Limits for Disaster Responders

In response to Hurricane Katrina, state and national regulatory agencies had to create emergency exceptions to licensing regulations and to HIPAA and EMTALA requirements in order to facilitate patient care.3 Both the Model State Emergency Health Powers Act (legislation designed to serve as template for states to use to create emergency health response mechanisms) and the Louisiana legislation that governed provision of medical care in a state of emergency limit liability of any provider assisting in an emergency.4-5 Providers assisting in an emergency will not be held liable for any injury resulting from action or inaction except for intentional or grossly negligent acts or omissions. Such limitation of liability is essential to ensure that all available resources are utilized in an emergency. However, given that patients will have limited remedies for injuries caused, it is increasingly important to proactively define limitations on provider activity during emergencies. Because other remedies and regulatory structures are relaxed, ethical self-regulation becomes increasingly important.

The first priority in emergency disaster response must be ensuring that providers are available and do not encounter unnecessary barriers to providing care to ill or injured patients. However, a secondary goal must be ensuring that the safest and most effective care is provided under the circumstances. As with many things in disaster response, once the disaster has occurred there is little time for contemplation. Therefore, disaster response plans should include guidelines for providers on how to ensure safety in the care they provide.

Disaster response issues must be dealt with proactively because resources cannot be diverted to these issues in the thick of emergency response. Some organizations and providers have experience with disaster response and can provide guidance. A major goal of medical relief organizations is to provide relief for fatigued providers. When relief is not available and not likely to arrive soon, providers should be encouraged to self-impose sleep periods despite the apparent urgency of the situations they face. Urging providers to ensure that they eat at least twice and sleep for two to four hours in any 24-hour period is a reasonable limit on the physical activity of providers.

Providers and patients need to understand that this is essential to ensure that providers are capable of giving safe care in a sustained fashion. Emergency responders must maintain adequate perspective on their own abilities and patients’ needs to ensure that unnecessary risks are not undertaken nor avoidable injures inflicted. Importantly, these limitations should not be legislated or imposed externally, but should be defined by the profession and self-enforced by providers.

There have been significant discussion of what aspects of the U.S. system of response to large-scale disasters need to be improved. The Katrina disaster has given us the opportunity to enhance essential response mechanisms, whether the cause of the disaster is natural, infectious, or terrorist. A good disaster plan takes steps to ensure availability of care, but also to ensure that the care is as ethical, safe and effective as possible.

References

1. Arnedt JT, Owens J, Crouch M, Stahl J, Carskadon MA. Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA. 2005;294(9):1025-1033.
2. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Eng J Med. 2004;351(18):1838-1848.
3. Hyland, et al. Federal, State Regulations Relaxed for Providers Affected by Hurricane. BNA Health Law Reporter. 2005;15(36):1190-1191.
4. Gostin, LO, Model State Emergency Health Powers Act, §608 Licensing and Appointment of Health Care Personnel, December 21, 2001. Available at www.publichealthlaw.net/MSEHPA/MSEHPA2.pdf. Last accessed Dec. 1, 2005.
5. La. R.S. 29:656 (2005).