Public Health Preparedness

Preparation for Disaster
By

Lawrence K. Sands, D.O.,M.P.H., CoChair-NSMA Commission on
Public Health and Southern Nevada District Health Officer

Mary Anderson, M.D.,M.P.H., CoChair-NSMA Commission on
Public Health and Washoe County District Health Officer

Most physicians are so busy with the everyday demands of practice that they have little time to prepare for a major disaster. Certain specialties e.g. emergency medicine and trauma are better prepared for a disaster by their training and practice. Occasionally, we see the problems associated in a mass casualty situation when a bus rollover, a plane crash, or hotel fire occurs. However, the news quickly fades from our minds.

Usually there is a flurry of activity after a major natural disaster such as hurricane Katrina or LA’s Northridge earthquake due to the large numbers of casualties, the loss of electrical power and communications, and damage to structures including hospitals. How would we respond if we were in that situation? Some have volunteered to help out and gained first hand experience. Others get involved in local disaster planning and training or became volunteers in organizations such as the American Red Cross. Most of us quickly return to our normal routines and the question of disaster preparedness issues forgotten.

What disaster could affect us all? There are several possibilities. A major earthquake could occur in almost any area of the state and has the potential to be devastating. A terrorist attack could occur in Las Vegas, Reno, or a military base and might involve explosives, biologic agents, and/or radioactive materials. An epidemic could occur such as the highly pathogenic avian flu. All of these would tax our resources to the limit.

The good news is that the state and local offices of public health preparedness and emergency management continue to work in partnership to plan and prepare for these situations. Preparedness partners include first responders (police, fire, and ambulance), state and local offices of emergency management, local health districts, the American Red Cross, Southern Paiute tribe, county coroners, mortuaries, and acute and sub-acute hospitals. Planning and coordinating committees at the state and local levels meet regularly and emergency/disaster exercises occur several times each year, and hospitals continue to develop contingency plans to manage sudden patient surges.

All of the agencies have been schooled in the Incident Command System (ICS) structure in order to manage these emergencies. By applying the principles and concepts of ICS multiple and diverse agencies are able to coordinate their activities and manage resources efficiently and effectively by using the same terminology and organizational structure. When you volunteer, volunteer with an organization that uses the ICS management system, such as the Disaster Medical Assistance Team (DMAT), Medical Reserve Corps (MRC) or American Red Cross (ARC).

Unfortunately, most physicians are not aware of the plans that have been developed and don’t have the time to investigate. What would you do if we had a magnitude 7.5 earthquake that knocked out the electricity, shut down communication, started multiple fires around town, and damaged one or more of the hospitals? Do you have a family disaster plan with your spouse and children and a disaster plan for your medical practice and staff? Do you have a continuity of operations plan for your practice? This would include agreements with vendors from where you receive supplies. Do you have a notification system for your office staff?

Resources to aid in the development of a family and/or business disaster plan, including the Pandemic Flu Plan, are available on the Southern Nevada Health District (SNHD) website at: www.southernnevadahealthdistrict.org/preparedness/default.htm. 

Checklists, toolkits and guidelines to assist health-care providers and service organizations in planning for a pandemic outbreak can be found on the federal pandemic flu website at:
http://www.pandemicflu.gov/plan/healthcare/index.html. 

Additional information about emergency management planning can be found at:
www.co.clark.nv.us by clicking on “Emergency Preparedness” for the Office of Emergency Management.

During emergencies uncoordinated volunteer efforts working outside an established ICS structure can actually hinder emergency operations. It is important that volunteers work through an established system such as MRC, DMAT or ARC so that their efforts can be effectively managed and integrated into the overall emergency response plan and ensure that volunteers have liability protection. Physicians can become involved and stay informed by joining their local MRC. The MRC is a committed and available reserve of active, inactive, and retired health care professionals who can be rapidly mobilized to strengthen local medical and public health capabilities in response to large-scale emergencies occurring in their community. To find out how to become part of your local MRC, contact the coordinator in your area:

• Stacey Belt, Carson City Health and Human Services at (775) 887-2109
• Paula Martel, Southern Nevada Health District at (702) 759-0877
• Debra Barone, Washoe County Health Department at (775) 328-6111

