Weathering the Storm
Providing the best quality care is challenging during periods of crisis. Knowing what to do before, during, and after a crisis ensures you are able to tackle difficult situations.
The old adage “better to be safe than sorry” never rings more true than in situations of crisis. Hurricanes, earthquakes, blizzards, terrorist attacks — even something as simple as a power outage — can cause disruptions in the radiology department and affect the quality of patient care.
Do you and your staff know how to react to an emergency situation? And which precautions should you take ahead of time? Here are some considerations you should take, straight from radiologists who have weathered their own disasters.
Lines of Communication
Communication is critical during any disaster. The staff in your practice or department must be able to effectively communicate with one another and access outside resources immediately.
Storms can damage your ability to communicate, however. Geraldine B. McGinty, MD, MBA, FACR, experienced these difficulties firsthand when Hurricane Sandy made landfall in New York in 2012. During the hurricane, the wide area of impact and unpredictability of power outages was beyond what might have been expected — even after the storm. Cell phone towers were down and phone lines were often jammed, so it was difficult to contact both patients and staff.
To overcome the communication issues, McGinty’s practice used texting as a backup communication method. They found that while texts aren’t always 100 percent reliable, they often go through when calls cannot. FEMA recommends using other sources as well, such as email or radio systems.1
You may also want to consider your internal communications. During an emergency, establish times that your staff can speak together easily and effectively, even when there is much to be done. In the aftermath of the April 2013 Boston terrorist attack,communication was critical to operations at Massachusetts General Hospital, says Efren J. Flores-Serrano, MD, who attended to victims of several homemade bombs that exploded during the annual Boston Marathon. From the moment the hospital received news of the attack, the leaders and managers of hospital departments met to make sure that their facilities and staff were prepared for the sudden influx of patients. From there, each department established times for staff to discuss patients and make sure that every staff member was prepared and up-to-date on the current status of the hospital. A hospital-wide email ensured that all staff, even those outside the emergency department, understood the situation.
Flores-Serrano also notes that communication is helpful in boosting staff morale. Before the victims of the attack came in, he gave his CT technologists a pep talk, reassuring them that they were all working to provide the best care possible, despite the circumstances. He adds that this occurred throughout the emergency department; everyone wanted to make sure that they kept their ultimate goal — quality care — in mind.
Regardless of the situation, FEMA advises groups to try to have at least one daily meeting with staff. It will help to communicate reliable information, alleviate fear, and eliminate rumors. For a calm, safe environment, it is imperative that you be open and honest with staff members.2 Be sure to take the time to repeat information to ensure comprehension.
Staffing is an important consideration as well. If you are running services during any kind of disaster, make sure you consider how your staff will get to work and what happens if they cannot get home, recommends James V. Rawson, MD, FACR. He adds that his practice brings in overnight bags in the event of bad weather. This way, even if they do not need to use them, they have the option.
During Hurricane Sandy, the importance of communication in all areas — especially staffing — was reinforced for McGinty. Because there was such widespread damage, it was important that they had a procedure in place to reach out to staff and patients to inform them when the practice was functioning as usual.
Keep in mind that staffing issues don’t always stop when the storm does. McGinty’s practice continued to face staffing problems immediately after Hurricane Sandy. A gas shortage affected the entire New York metropolitan area. Some staff members lost their homes or their cars, and the city had imposed a curfew, so staff couldn’t stay out late. McGinty’s practice had to closely examine how staff could safely and easily get to work. Until infrastructure was back up and running, practice leaders evaluated which appointments were critical and which staff members were needed.
"Focus on the work and make sure that your readings are providing accurate information and helping patients." – Efren J. Flores-Serrano, MD
Equipment and Technology
Once you’ve got your staffing figured out, you also need to consider your equipment. Determine which machines and imaging services will absolutely need to be functioning. If your department cannot provide certain tests, there should be a plan in place to obtain these studies at a different institution or to transfer patients, according to FEMA.1
Rawson recommends that you remember to check the temperature of your exam rooms and assess equipment for potential failures in your emergency plan. As you examine your critical equipment, also note that many machines rely on an optimum temperature, and the failure of cooling or heating systems could prove disastrous. For instance, MRIs need liquid helium and nitrogen to cool the superconducting magnet. If the power is out and the temperature rises, the gases burn off. Without water as a cooling agent to take the gases’ place, the magnet could become damaged.
Mass Casualty Events
Mass casualty events come with another set of considerations. For instance, how might you handle a large influx of patients? Following the Boston terrorist attack, leaders at Massachusetts General made sure that they first quickly took care of the patients who were already in the emergency room. Anyone who needed imaging was given expedited care to make room for the coming influx of patients. All imaging rooms and scanners were made accessible, not only in the ER but also in the inpatient and outpatient units.
When dealing with a patient surge, make sure there will be enough staff on hand. For instance, a shift should plan to come in earlier or stay later to cover other staff members. Many hospitals overestimate their capacity for treating a large number of patients, so you may want to consider running drills for patient surge situations.3
In any event considered a disaster, but especially those involving large numbers of trauma cases, providing medical care to injured and distressed patients will undoubtedly cause stress on your staff. If possible, consider bringing in psychological support, such as counselors, to ensure the physical and mental wellbeing of your staff. For Flores, overcoming his emotional ties to the scene was difficult, especially seeing the many patients injured with shrapnel. The way he overcame this, he explains, was to treat the day like any other. “Focus on the work and make sure that your readings are providing accurate information and helping patients,” he says. “We made sure that we were giving the best possible care at every single moment.”
Finally, it is important to understand that despite all of your planning, not everything will go as planned in an emergency. Leaders and staff should be patient and flexible regardless of the situation. By preparing your staff and having procedures in place, you can be as ready as possible to provide the best care to the patients who enter your doors.
By Meghan Edwards
1. Federal Communications Commission. “FCC/FEMA Tips for Communicating During an Emergency.” Available at http://bit.ly/CommTips. Accessed Aug. 25, 2013.
2. Bluth EI, et al. “Managing a Catastrophe During Hurricane Katrina.” American Journal of Roentgenology 2007;188:630–32.
3. Sosna J, et al. “Facing the New Threats of Terrorism: Radiologists’ Perspectives Based on Experience in Israel.” Radiology 2005 Oct;237(1):28–36.