Symposium Tackles Continuity of Care in a Community Disaster

The term “disaster” refers to either a man-made event such as a terrorist attack or major accident, or natural, such as a hurricane or tornado. They can strike at any moment. With the experiences of several recent disasters fresh in our minds, New York’s Adelphi University Center for Health Innovation tackled the subject in a recent symposium called, “Assuring the Continuum of Care in Emergency Situations.”

Have you ever considered what you would do if there was an emergency or disaster in your area and you needed medical assistance? Are you, your doctor and your community prepared for a disaster that could inhibit a range of services from simple follow-up visits to more complex services such as kidney dialysis or cancer treatment?

Ironically, as this symposium took place, the Adelphi University area of Long Island was suffering the aftermath of a large-scale blizzard, which blanketed some communities with more than three feet of snow. Residents were trapped in their homes with unplowed streets, municipal transit systems were paralyzed, and major thoroughfares were impassable due to bureaucratic conflicts over who was responsible for administering the cleanup process.

Additionally, this geographical location had been at the heart of devastation months earlier during Superstorm Sandy. Residents and public officials indicate it will be years before Long Island fully recovers from this unprecedented hit.

The symposium could not have been more timely.

“We planned this symposium for over a year. The timing [during a blizzard, during storm recovery] could not have been more critical after what we had just lived through in the New York area,” said Meghan McPherson, MPP, CEM, coordinator for the Adelphi University Center for Health Innovation. “We were thrilled to be able to offer this program for our community and will offer more going forward.”

Emergency Management Care

The day began with keynote speaker Edward Gabriel, MPA, EMT-P, CEM, CBCP, who is the Principal Deputy Assistant Secretary for Preparedness and Response for the U.S. Department of Health and Human Services. He spoke of his experiences in both his current position and previously with the Walt Disney Company, where he served as Director of Global Crisis Management and Business Continuity. Prior to his time in the private sector, Mr. Gabriel spent 26-plus years with the FDNY before retiring at the rank of Chief of the EMS unit. During his tenure working for New York City, he was responsible for preparedness and planning-related strategies, projects and initiatives.

While working in New York City, he experienced two attacks on the World Trade Center; a major blackout; and fire-related events with extensive death and devastation. How he administered and managed the organization of healthcare for victims provided a riveting kickoff topic for the symposium’s opening.

Featured speaker Dr. D. Sean Smith, from the Joplin, Missouri-based Mercy Clinic Hospital, spoke about the devastation that a large tornado brought to his area in May 2011. Dr. Smith said that it was just by chance that he was not in the midst of the event when it struck; however, he found upon arrival at the medical facility that the effect of the twister was surreal. Providing emergency medicine and initiating search and rescue efforts became the priorities for all of the hospital staff, despite not knowing how their own families had weathered the event. At least 150 people were killed and more than 1,000 injured. The Joplin tornado is the seventh deadliest tornado in United States history.

Dr. Smith discussed the severe and unusual nature of many of the injuries discovered, and how the medical professionals had to think beyond traditional methods of care to save lives. He also spoke of the need and the difficulty it would take to restore both Mercy Clinic and St. John’s Hospital (an affiliated part of Joplin’s critical medical infrastructure). As the largest employer in the area, the decision to remain and rebuild provided an added level of resilience for the area.

The final featured speaker of the morning was Kimberly Glassman, PhD, RN, NEA-BC, Senior Vice President, Patient Care Services and Chief Nursing Officer, NYU Langone Medical Center. Dr. Glassman shared compelling tales of bravery and ingenuity from Superstorm Sandy. The NYU medical facility, which sits close to the waterfront in Manhattan, was breached by the storm surge from Sandy. The surge caused several power outages throughout the hospital. Glassman and her team of nurses made the difficult decision to begin transport of patients from the maternity and NICU wards. She discussed the team’s first-time implementation of medical slides that aided in moving patients down hospital floors safely. The success of this tactic has led to the hospital acquiring more slides for future emergency needs.

The most dramatic transport during the storm was perhaps that of the 20 NICU infants to a facility that could better treat them under the circumstances. Teams of nurses, hospital workers, police, and firefighters joined together and moved in unison using flashlights and battery-operated equipment to ensure the infants’ safe arrival at their temporary treatment location, ensuring their continuity of care.

