By SUSAN BITAR, RN, MSN

The 2017, hurricane season has been an eye opener and has prompted hospitals to adapt a costly and convoluted action plan to prepare for the impending natural disasters with the potential for mass casualties.

In 1980, the natural disaster preparation plan for a hospital, consisted of making sure the hospital staff, administrators and doctors are on standby at their residences and have a viable mean of communication, merely, a phone line and a pager. The local sheriff was also alerted in case help was needed to assist doctors and staff to get into the hospital if access was limited due to the disaster itself. Back then, there was no need for extra personnel to stay in house (camp out at the hospital) unless a medical staff member knew ahead of time that he or she would be cut off during or after the disaster. The cost of disaster preparedness was due to lack of new patient admission and cancellation of elective procedure when the local community is hunkered down during the natural disaster.

In 2017, the natural disaster preparedness is a complex process and has many disciplines:

• The maintenance crew and engineers have to be deployed on site to help maintain and implement backup plans for power loss, water damage, flooding, contamination of water supply, alternative shelter if upper floors are damaged or lower floors are flooded.
• The administrative team has to be on site to assess disaster related problems and to make decisions as problems arise.
• Additional staff and certain specialty physicians have to be in house in case access to and from the hospital is impeded by the disaster itself.
• The patients who could not be discharged from the hospital prior to the disaster and their families that wished to sleep in a cot next to them and the family members of anyone on the hospital ancillary personnel or medical staff along with their loved ones who could not be left home alone ( a vulnerable family members at home during the disaster, single parent with children, elderly parent, family members with special needs etc).

It is no surprise that a hospital facility that ordinarily has 150 patients and 250 support staff finds itself housing a patient load of 50 but with 250 support staff and additional 200 family members (patient families and staff families). This demands additional security staff, additional food services and housekeeping personnel to deal with this hospital population overload. The hospital is now saturated to maximum capacity and turns into a large: part shelter part hospital.

One can only imagine the financial and manpower burden on the hospital during the natural disaster - couple that with halted elective procedures during and after the disaster due to community recovery efforts.

Normally, the local authorities and federal government agencies have various search and rescue plans that have manpower resource limitation and budget restraints attached to it. The national guard search and rescue policies factor in the risk to first responders, the available manpower and the cost of the mission. Sometimes, judgment is made by the local officials in charge, to abandon a search and rescue mission based on various factors, some of which may be exhausted manpower resources, low yield of a successful mission and exhausted financial resources.

In case of a flood of injuries during a disaster, the fact that the hospital is already saturated with staff, ancillary staff, families and pre-disaster inpatients, is a detriment. The overpopulation of the hospital will impede the work flow and limit the hospital's ability to accept and care for a large number of disaster related injuries.

All local and federal agencies including FEMA, operate within a limited budget and, therefore, hospitals too, may need to revisit the disaster preparedness process and consider the financial ramification. The preparedness execution plan should not have an open account expense and should have reasonable fiscal restraints.

The hospitals taking on the role of a part shelter, as a way to accommodate extra ancillary staff and family, put the facility at greater risk if the physical building itself is affected by the disaster, for example, fire, flood, partial building destruction. The added number of people in the building puts more stress on the resources to help a hospital population in need of dire help.

One idea to consider, is to designate a nearby shelter for the ancillary staff families, so the staff can feel that their families are close by and yet protected.

Another idea is to classify the necessary added ancillary staff into group A that has to be on the premise during the impending natural disaster and group B, that can stay with their family in the nearby shelter and can be quickly transported into the hospital if the need arises.

The medical facility should incorporate an expense account to fund the disaster related financial burden and attempt to stay within an allocated annual fiscal budget.

Susan Bitar, RN, MSN, is a professor in the Department of Nursing at Seminole State College in Altamonte Springs, Florida. She can be reached at Suebitar@gmail.com