If the past two decades have taught the medical world anything, it is that healthcare providers can never be too prepared for a disaster.
Explore This IssueNovember 2020
Although medical facilities in the U.S. are required by state regulators and accreditors to create emergency preparedness plans, such plans don’t always anticipate the ultimate impact of a crisis, be it environmental or man-made. The potential short- and long-term effects of a powerful hurricane, tornado, or earthquake differ vastly from those of a widespread power outage, mass shooting, or viral pandemic. Yet, healthcare organizations must be agile enough to respond to all of these.
As emergency preparedness experts become more adept at predicting the occurrence and effects of disasters, climate-related events are upping the ante. A 2014 National Climate Assessment issued by the U.S. Global Change Research Program reports a steady increase in the intensity, frequency, and duration of hurricanes in the North Atlantic U.S. since the 1980s, and a 2020 study found that the likelihood of a hurricane becoming Category 3 or higher rose over a 40-year span by approximately 8% per decade (see “Billion-Dollar Disasters” below). The number of tornado clusters capable of wreaking widespread destruction is also on the rise.
More recently, the COVID-19 pandemic has created an ongoing state of emergency that impacts all health providers, but otolaryngologists in particular. This was especially true in the early months of the outbreak, when so little was known about the virus’ transmission. “There was a report out of Wuhan made available by a group of ENT doctors at Stanford University that documented a sentinel surgical case in which a surgical team performed endoscopic transnasal surgery on a COVID-positive patient,” recalled Daniel W. Nuss, MD, George D. Lyons Professor and chairman of the department of otolaryngology–head and neck surgery at the Louisiana State University (LSU) School of Medicine, New Orleans. “There were 14 support people in the operating room, including the surgeons, and all of them got sick with COVID. Subsequently, in Asia, Iran, and Italy, some of the highest mortality rates from COVID were among ENT doctors. So, this was almost a panic point for otolaryngologists.”
For doctors, nurses, and other medical personnel on the front lines of disaster, every experience brings hard-won lessons on what it means to serve a community under siege, and what lessons can be gained in the aftermath.
The Legacy of Katrina
On Aug. 29, 2005, Hurricane Katrina made landfall on the Louisiana Gulf Coast, bringing with it 127 mph winds and subsequent flooding that lasted for weeks. When it was over, more than 1,800 people had died in and around the state, and the cost of damage totaled an estimated $161 billion. By far, the city of New Orleans, which sits predominately below sea level, was the hardest hit.
Evelyn Kluka, MD, was both an associate professor at the LSU School of Medicine and director of pediatric otolaryngology at Children’s Hospital in New Orleans when reports of Katrina’s projected path were issued. In response, the hospital called a Code Grey. “The procedure includes discharging medically stable patients and determining the team of physicians considered essential personnel,” Dr. Kluka said. “Employees—nurses, pharmacists, assistants, and respiratory therapists, among others—are divided into teams and assigned shifts.” Following the advice of the hospital’s CEO to “get your personal affairs in order or you won’t be good for anyone else,” Dr. Kluka and her family evacuated to higher ground.
As Dr. Nuss explained, although nature had dealt the storm, man-made problems severely worsened its aftermath. “In New Orleans, parts of which are below sea level, there’s a delicate balance of man-made structures that help pump water out when it builds up. When that system is overwhelmed, we’re essentially a swamp,” he said. “In Katrina, there was a sequence of really bad management of the levee systems of the Mississippi River, the public works, and the Army Corps of Engineers that compounded everything. Ultimately, there were bodies floating in 10 to 12 feet of water, which covered our city for weeks. We had muck, mold, and decaying vegetation that had nowhere to go, and a surreal absence of birds and other wildlife.”
Although the staff at Children’s Hospital was still relying on its emergency generators, “the loss of the city’s water supply affected its ability to run the physical plant,” said Dr. Kluka. For the first time in 50 years, the hospital closed its doors. Dr. Kluka, with no place to practice or patient charts to reference, began to advise her patients to seek care in the communities to which they had scattered.