The Nevada 1 Disaster Medical Assistance Team (DMAT) is a state-wide emergency response team, as well as a Federal asset to the United States Public Health Service/National Disaster Medical System under the Department of Health and Human Services, commissioned in 2001. DMAT teams provide essential emergency medical care and patient evacuation during time of natural or man-made disasters or in time of a national security emergency and can be assigned to work in hospitals, tents or on sites. The DMAT can assist locally by being requested through your county’s Office of Emergency Management who then submits the request to the state Department of Emergency Management (DEM) and then up to the Federal level. To find out how to become part of the DMAT, contact Administrative Officer Karen Strutynski at (702) 809-5497 (24-hours) or visit their website at www.nv1dmat.com. 

Nevada physicians and health care professionals are responsible for completing continuing education on the medical consequences of an act of terrorism under the provisions of Nevada Revised Statutes (NRS) 630.253 passed by the Legislature in 2003. The Area Health Education Center (AHEC) of Southern Nevada offers a class that meets the criteria for licensure and renewal. The class, “Weapons of Mass Destruction: The Health Care Professional’s Role in Nevada’s Preparation and Response” is available statewide. For more information access the AHEC website at www.snahec.org. The course is also held monthly in Clark County at Southern Nevada Health District (SNHD). To register for the course, “Medical Consequences of an Act of Terrorism,” please contact SNHD Nancy Gerken, Nurse Trainer, at (702) 759-1309. CEUs are available for the course.

Participating as a member of a Community Emergency Response Team (CERT) can provide training for assisting your neighbors and/or co-workers in the event of an emergency or disaster. A six-week training meets once a week and includes training in Disaster Preparedness, Fire Suppression, Medical Operations, Light Search and Rescue, Disaster Psychology, Weapons of Mass Destruction, Team Organization and a final exercise. In Clark County contact Rick Diebold of Las Vegas Fire and Rescue at (702) 383-2888. In Washoe County contact Kaydie Paschall at (775) 328-2866.

Other excellent resources are available to learn about these issues including the following:

1. Jackett, G., Avian Flu, Preparing for a Pandemic, Am. Fam. Phys., 74:783, Sept. 1, 2006. (An excellent overview of the avian flu and an introduction to the care of one’s patients during an epidemic.)
2. Educating Physicians on Controversies in Health at: www.ama-assn.org/ama/pub/category/15369.html 
   - Disaster Preparedness: Are Physicians Ready?
   - Avian Flu: How Real is the Threat of a Human Pandemic?
   
   (The two sessions are part of a series of 5-minute programs in video format, designed to initiate discussion among physicians.)
3. New York Consortium for Emergency Preparedness Continuing Education at: www.nycepce.org/courses/ept.htm  Emergency Preparedness Training for Hospital Clinicians – a series of 6 modules with 1 hour of CME credit for each module. (We recommend all physicians review “The Basics” module and others if interested.)
4. Basic Disaster Life Support (BDLS) and Advanced Disaster Life Support (ADLS), two one-day courses patterned after BCLS, ACLS, ATLS, etc. leading to certification. Presented by the UNLV Institute for Security Studies and provides 8 hours of approved CME. Cost of $200 per student per course. Contact: ross.bryant@unlv.edu or: Mr. Ross Bryant; UNLV Institute for Security Studies; East India Building; 4045 Spencer St. Suite A-41; Las Vegas, NV 89119
5. www.redcross.org/services/disaster/ -click on “Be Prepared”, then click on “Family Disaster Planning”. This web site provides excellent, comprehensive recommendations for preparing your family for a major disaster. We would also recommend you review other preparedness topics of interest to you.
6. www.nvha.net/bio/intro.htm - Information from the Nevada Hospital Association on statewide disaster planning including hospital surge capacity and a variety of references.

(Thanks for the work of former NSMA Commission on Public Health CoChairs George H. Hess, M.D. & Donald S. Kwalick, M.D., who authored an earlier version of this article.)

A useful overall internet site for updates on the range of issues covered by public health emergency preparedness and response is found at: http://www.emergency.cdc.gov/.