In a large-scale catastrophe, assume your communications systems won't work, your inventory of emergency supplies is inadequate, individual facility plans won't apply and your government will be overwhelmed.
If you know those things going in, you may survive, John Finn told health-care providers and administrators at Intermountain Healthcare's Healthy Communities Conference recently in Salt Lake City.
Finn, president and chief executive officer of the Metropolitan Hospital Council of New Orleans, saw firsthand the devastation of Hurricane Katrina in 2005 — first from the floodwaters and then from lack of adequate preparedness and response, particularly by the Federal Emergency Management Agency.
"I apologize that I'm going to be using politically incorrect words," he said, "particularly the 'F' word: FEMA. It's the dirtiest word we have in New Orleans."
For starters, Finn said, local disaster-planning focused on the wrong disaster. They spent endless hours and resources figuring out how to handle a chemical disaster and were gearing up to tackle biological threats. They were completely unprepared for Katrina's devastation. But the lessons they learned are applicable to any large-scale disaster, he said.
Hospitals all had individual facility disaster plans, but they failed to take into account an entire city and beyond that had no services, no fire departments, no transportation or communication and more. They had the recommended three-day emergency inventories, which were not enough.
Landline and most cell phone services were out, with the exception of Nextel, which by chance had one cell tower standing. Even the "special" radios failed in the first few hours. He counseled local health providers to make sure their hospitals don't all rely on one phone service, since it's impossible to guess which ones will stand and which ones will fall in a disaster. Every hospital should recruit a ham radio operator if they don't have one on staff, because that may be a lifesaver, he said.
The hospitals that fared best were those that were part of large systems and could call on sister facilities outside of the area for help, he said. The larger hospitals, once stabilized, tried to help the smaller, independent hospitals.
But the conditions they all faced were dire — no food, no water, few medications and 130-degree temperatures in the facilities.
You take your resources where you find them and sometimes it's a surprise. An assistant hospital administrator proved adept at getting and moving supplies, directing helicopter landings and other tasks so efficiently, she ended up running the airport and bossing around the military staff. When Katrina was over, Finn said, she never set foot in her hospital again.
A surgeon with finely honed small-motor skills proved adept at opening padlocks at convenience and other stores to get supplies that were direly needed. They left notes, Finn said, and paid for things later. "Heroes and heroines were not the people you expected. They were all types of people who, when it got to the bottom line, did it."
He also told the hospitals to make sure they have weapons to protect the inhabitants and prevent looting of critical supplies. You don't have to shoot someone. But discharging a weapon at a ceiling is a great dissuader, he said.
The most important thing is maintaining flexibility and creativity. One hospital was able to get and give crucial information simply because a doctor decided to try the OnStar system in his vehicle. It worked.
At one point, Finn said, things were so dire and needs so great that his administrators created their own "state police" letterhead and documentation to allow their food and fuel trucks to move around as needed without being confiscated and obstructed by government agencies that were "helping."
Do what you need to do, he counseled. "Think what your purpose is. You're there to save lives."
In crisis, he added, forget rules in favor of principles.