Natural disasters cause challenges for healthcare organizations because of circumstances such as limited communication, restricted transportation, and the emotional toll of the devastation. For oncology nurses and providers, disasters present unique challenges, like maintaining chemotherapy treatment schedules and adhering to research protocols for clinical trial participants. To ensure continuity of care, nurses can provide patients with critical medical information that will be needed if they are displaced, use electronic health records, maintain current copies of patient contact lists and treatment schedules, and stock up on supplies and medications.
AT A GLANCE
- Common challenges following natural disasters include limited communication, restricted transportation, and increased psychological distress.
- Individuals with chronic illnesses, including cancer, are at greater risk for adverse health outcomes during and following natural disasters.
- For patients on clinical trials, communicating with clinical trial sponsors and working with colleagues in other states to coordinate patient care for displaced and nondisplaced patients are crucial.
Hurricanes, floods, fires, cyclones, tsunamis, and other natural disasters take a devastating toll on communities through loss of life and have dire effects on infrastructure, such as water supply, electricity, roads, and telecommunication. Disasters create complicated challenges for healthcare providers who care for patients with limited resources during the events, such as restricted communication, limited transportation, and the emotional toll of the devastation. Particularly for oncology care providers, disasters present unique challenges, like maintaining chemotherapy and radiation treatment schedules and adhering to research protocols for clinical trial participants (Joseph et al., 2007). Joseph et al. (2007) used Hurricane Katrina in 2005 as an example to describe challenges experienced during a natural disaster and identified lessons learned that can be applied to other disasters.
The Impact of Natural Disasters and Challenges for Survivors
Each natural disaster is a reminder of overwhelming devastation. Hurricane Katrina, a Category 5 hurricane that was considered to be one of the most devastating and costly hurricanes in U.S. history, made landfall in 2005, affecting lives and communities in its path along the Gulf Coast (Federal Emergency Management Agency [FEMA], 2006; Rudowitz, Rowland, & Shartzer, 2006). In addition to the loss of homes, jobs, and access to health care and prescription medications in the months after the storm, Rudowitz et al. (2006) demonstrated the psychological distress experienced by survivors, including anxiety, depression, and symptoms of post-traumatic stress. Hurricane Katrina caused a storm surge that destroyed a large part of the infrastructure in New Orleans, Louisiana, and flooded nearly the entire city and surrounding areas, displacing more than a million people (FEMA, 2006; Rudowitz et al., 2006) and affecting an estimated 23,500 people with cancer (Joseph et al., 2007). The historic hurricane left a lasting impression on all who experienced it firsthand.
In September 2017, when Category 4 Hurricane Maria hit Puerto Rico, the island was still recovering from Hurricane Irma weeks earlier, which already had left much of the island without power. Hurricane Maria left residents isolated on the island, with closed roads and bridges; limited supplies of food, water, and power; and limited access to medications and communication. The effects took a toll on the physical, emotional, and mental health of Puerto Rican residents, including concern for loved ones because of lack of communication, anxiety from loss and uncertainty, and illnesses and infections from poor sanitation (Lopez-Candales, Hernandez-Suarez, Osterman-Pla, & Conde-Santiago, 2018). A survey of Hurricane Maria survivors conducted by Kishore et al. (2018) demonstrated that 31% of survey respondents reported issues with access to health care, and nearly one-third of deaths following Hurricane Maria were attributed by family members to limited access to health care.
Ochsner Health System and Hurricane Katrina
Ochsner Health System (2018) is the largest not-for-profit academic healthcare system in Louisiana. In 2005, when Hurricane Katrina hit New Orleans, Ochsner Medical Center was one of three hospitals in the area to remain open (Rice, Colletti, Hartmann, Schaubhut, & Davis, 2006). Dedicated staff members, nurses, physicians, and volunteers maintained patient care throughout the storm. The facility’s disaster plan prepared the team for Hurricane Katrina and its challenges. Strategies to prepare the facility before any disaster included compiling recommendations from other organizations that had disaster experience and educating employees by scheduling annual seminars to prepare them for hurricane season (Rice et al., 2006). Staff members rotated working during and following the storm. A team arrived before the storm, prepared to stay and work through it. Another team started to arrive several days after Hurricane Katrina to relieve the first team.
Rice et al. (2006) reported a detailed account of experiences at the hospital during Hurricane Katrina. As the storm approached the city, staff members and volunteers relocated patients to secure locations in the hospital, families settled in to weather the storm, and some people signed up to volunteer for tasks such as caring for children, caring for pets, or carrying food trays and water. Managers held frequent meetings to make final preparations and backup plans, and others organized child and pet care. Patient care continued in 100°F heat when the air conditioning went out. Staff and volunteers carried rationed water and meal trays using the staircase when the elevators stopped working, and patients were moved because of leaking rain and a fire on the upper floors. To make room for incoming patients, some patients were transferred to Baton Rouge while there was time to evacuate (Rice et al., 2006) (see Figure 1).
