NEW YORK NURSE: October/November 2008
by Randi Hoffman
On the morning of Sept. 10, NYSNA Occupational Safety and Health Representative Tom Lowe stood before a group of executives and administrators from Terence Cardinal Cooke Health Care Center (TCC) in East Harlem to help them prepare for a worst-case scenario.
As part of his role in promoting safe and healthy workplaces for NYSNA members, Lowe outlined a disaster plan he had developed specifically for the health center. Although everyone hopes it will never need to be put into use, TCC is now better prepared to care for its residents in the case of a flood, crippling snowstorm, bombing, or any other unforeseen disaster.
TCC is a long-term care facility that cares for AIDS patients, the severely developmentally disabled, Alzheimer’s patients, and those living with chronic illnesses, in addition to the elderly who require nursing care.
“All disasters begin and end locally,” Lowe told the group. “You must assume that everything that can go wrong, will go wrong. You have to be prepared for anything and everything that could happen.”
“Before the generator goes down and the lights go out, you need a plan,” Lowe continued. “The plan must be dynamic and reviewed on a regular basis. It must address issues of capacity, food, water, and the personnel to care for patients. The continuity of care for patients being transferred must also be considered, including their medical records and medications.”
The plan also must be easy to access and understand. The old, pre-9/11 model for TCC was a four- to five-inch thick book. “In case of an emergency, you’d be hard-pressed to figure out what to do,” Lowe said.
During an emergency situation, a facility must continue to care for its patients in its day-to-day operations as closely to normal as is possible.
The disaster plan Lowe shared with TCC administrators was based on the Hospital Incident Command System. Under its structure, groups of individuals are trained to carry out five major management functions.
It is important that the plan be function-defined rather than people-dependent. “That way you are not depending on one person, who may be on vacation at the time disaster strikes,” Lowe said. “The job is the same no matter who fills it. You’re handed a job action sheet and you follow directions. Everyone takes a deep breath, pulls out the plan, and gets to work.”
The person in charge during an emergency is called the incident commander and usually is the CEO or the administrator on call. He or she manages all aspects of the disaster. This position should be distinct from the person running day-to-day operations. The plan also calls for a logistics specialist, the “Radar O’Reilly” who takes care of food, transportation, and procures what is needed to maintain operation.
Emergency drills that involve both management and staff help to define what the staff is capable of doing. After this training, TCC may have to revise the plan and determine whether outside people might need to be brought in to assist in managing the disaster.
As the deputy commander of the New York State Disaster Medical Assistance Team (DMAT), Lowe went to Louisiana for the week after Hurricane Katrina struck in 2005. He took charge of the team assisting the disaster recovery at West Jefferson Medical Center in West Jefferson Parish. The medical team operated out of three tents set up on the hospital’s front lawn, determining who needed to be admitted or who should be transferred to other hospitals. At the height of the patient surge, Lowe’s team saw more than 2,000 patients in a 24-hour period.
Lowe received similar reports from colleagues who responded after Hurricane Ike this year. “They lost utility infrastructure,” he said. “They expected to be down for three to five days, but it lasted two weeks. The water pressure was down, and the water was not potable. You couldn’t flush toilets. The first floor of the hospital was flooded with two feet of contaminated water.”
Lowe concluded, “Facilities want plans they can really implement. TCC is effectively using the resources available to it as a NYSNA-represented facility. They are taking a step that a lot of other long-term facilities are not.”