Preparing for Disasters

It has also finally come to public attention that during these catastrophes, the elderly and the sick are typically the last to receive outside aid. In fact, this group is disproportionately affected. But with a more detailed understanding of emergency planning, better preparation by long-term care facilities can save thousands of lives. Moreover, it can be accomplished at minimal expense through creativity and a checklist approach.

Taking these steps are both timely and critical, as indicated by Keith Robertory, a community disaster educator with the Red Cross who spoke to USA Today: “If the interest holds up and the money holds up, we can prepare for anything, (but) it’s a short window…before we hit that snooze button again.” And, once again, we’ll see helpless nursing home residents left behind.

Exactly Who Is in Command?
During a disaster, as we learned the hard way after Katrina, it’s often difficult to determine who is calling the shots. Roles become confused as people lose perspective-especially when emotions run high. This was reflected in the aftermath of Katrina when two police officers committed suicide and hundreds more turned in their badges, as the New Orleans mayor, Louisiana governor, and Federal Emergency Management Agency (FEMA) director took turns deflecting blame and indulging in heavy hand-wringing.

There is a proper hierarchy. Basically, the governor often works from the civil defense bunker, commanding relief teams through the fire chief, who works outside. The only exception is in the case of a terrorist attack, during which the chief of police heads the operation because the area is considered a crime scene.

If these people successfully accomplish their tasks-which are utilitarian in nature-they then worry about providing the greatest good for the greatest number, but with few, if any, resources specifically dedicated toward working with the medically ailing population.

Nor does it make much difference that facilities can arrange Mutual Aid Agreements (signed documents between a nursing facility and various agencies to provide ambulances or medical supplies in times of need)-a wonderful concept, but useless when put into practice. When disaster strikes, there are too few services available to meet the demand and these agreements are nearly impossible to enforce-even if roads are open and passable.

This is why it’s recommended that long-term care facilities assume the worst under certain circumstances. As scary as it might be, you may be on your own, at least for a while. Comments bolstering this “real-world” stance have come from the U.S. Department of Defense, the Center of Excellence in Disaster Management & Humanitarian Assistance, the Pacific Tsunami Warning Center, and the Hawaii State Civil Defense (the latter three in my own experience).

Here are ways to prepare for that dire necessity.

Basic Tools of the Trade
Communication. Communication for a nursing home during an emergency is vital-not only to relay information to hospitals or teams of relief workers, but also in communicating residents’ conditions to family members. But, during most disasters, cell phones, landlines, and even radios are sometimes cut off.

Satellite telephones often answer the call. The least expensive are preowned but can still be in good condition. Initial prices range up to $1,000. These phones provide more than 3 hours of talk time and 30 hours in standby mode. Different calling plans exist, but because the phone is not meant for daily use, the best option is a onetime annual activation fee of approximately $350. Time used is then priced on a per-minute rate. These deals are aptly named Emergency Plans and are available from a variety of satellite phone providers.

Extra supplies. Most residents are allowed by their insurance to maintain a 30-day prescription of their medications, and that’s great-but you never want to dip below a 7-day supply. The facility should also stockpile some extra medications and equipment, including broad-spectrum antibiotics, pain medicine, and oxygen tanks. The safest place to store these is in a waterproof, airtight container. This avoids the possibility of a fire ignited by the oxygen and any contamination by insects or rodents.

To keep costs down, use the same container for a seven-day emergency supply of food and water. Choose canned goods consisting of 10% fats and 12% proteins, and ensure there is enough for everyone to receive at least 1,900 kcal/day. To limit looting, the container should have restricted access. Use a sturdy lock for which only the administrator, director of nursing, and director of operations know the combination or have a key.

Helpful Hints for Protection
Long-term care facilities can take other measures to prepare for, and endure through, a disaster. These include:

• In high winds, glass tends to shatter because of flying debris or the force of the wind; plastic windows are stronger and safer.
• Create, or maintain, normal activities to keep the minds of residents and staff off of whatever is unfolding outside. Board games don’t keep you bored.
• When bathing residents, it’s preferable but not necessary to use potable water. In any case, cleanse residents’ feet daily and put on a washed or new pair of socks. Baby wipes and foot powder can take the place of water and socks if necessary, but would need to be purchased for the supply stockpile.
• Ensure both residents and staff have updated immunizations, particularly for influenza types A and B and typhoid.
• Anything you can do to bolster physical support to your building is welcome. Concrete structures reinforced with steel are the sturdiest, and reinforcements can be installed in key structural locations.
• During a disaster, devote a room within the home to use as a staff rest area. In times of extreme stress, it can become difficult for staff to keep a sharp mind. Install a CD player with soothing music to produce a feeling of calm. Force a regular “time-out” for every staff member!
• Keep adding to your “disaster plan.” Ideas are best written down and practiced. Run routine, unannounced drills with staff so they become familiar with any procedures in place. Preparedness is a large part of the battle. But so is informing those who will carry out the plans.

In the aftermath of Hurricane Katrina, the White House launched an inquiry to determine why the multibillion-dollar post-9/11 national emergency system-in its first test-failed so horribly, and how to better prepare for the next disaster. Indeed, Hurricane Katrina brought many important problems into the spotlight. But it is time to move forward. Some criticize the White House report as being too Katrina-specific, potentially undermining its viability. Now is the time to look outside the box for solutions, knowing that there is much we can do to help ourselves before, rather than during or after, the next major emergency. If not now, when?