to lose their lives. The hospital had also been prepared with a disaster trailer, which was to have served as a communications center in the event of the disaster, and which carried a store of basic supplies, but it too was leveled by the tornado.

Minot took early steps to prevent the contamination of drinking water by building reinforced levees around the water supply facility, but an unexpected breach occurred briefly during the height of the flood that nevertheless affected the entire area, including the hospital. “We‘re drinking bottled water, and have been told to use hand sanitizer between patients,” Dr. Kiok reported, adding at the time of the interview that residents had been issued a boil-water order until a clean water supply could be restored.

Dr. Avitzur, a neurologist in private practice in Tarrytown, NY, holds academic appointments at Yale University School of Medicine and New York Medical College. She is an associate editor of Neurology Today, as well as the editor-in-chief of the AAN Web site, , and chair of the AAN Practice Management and Technology Subcommittee.

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The American Red Cross recommends that you keep basic supplies in an easy-to-carry emergency-preparedness kit that can be used at home or taken with you in case an evacuation is needed. This includes one gallon of water per person per day for at least three days, for drinking and sanitation; at least a three-day supply of non-perishable food and a can opener; a battery-powered or hand crank radio and a NOAA weather radio with tone alert and extra batteries for both; a flashlight and extra batteries; a first aid kit; a whistle to signal for help; a dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place; moist towelettes, garbage bags and plastic ties for personal sanitation; wrench or pliers to turn off utilities; local maps; and a cell phone with chargers, inverter or solar charger.

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©2011 American Academy of Neurology