In a crisis that threatens an entire community, what do you do when even the hospital has to shut down? Public health professor and emergency room physician Louis Francescutti explains how the health system responds in a disaster.
Evacuating a hospital is a complex job with so many people who may not be able to walk or who have limited mobility, may depend on specialized equipment, or otherwise can't be moved easily. How do you decide when it's safer to leave and when it's better to try to care for patients on site?
That decision is best left in the hands of agencies properly trained to decide when it is time to evacuate a hospital based on the imminent dangers at hand. This is done all the time when medevac helicopters are dispatched: the pilot does not know the details of the medical mission, so he or she determines whether they can fly based on the weather conditions and not the patient’s needs, which can bias their decision.
Hospital administrators and emergency disaster response officials are risk-averse and err on the side of caution when making such an important decision.
In terms of simple logistics, how do you get a building full of vulnerable people safely evacuated and out of the area?
The ones that can be easily discharged are the first to be evacuated: patients in outpatient clinics, patients on the wards that are ready for early discharge and emergency room patients not needing admission. Then the more complex post-operative or intensive care unit patients need a final destination to go to.
Transferring physicians contact other physicians in receiving institutions that can accept these complex patients, and properly trained and equipped medical teams are organized to safely transfer care to another facility suited for the patient.
A lot of the time, when we think about first responders who are working in a community after the people are evacuated, we think of people like fire crews, but there are also medical support teams who work with them. Who goes, and how do they help?
That varies according to the disaster in question. If there are no injured individuals expected to need treatment, then basic first aiders are amongst the firefighters. Emergency medical personnel may be on standby or embedded among firefighters as well.
In an event such as an earthquake, where we are expecting more injured individuals, a variety of medical personnel are needed on scene, from first aiders to paramedics, nurses and doctors.
If people have medical conditions or mobility issues, what should they consider to be prepared for an emergency like this? What should we all be doing to be able to care for our health in an emergency?
Always assume that for the first three days after any disaster, you are on your own. Have an emergency kit packed and be prepared to leave at a moment’s notice. The kit should include water, food, medications, emergency contact information, cash, valuable documents, enough clothing and a phone charger.
For a fuller list and some planning tools, visit the Government of Canada’s Emergency Preparedness website.
We've heard about things like babies being born to evacuees who are taking shelter in a couple of the work camps, people who have chronic conditions and can't access pharmacies, and other concerns. How do medical responders deal with regular human health concerns on top of the potential emergencies that come during an incident like this?
You establish emergency care posts where they are easily accessible, you have extra ambulances available and you make sure people know where to go and when the facilities are open. You basically improvise and constantly assess how you are doing and readjust your strategies. You make sure that these facilities are adequately resourced as well.
In this situation, front-line hospital workers evacuated the facility and got people out by bus and on the evacuation flight. What do workers do to prepare for a crisis like this?
You can have tabletop exercises where you plan for such an event and establish a command post and have all the players together discussing what you actually would do. You can then actually have a full-scale mock-up disaster response plan acted out in your facility, videotaped and debriefed.
No matter how much you plan for these events, they are always unexpected, and you have to be very fluid in your response to a crisis.