The Big One

The Hospitalist. 2009 July;2009(07):

July 1, 2009 | The Hospitalist

Personal Disaster Plans

“I think another vitally important—and I mean vital importance in the same manner as vital signs—is for each hospitalist to have a personal disaster plan for their family/personal life,” says Mitchell Wilson, MD, medical director, FirstHealth of the Carolinas Hospitalist Services and section chief of Hospital Medicine in the Department of Medicine at the University of North Carolina at Chapel Hill. “As the front line ‘foot soldier,’ the potential to harm our families during a pandemic is enormous.”

Dr. Garrett agrees. “One of the things that we’re not so good at in this country is coming up with emergency plans for our own family—even those of us who are in the medical business and take care of others,” he says. “Taking this step just makes good sense—and serves to be able to maximize your own availability and also be confident that you have the ways and means to know that your family is safe and secure and given the best opportunity to survive in a disaster.”

According to Dr. Wilson, families with vulnerable members, such as the young, elderly, and infirm, must have a plan in place to minimize the risk to them. “The hospitalist who comes home sick [or] infected is a danger to the very safe place [to] which [hospitalists and their families] seek refuge,” he says.

Preparedness includes delineating in your family what your points of contact will be. “Part of the stress that’s involved in being a physician and being expected to report to work [may involve] worrying where your family is or whether they have a safe meeting place; who’s picking up the children from school; does the school for my children have a plan, etc.,” says Dr. Garrett.

If you know that your children’s school has an emergency plan, your spouse’s workplace has a plan, and any relative in a long-term care facility has a plan, you’ll be much more likely to stay on the job and care for patients.

“And if my child is on a school bus that needs to be evacuated somewhere out of town,” he says, “I want to know there’s a phone number that my whole family knows to reconnect somehow.”

Disease Surveillance

Disease surveillance is of huge importance to detect and monitor biological terrorist and natural threats. The North Carolina Disease Event Tracking and Epidemiological Collection Tool (NC DETECT), a reporting and surveillance system, was awarded the 2005 Nicholas E. Davies Award of Excellence in the Public Health category by the Healthcare Information and Management Systems Society. The Davies Award program honors Nicholas Davies, MD, an Atlanta-based practice physician and former chairperson-elect of the American College of Physicians, who was committed to improving patient care through better health information management. Dr. Davies was killed in a plane crash with Senator John G. Tower (R-TX) in April 1991.

“One of the things that we’ve done in North Carolina that contributed to our receiving the award was the fact that we really did build this from the bottom up,” says NC DETECT’s Waller. There was guidance from the top down, she explains, but efforts began on a basis whereby hospitals came on board voluntarily and agreed to provide the information they had electronically. In turn, the epidemiology team agreed to give information back to them. “It was very much a joint effort working with the local hospitals and the state-level public health people and bringing them together and designing a system that would meet everyone’s needs with the least impact on the workload for the local hospital.”

Waller says the program was designed to alleviate emergency department clinicians from having to do anything extra in addition to their normal methods of documentation. “We were just going to pull out the electronic information they were collecting and then standardize it centrally, utilize it, and provide a report back to them,” she explains.

Although this system is clearly driven to supply needed information to the state, “we recognize that individual clinicians, administrators, and people at the hospital level also need to know what’s going on in their emergency department,” says Waller. “And it gives them a window into the sort of information that they might not have ever had before.”—AS