Disruption of the healthcare system is a growing contributor to morbidity and mortality following natural disasters (Kishore et al., 2018). In addition, individuals with chronic illnesses, including cancer, are at greater risk for adverse health outcomes following natural disasters (Arrieta, Foreman, Crook, & Icenogle, 2009; Icenogle, Eastburn, & Arrieta, 2016). This makes appropriate disaster preparedness and effective response crucial for hospitals. The following are lessons learned from the experience of providers at Ochsner Health System during Hurricane Katrina.
Patients are provided several different written verifications that document important treatment information. At discharge from the hospital or clinic, patients receive an after-visit summary that describes the care provided, such as medications administered and treatment regimen. It includes a statement that reminds patients to keep a current copy of the summary, particularly during hurricane season, in case they are displaced or require medical attention elsewhere. Patients participating in clinical trials receive a disaster card and a one-page letter that includes information about what do during an evacuation. This information is also posted on the Ochsner Institutional Review Board (IRB) website (S. Gaudreau, personal communication, May 29, 2018). The National Cancer Institute and the American Society of Clinical Oncology offer a wallet card that guides patients to Internet and telephone resources where they can get more information during a disaster. It also includes space for the patient’s name, diagnosis, treating physician, and treatment regimen (https://www.cancer.gov/contact/emergency-preparedness).
Electronic health records (EHRs) makes patient information instantly available, which creates a smooth transition for patients from one hospital or healthcare system to another. Ochsner staff members benefited from the availability of EHR information after Hurricane Harvey, when patients displaced from the Houston, Texas, area were admitted to Ochsner for care.
Having patient contact lists that include study contact information and daily treatment schedules before and after weather events can help with contacting patients who have been displaced, quantifying patient loss in the event that patients are permanently relocated, and quantifying the financial impact of these events.
In anticipation of disasters, the oncology clinic established a system to reschedule patients so they do not miss chemotherapy treatments. If the clinic closes in an extreme weather event, the clinical trials supervisor assigns patient calls about rescheduling to staff members. In the period during and after a disaster, clinics are closed, preventing regular treatment scheduling. Ochsner Health System opened clinics on Saturdays to accommodate patients and to avoid missed or delayed treatments.
The oncology clinic stocks up on supplies before storm season to ensure adequate amounts in the event of an influx of patients from surrounding areas or the inability of supplies getting into the area. The pharmacy department does the same with medications.
For people affected by disasters, social support protects against the negative psychological impact of disasters (McGuire et al., 2018). Reflections from nurses working at MD Anderson Cancer Center in Houston, Texas, who weathered Category 4 Hurricane Harvey in 2017, reinforce this finding. The nurses expressed that outreach from the oncology nursing community from other states was an important source of support (Carr, 2017).
The Ochsner team supported staff during Hurricane Katrina by assigning a staff psychiatrist to a specific location where staff could gather together to process their concerns for themselves or others. The gatherings were held in the hospital’s Winter Garden, an open, nonclinical area. The forums were well attended, and some staff members were referred for individualized assessments (D. Hickman, personal communication, February 23, 2018).
Ochsner uses the “all hazards” approach to emergencies, addressing the needs of the system by analyzing threats of disasters across the organization and using the basic principles of emergency management, which include mitigation, preparedness, response, and recovery (M. Dupuis, personal communication, May 14, 2018). Employees practice evacuation drills routinely and receive annual education on emergency preparedness (M. Dupuis, personal communication, May 30, 2018). In 2015, Ochsner commemorated the 10th anniversary of Hurricane Katrina with a full-scale hospital evacuation drill, led by the emergency preparedness team, that incorporated a variety of departments, clinical and administrative (M. Dupuis, personal communication, May 14, 2018). In the evacuation exercise, the team used the hospital’s fleet of flat-bottom rescue boats that can be used to evacuate patients out of the area if necessary. Ochsner’s IRB Division of Research office hosts an annual disaster preparedness presentation for employees and provides annual communications with specific information on disaster planning for principal investigators and clinical research coordinators (S. Gaudreau, personal communication, May 29, 2018). Figure 2 lists disaster preparedness resources.
The heroic efforts of healthcare workers and volunteers and the outpouring of support from the international community are a reminder of people’s capacity for survival and resilience. Emergency plans that involve patient care coordination for displaced and nondisplaced patients and support for staff can be useful when continuing treatment in the aftermath of a disaster and managing the emotional toll of the event.
About the Author(s)
Maria Nix, MSN, BSN, RN, is an RN clinical educator, and Daphne Caldwell, RN, OCN®, is a staff RN, both at Ochsner Health System in the Greater New Orleans Region, LA. The authors take full responsibility for this content and did not receive honoraria or disclose any relevant financial relationships. Nix can be reached at firstname.lastname@example.org, with copy to CJONEditor@ons.org.
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