Shelters From The Storm

Shelters From The Storm
How ASCs Can Best Prepare for Hurricanes and Other Natural Disasters

By Kris Ellis

The unprecedented destruction wrought by this year’s hurricane season on parts of the Gulf Coast will not soon be forgotten. The plight of those who lost homes, businesses, and family members underscores the need for detailed and realistic disaster planning, particularly in areas prone to destructive natural disasters. This is especially relevant for ambulatory surgery centers (ASCs), which must make every effort to be prepared for the worst.

Michael T. Gossman, administrator of Biloxi, Miss.-based Cedar Lake Surgery Center, and his staff witnessed first hand the destructive power of Katrina. Although Cedar Lake Surgery Center sustained only minor wind damage, the power was out for six days, and the phones were down for several days as well. Fortunately, the center was able to re-open on Sept. 10, for pain management and GI procedures, with full functionality returning a few days later.

“Of course, there was nothing we could do without power,” Gossman says. Although the center had policies and procedures in place to deal with such a disaster, circumstances prevented some of them from being carried out. “We utilize a call tree, but of course there were no phones for 10 days, including cell phones. Our fire alarm also went down because it required a phone line for monitoring purposes. Our diesel generator ran out of fuel and had a vapor lock. The automatic doors weren’t working and needed parts. One of the limiting factors was finding craftsmen to repair things; they were all dealing with their own problems.”

Given the severity of the hurricane, Gossman believes the situation was handled adequately. “I think we planned appropriately,” he says. “For a storm of this size which this country has never experienced, I believe we did fairly well. We are rotating staff to give everyone hours as we ramp back up.”

Cedar Lake Surgery Center, which opened on Jan. 1, 2001, was designed by CDH Architects of Atlanta. Gossman notes that Chuck Holmes, a principal with the company, called to check on the building shortly after the storm. “He designed it to withstand hurricane winds and it held up beautifully.”

Further testament to the center’s durability came from an eyewitness account. “One of our physicians stayed at the center during the hurricane,” states Gossman. “He said it was ‘like a bunker’ and that he wouldn’t have known the storm was there unless he looked out of the window.”

Gossman and some of his staff were not so lucky in terms of their personal property, however. “About a third of our employees lost their homes and all of their possessions, including myself,” Gossman says. “Another third had several feet of water in their homes. Some of these wish they had lost everything because of the mess they are left to deal with. Another third came out fine.”

Being ready for whatever nature might throw at your ASC is essential. According to Gayle Evans, RN, MBA, CNOR, CASC, president of Continuum Healthcare Consultants and Quality Surgery Centers, all ASC staff members should be involved in preparation for an event.

“Determining what to do with the computer backup, cancellation and rescheduling of patients, emergency shutoff of oxygen, narcotic security, and equipment storage related to removing from power, are some of the activities that the ASC staff must be concerned with,” she says. “Plans for reopening should also be considered. Who will be the first to report back to assess the damage and determine when operations resume and a chain developed to call employees back?”

“Most of the time, because we’re freestanding surgery centers, we do elective cases only. Our first priority is canceling the cases, rescheduling, and notifying our patients that we’re going to be closing in the event of a hurricane warning,” says Michael Pankey, RN, MBA, administrator of the ASC of Spartanburg in South Carolina.

Pankey, a veteran of hurricane planning and occurrences from his time in Florida, recommends using a computer-based weather notification service such as WeatherBug® to keep abreast of any serious developments in the weather. “That way advisories will pop up on your computer days in advance to post the projected hurricane path on the board — make sure your staff is aware of what’s going on at all times and what’s going to be expected of them,” he advises.

“During watches we continue to do procedures,” Pankey continues. “Once the warning is issued, then it becomes a matter of property and security issues. We try to get as much staff into the facility as possible, raise any items or equipment that may be on the floor, off the floors. We then cover all equipment and medical supplies in plastic bags, and in our sterile room, all the carts would be covered with plastic in case water intrusion was to occur.”

Pankey also recommends that all gutters be cleared before a hurricane to ensure that water will be pulled away from the building. Battery-powered equipment should also be checked, as well as back-up sources and generators. “Store the equipment if you know which way the hurricane path is coming — if it’s coming in from the East, store it on the west wall. Make sure your emergency generator is full, because even if you can’t do surgeries when you get back, you’re probably going to have to do some clean-up, so you’re going to need power in the building. In Florida, we kept about 20 gallons of bottled water on-site in the event that we would run out of water or need to act as some sort of triage or hospital system, we would make sure that we had plenty of bottled water and sterile water for hand washing and those kinds of things, and also alcohol handrubs.

“If you have electronic medical records, the best thing to do is have a safe place, even outside of the hurricane area, that you send medical records, back-up tapes there,” Pankey continues. “Waterproof storage is what we did; we took them out of the building and had them in a waterproof storage container that stayed with the administrator. As people found out with Katrina, business owners couldn’t get back in to retrieve their data and were just getting in two and a half weeks later. You’ve got to plan ahead for those kinds of things.”

Pankey also suggests referring to the disaster plan in an ASC’s environment of care manual and enacting it. “Turn the electricity off if you know the hurricane’s coming; we would shut off our gas as well — that meant you wouldn’t have any damage from lightning strikes,” he explains. “Early in the hurricane season, have a tree-trimming service come and make sure your trees are trimmed away from power lines or from being able to fall on the building. It’s all anticipatory things you have to do, starting in the middle or end of May, because June 1 is when the hurricanes usually start.”

Pankey contends that hurricane drills are a useful exercise for establishing familiarity and gauging speed. “We could pretty much get our center prepared in about two hours. We could get everything moved where it needed to be, covered with plastic, and closed up.” Pankey says he used a service to cover the windows to enable his staff to finish preparations more quickly. “I didn’t want my staff there — I wanted them home protecting their own homes.”

Staffing itself may be a concern if homes are affected by the storm. “I was in Miami during Hurricane Andrew; I worked at a hospital at the time,” Pankey says. “What happens when people’s homes are destroyed is they’re not able to come in to work. I was at the hospital for three days without relief because people’s homes had been destroyed.”

After a hurricane has passed, the focus turns to inspection of the facility and its contents, and reporting any necessary claims to insurance agencies. “Because we’ve rescheduled cases, get back on the phones, if available,” says Pankey. “If not, use cell phones, if available, to communicate and start your action plan to get going again. There may be many patients who were scheduled for surgery but may not want to have surgery or may not be able to. With Katrina, obviously it was complete lights out — I saw a center down there that’s going to be down for three months and in this case you’re talking about a situation that almost amounts to a major start up from the very beginning again.”

Large-scale hurricanes and other natural disasters can also have repercussions that reach far beyond the region in which they occur. “What we’re finding now as far as availability of supplies, are medicine shortages,” Pankey notes. He says lidocaine in particular was in short supply immediately following Katrina. “Have alternate supply routes or alternate suppliers in place, or at least know what numbers to call. If you’re outside the damaged area, you can prepare for those kinds of things.”