Keeping patients safe when disaster strikes.

SINCE SEPTEMBER 11, 2001, hospital disaster planning has become a high-profile issue debated in both the professional and popular press. With the disaster to the Gulf Coast caused by Hurricane Katrina, and the virtual destruction of New Orleans' healthcare delivery system, there is even greater scrutiny of disaster planning. The article by Havidan Rodriguez and Benigno E. Aguirre is a theoretical discussion of the resiliency of hospitals during a disaster, while the article by Bovender and Carey describes an excellent example of what was required to maintain Tulane Hospital during Hurricane Katrina, now classified as the single worst disaster that has befallen an American city. At this propitious time, these two articles touch on critical issues of emergency management. In the last five years this country has experienced its most concentrated period of destruction related to natural and man-made disasters. With the increasing concern of the emergence of pandemic influenza, the increasing sophistication and long reach of America's sworn enemies, and the promise of continued natural disasters, now is the time to improve our understanding of disaster planning and harden our healthcare delivery system against such assaults. We must be able to answer the question, "When a healthcare system experiences a disaster, what is required to maintain its operations and how can the necessary resources be accessed?" Since 2001, beginning with the damage to the Texas Medical Center from Tropical Storm Allison and followed closely by the September 11th attacks in New York City and Washington, DC, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has routinely debriefed hospitals and their communities following natural and man-made disasters. Our aim has been to better understand the effectiveness of hospital and community planning as it relates to maintaining quality and safe medical care under a broad range of disaster conditions. We sought to answer the question, "As hospitals attempted to maintain quality and safe patient care during a disaster, what worked and what failed?" The ultimate goal was to disseminate lessons learned and eventually modify our existing standards with the hope of mitigating future problems and enhancing successes. Our debriefings to date have included over 200 hospitals facing a wide assortment of disasters: hurricanes, floods, wildfires, widespread power failures, terrorist attacks, and infectious agents (i.e., SARS in Toronto). Often the local or state hospital association has been instrumental in organizing the gathering of affected facilities. The focus of the discussion has been on investigating the issues discussed in these two articles-namely, examining * the resiliency of Healthcare organizations as they face disasters; * what type of advance preparations succeeded; * the ability of organizations to respond as unexpected contingencies emerged; * the recovery from the event; and * the planning for the next event. PATTERNS EMERGING FROM HOSPITAL DEBRIEFINGS A number of patterns have emerged from these debriefings. The first is a set of parameters that appear to be related to a hospital's resiliency. The five parameters noted in the debriefings were communications, utilities, staff, supplies, and security. While a detailed discussion of these issues is beyond the scope of this commentary, I will briefly describe each parameter. 1. Communications: Maintain a reliable communications system that allows important information to be communicated to both internal and external contacts so as to stay informed and keep others informed of all critical information necessary to manage the disaster. 2. Utilities: Supply the organization with sufficient amounts of power, adequate water, and sewage removal. 3. Staff: Maintain a sufficient number of competent clinical and non-clinical staff to run the organization 24 hours a day, seven days a week. …