In October 2017, in support of the Federal Emergency Management Agency’s response to assist the Governor and people of Puerto Rico, three Department of Defense (DOD) military hospital platforms were deployed; one each, by the US Army, Navy, and Air Force. They arrived on the island at different times with predominantly wartime surgical capabilities and augmented the Federal Emergency Management Agency (FEMA), US Public Health Service, National Guard, and Puerto Rico Department of Health efforts. My perspective is that of patient care and transport between the Centro Medico hospital complex in San Juan, the larger regional hospitals, the Veterans Administration hospital, the DOD response, FEMA Disaster Medical Assistance Teams (DMAT), and FEMA Federal Medical Shelters about 4 to 6 weeks after Hurricanes Maria and Irma struck. Based upon this experience, I would like to offer the following.
Pre-Disaster: All clinicians have a few patients that teeter “on the edge.” When basic services go away, these patients fall over that edge and become inpatients. Establish a list of patients who require oxygen and devices such as vests, cough-assist, or ventilation. If evacuation before the disaster is possible, those patients need to leave. If they refuse, or are unable to leave, they need to be able to supply their own generated power for a prolonged period of time, as batteries will run out prior to power restoration. They must be able to use oxygen concentrators, as tank re-supply may not be readily available. By law, FEMA cannot give generators to individuals, so individuals must prepare for themselves. In a hurricane-prone area where seasonal risk can be established, planning medication refills at the beginning of the season or giving a larger than normal supply may prove useful. In an area prone to sudden disaster, such as earthquake or tornado, then counseling patients to request refills at least 2 weeks early may be adequate.
Post-Disaster: The most reliable form of communication will be text. You likely already have text contacts for your staff and family members; add other providers, responders, planners, pharmacists, and oxygen suppliers to your text contacts. While you may wish to share a text point of contact with patients, understand that your ability to actually help during the initial disaster will likely be limited. Identify possible language translation needs and possible translators among your staff and/or friends as telephone services will be limited or absent following the disaster. Finally, identify your local emergency response planners on Facebook, Twitter, or other social media feeds. This will allow you to direct others to these sites for accurate information after the disaster.
Responder Recommendations: A single social media post can DESTROY your plans and hamper your efforts. Advertise a single contact point and an information resource (eg, bulletin board, webpage) early and often. Publicly and accurately declare the means by which people will access health care and health-care services, such as medications, dialysis, and oxygen. There will be nongovernment organizations (NGOs), friends, and other well-meaning individuals who will try to assist people in need through unconventional channels. Yet, by requesting assistance through nonroutine channels, those efforts tend to delay assistance, cause confusion, and/or squander resources. Continue to direct those requests through the established response channels, ie, the local 911 equivalent.