Lisa Kirkland, MD, a hospitalist at the Mayo Clinic in Rochester, Minn., agrees disaster planning should be local in the sense of preparing for specific events. Tornadoes are the most likely weather-related crisis to occur in Rochester, she says, and the area is not a prime terrorism target.
Yet disasters don’t have to happen suddenly or involve mass casualties. “A disaster is anything that overwhelms the usual system,” she says. “Putting a community under quarantine during an outbreak of influenza or bird flu, for example, could require the initiation of disaster plans since staff couldn’t get to hospitals.”
In this sort of scenario, like during the SARS outbreak in Toronto in 2003, patient care would be largely medical, rather than surgical, so hospitalists would be key providers of treatment, Dr. Kirkland says.
Hospitalists would also be key in maintaining effective communication, internally and with the outside world because of their thorough knowledge of hospital services, she adds.
Some 75 miles away in Minneapolis, many victims of the I-35W bridge collapse were taken to Hennepin County Medical Center (HCMC). Glen Varns, MD, hospitalist program leader at HCMC, was unable to get to work because he lives on the other side of the bridge. But he says hospitalists played a critical role in dealing with the crisis.
“Since our hospitalists are most familiar with the inner workings of the facility, they played a huge role in determining who needed to be hospitalized and where in the hospital they would best be treated,” he says. “This included reviewing the existing patient census when the collapse happened so we could discharge and transfer inpatients appropriately to ensure that the hospital was in the best position to deal with the collapse victims.”
Because the bridge collapsed during the early evening, there was plenty of staff on-hand to treat the victims, including residents who worked hand-in-hand with hospitalists in making admission and transfer decisions.
Challenge for Hospitalists
In smaller facilities where there are no residents, or in small emergency departments (ED) and intensive-care units, hospitalists will and should have even more critical roles in handling disasters and planning for them, Dr. Varns says.
He believes all hospitalists—but especially those in small, nonteaching facilities—should get triage training. “Hospitalists have a very broad skill set—especially with increasing responsibility for co-management of surgical cases—but they should develop triage skills,” says Dr. Varns, who suggests hospitalists take a two or three-day advanced trauma life support course.
Steven B. Deitelzweig, MD, FACP, system chairman, department of hospital medicine and vice president of medical affairs for the Ochsner Health System in the New Orleans area, agrees.
“I think the folks who are closest to guiding the care should be offering input into triage decisions,” he says. “Hospitalists can be invaluable in doing triage of inpatients. They provide objective detailed information.”
Dr. Deitelzweig, who experienced the three-week lock-down following Katrina, suggests hospitalist groups create a system of prioritizing evacuation of patients—including what kind of support they’ll need.
He believes hospitalists will be invaluable during crises because they are “front-line decision-makers, along with ED physicians and intensivists.” Hospitalists should be on disaster-preparedness committees and a key part of communication during an actual crisis, he urges.
“Communication is critical during a crisis—and hospitalists know their systems,” he continues, noting that Ochsner has out-of-state cell phones, satellite phones, ham radios, spectral light phones, radio frequency antennas in secure places, and more.
In addition to equipment and supplies, hospitalists need to be prepared to do whatever is needed in a crisis, Dr. Deitelzweig says. “In a disaster, you might have to do a procedure usually done by a specialist—with supervision—to extend that person,” he says. “You also may have to go past the physician role. That’s where leadership shows. Our CEO served food in the cafeteria during Katrina. During a disaster, you have to be a flat organization and just do what needs to be done. That gives emotional support to everyone.”