Hospital Care and the EMS/911 System in Disasters

The case for worst-case planning.

by Eric Holdeman / March 17, 2019

Last Friday I attended a Northwest Healthcare Response Network (NWHRN) event that included a number of speakers. One was Sheri Fink, a correspondent for The New York Times. NWHRN is a health-care coalition, and one of the few truly functional regional organizations here in the state of Washington. They have it going on!

Sheri is also the author of the New York Times bestselling book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.

The book details the response and immediate aftermath of one hospital in New Orleans following the impact of Hurricane Katrina.

I tried to take notes while she was speaking and so what is below — can be cryptic, but there are some factoids there for your future consideration in disaster preparedness planning and response.

Fink Speaking:

Dependency on technology creates more hazards when power fails. You need to be thinking catastrophic scenario. [I feel we are becoming more efficient with technology, but instead of having resilience be supported, in many cases it has made us more fragile. Lose electrical power and see what stops working in the modern hospital setting.]

Big issues are “how do you prioritize care?” You have both the young and elderly. Social worth can become debated. Triage within the institution itself is not something much considered.

Hospitals become magnets for people looking for resources other than medical care at a hospital. Workers, for big events and that have warning, may be able to bring their families and pets — which is another complicating issue.

Hurricane Harvey

Harris County, Texas, priority was to swift water rescue and medical rescues. Extreme flooding and medical emergencies. You discharge people who can be discharged early. One woman sent home, without the medication she needed, unfortunately died when she was not able to get back to a medical facility due to flooding. The question to answer in patient discharges, "Will they be safe when they leave the institution?"

They had two 500-year floods prior to this immediately prior to Harvey. [Which argues for the impact of climate change on the frequency and severity of disasters that we are currently seeing].

The county leadership asked citizens to help with evacuating flooded areas of the city. [Harness the power of average citizens with the equipment and means to help. Don't let attorneys stop you from doing good.]

911 calls sky rocketed, not so much for medical calls, but calls in general. Many water rescue calls and then some medical calls. At least one 911 center stopped triaging calls because of the volume of calls. A key aspect of this lesson learned. Thus the targeting of medical assets was not done appropriately. Medical resources were not being directed in any meaningful way. Some Emergency Medical Service resources went wasting due to the failure to prioritize medical calls. 

Sheri encouraged everyone to look at how you are thinking about social media and incorporating it into your public information and operational plans.

911 centers in that event could not call directly for a helicopter.

Holdeman Commentary:

In disasters, tough decisions need to be made. Medics are trained to make these at the scene of a mass care disaster. When patients get to the hospital, the care and decision-making is “usually” totally focused on treatment and preserving life. Thus, the ethics of making life-and-death decisions is radically different, based on the medical situation/location. See Sheri's book for a textbook look at these issues in real life.

The planning assumption I share in my disaster preparedness presentations these days is, "No one is coming to help!"  Learn to be self-sufficient. 

Reference the ability of 911 centers to make contact with aviation assets. When we built out the King County Regional Communications and Emergency Coordination Center, we incorporated a full 911 dispatcher console into the radio room. The idea was to provide a closer interface with disaster operations and the EMS/911 system. It is steps like this that can enable 911 access to resources, like aviation assets, that are being controlled or coordinated out of the ECC/EOC.

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