As the storm battered the area for days, the medical teams continued their care, much like those in Joplin - not knowing whether their own loved ones were safe.

“We have quickly made a lot of structural changes,” Glassman told the audience, “so we may weather a storm differently.”

Mental Health Care

Though not often discussed in emergency and disaster planning, the continuity of care for mental health patients was addressed at the symposium. A panel of experts from across the discipline was convened to discuss the variety of effects that disasters can have on those suffering from mental health issues. Whether it is the need to understand critical instructions, or have the ability to make appointments, contact care providers, or acquire needed prescriptions or medications, it is important to discuss what types of strategies need to be in place for mental health patients to successfully survive an emergency situation, and not experience discontinuity of their care structure.

The panel also announced the results of the latest Center for Health Innovation (CHI) Poll, surveying industry professionals nationwide about how prepared they felt for an emergency. The Adelphi University CHI Poll was conducted by Wakefield Research (wakefieldresearch.com) among 100 mental health professionals, defined as psychologists, psychiatrists, LICSWs, LISWs and CSW-Cs, between January 25 and February 4, 2013, using an email invitation and an online survey.

One of the most startling revelations to come out of the of Mental Health Preparedness and Disaster Response Poll is that out of the 100 surveyed, nearly half of mental health professionals in the Northeast (48 percent), South (48 percent) and West (46 percent) feel their community’s mental health system is unprepared for a disaster. Midwesterners feel differently—only 21 percent say their community’s system is unprepared.

Additionally, the poll asked how prepared the practitioner was for an emergency and whether these mental health professionals had planned ahead. The survey found that many have not. Ninety-two percent of these professionals don’t have a clinical will in place in case of an emergency. Further, 82 percent haven’t discussed a contingency plan with their clients and 65 percent haven’t discussed alternative ways for clients to reach them. The list continues with more than half (52 percent) not having referrals available in case they’re unreachable and nearly half (46 percent) not having backed up their files digitally.

Additional panelists described their own experiences in emergency care and talked about the current state of affairs for patients following Superstorm Sandy: Lisa Murphy, Commissioner of Nassau County’s Department of Human Services; Georgine Gorra, DSW, LCSW-R of the American Red Cross; Victor Fornari, MD of North Shore-LIJ Health System; and Robin Kerner, Ph.D. of St. Luke’s-Roosevelt Hospital. Storms of such magnitude can potentially bring forth issues that patients have not dealt with, while other patients may not feel affected right away because they are in a shock-like state.

Specifically, Dr. Fornari discussed how the genesis of his expertise came from dealing with mental health patients in crisis after the Avianca plane crash on Long Island in 1990. His work with those people who were affected by the tragedy catapulted him into a position to develop state, and eventually nationwide, plans to manage psychological trauma in times of crises.

As the symposium came to a close, the final panel focused on healthcare informatics, and how to prepare the data systems now required by the Affordable Care Act (ACA) to maintain operations during an emergency. As all levels of healthcare anticipate a complete transition to electronic medical records, professionals must prepare redundant and back-up systems to maintain the continuum of care when the primary record system fails. The members of this panel included Maureen Gaffney, Senior Vice President, Patient Care Services and Chief Medical Information Officer of Winthrop University Hospital; Nick VanDuyne, Chief Technology Officer at NY eHealth Collaborative; and Jack Hueter, South Jersey Director of NJHITEC. Participants offered useful advice on how practitioners can work through the issues that will be brought about by the EMR mandate in the ACA. The panelists emphasized the importance of those redundant systems during Hurricane Sandy and stressed the need to maintain the management of such systems as a complete system-wide shift is made.

In closing, Dr. Patrick Coonan, the Dean of Adelphi’s School of Nursing and the academic director of the Center for Health Innovation, echoed a theme that rose to the top of each of the day’s panels. “We all have to learn to work together - between local agencies, government agencies, volunteer agencies and all the people who provide care from a medical and mental health perspective,” he said.

Ms. McPherson added, “We are very pleased that our first CHI symposium was so successful and timely for our community. Eliminating stovepipes that are inherent in every discipline will only help us to better serve our fellow citizens in their time of greatest need. It is important to have conversations that highlight the multi-disciplined approach that is such an important part of emergency response and recovery.”