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Patient Flow E-Newsletter
Volume 5, Issue 1
March/April 2008
Special Focus Issue-Emergency Management
Best Practices
Preparing for a Disaster Through a Regionalized Approach
For emergency management professionals at hospitals across the country, the events that unfolded on Sept. 11, 2001, were an epic reminder of the need for disaster preparedness. Although some hospitals had previously relegated emergency preparedness to the back burner, the attacks quickly renewed the drive for emergency planning and coordination nationwide.
Those efforts were accelerated by a 2002 federal mandate from the Bush Administration, which required hospitals to increase capacity in order to cope with potential large-scale emergencies. The Department of Health and Human Services’ Health Resources and Services Administration (HRSA) distributed grants to help regions develop highly tailored plans to handle a sudden surge caused by a natural or man-made disaster. In 2006 these grants were transitioned to the Assistant Secretary for Preparedness in Response (ASPR) also under Health and Human Services.
Little did hospital officials in parts of Louisiana know how soon they would need to implement those plans.
In the first of a five-year grant series, the Louisiana Department of Health and Hospitals (LADHH) contracted with the Louisiana Hospital Association (LHA), who in tern contracted with Erin Downey, MPH, ScD, to serve as its HRSA Director of Emergency Preparedness.
“When an emergency hits, resources need to be provided at the most local level possible – and existing community health care resources are best suited to provide this,” Downey says. “Because of Sept. 11, Hurricanes Katrina and Rita, and other tragedies, we know that the plan to provide effective and timely emergency preparedness has to be generated by existing service providers in a community, rather than from the outsiders who present after the disaster. The federal grants enable communities to do this. In Louisiana, for example, we worked to develop the state’s resources so that they could link communities with the state and federal responses.”
Hurricane Katrina
From 2002-2005 Downey led the implementation of the (then) HRSA grants at the local level to help form a regionalized Louisiana infrastructure for patient surge capacity. This primarily consisted of implementing the mindset and environment that allowed area hospitals to think and function regionally in the wake of a disaster.
“The government can provide grants to help hospitals and others come together to think about coordinating a disaster response, but it can’t mandate a willingness to work together,” says Downey. “That takes time and trust.”
During Downey’s tenure, there were five major declarations of state emergencies, including Hurricane Katrina, one of the deadliest natural disasters in U.S. history.
Given the destruction and suffering that resulted from poor state and federal coordination, analyses have rightly judged the response to Katrina negatively. But for Downey and hospital emergency managers on the ground, the system that they had been planning worked – it was the magnitude of disaster that no one could have properly anticipated.
“Katrina was the mother of all storms,” says Kerry Jeanice, RN, EMT-P at West Jefferson Medical Center in New Orleans and the hospital’s HRSA emergency coordination representative. “Nearly three-quarters of our region was decimated and area resources were completely wiped out. Just three of 26 hospitals in our four-parish region were able to stay open. Given the truly catastrophic nature of the disaster, locally we actually did quite well and that is entirely because we began this planning process through the grants. Without that preparation, it would have been much, much worse.”
Downey agrees, saying she “could not have been prouder of how well the hospitals worked together.” While she agrees that the regional response system was still in its infancy and not nearly ready for a storm the size of Katrina, the health care system in the region stayed operational throughout the crisis and implemented the regionalization practices successfully.
“Those hospitals did an amazing job managing their own crises and coordinating with each other,” she says. “In most ways, they behaved as near-perfect models of crisis preparedness and implementation. They were leaders in the response.”
Three Pillars of Success
Analyzing the hospitals’ performances after Katrina, Downey identified three pillars of practice in the Louisiana regionalization system that collectively worked to support the system’s emergency response: Coordination, Communication and Infrastructure.
Downey says regional coordination is the most basic facet of a regionalized health care system – how to bring order to chaos. Downey helped to implement this by organizing the state’s 64 counties (known as parishes) into nine emergency response regions. Overseeing each region is a Designated Regional Coordinator (DRC). His or her job is to coordinate emergency response information and efforts in the event of a crisis with coordinators at every hospital and some other related institutions.
“The regional coordinator is a local individual who best knows the region and can quickly implement realistic plans,” says Downey. “The regional coordinator assesses the emergency situation and lets the hospitals throughout the region know where to place emphasis and what to focus on.”
The coordination is strengthened through regular meetings, training sessions and “what if” scenarios with regional coordinators and hospital emergency managers from across the state. Other relevant disaster preparedness groups also attend. The ongoing meetings help develop and strengthen the crucial relationships between local entities that might not otherwise exist.
Another crucial component for the regionalization concept to work effectively is crystal-clear communication among all resources within a region. Information cannot be shared or help provided if some hospitals are out of the loop. Downey says that this is a very common problem experts notice when reviewing disaster responses – some hospitals just go into lock-down and operate in a vacuum; others lose the technical ability to communicate. A similar problem is failure to communicate with others outside of one’s region during an emergency.
Downey addressed these problems by implementing back-up communications protocols within each region and between all regional coordinators through two-way radios and special training on how to communicate during emergencies. This kept all hospitals and regional coordinators aware of what was happening in the farthest corners of the state. While this had never been done before, it proved crucial to planning for things like evacuee surges hitting other areas of the state, away from where the disaster occurred.
“Keeping communications flowing was a direct result of the preparations and planning that we put into this system,” says Jeanice. “The regular communications we had helped us know what was coming, prepare for it as best we could and weather some of the catastrophes of the disaster. It is an important reason why we were able to help so many patients and also stay sane during the storm.”
Downey says the third pillar for keeping a regionalized system on track during emergencies is to maintain important infrastructure before, during and after a crisis. She says this includes both physical and personnel infrastructures, which will grow fragile without use. If properly planned, developed and exercised, however, she says the emergency preparedness infrastructure will provide hospitals with what they need to successfully work through a disaster.
“It is increasingly acknowledged that the role of a coordinator in keeping the infrastructure intact and keeping internal and external communications flowing is crucial to the emergency response,” says Downey. “This is not something that can be done in addition to someone’s regular job, especially during an emergency. This is their job. But the reality is that most hospital decision makers still do not see the importance of putting someone in this role in a dedicated, paid, full-time position. That needs to change.
Additionally, explains Downey, the regional coordinators’ roles via the federal grants are not designed to fund full-time positions and consequently the majority of these individuals filling these positions are volunteers of the community. “While their roles continue to expand with responsibility, there is no payment or security that expands with their efforts. This makes the regional infrastructure – which we know works – extremely fragile. States and federal entities need to address this.”
Downey stresses that keeping the infrastructure ready boosts the region’s long-term emergency functionality and keeps the coordination and communications pillars strong.
“Too many hospitals think of this as an exercise you do once and then you can put it on the shelf because you’re ready,” she says. “Anyone who has been through a disaster knows that it doesn’t work that way. It truly is a case where practice really does move hospitals closer to perfect.”
Assessing the Impact of Regionalized Emergency Preparedness in Louisiana
While Louisiana’s regionalization system did not avert the unprecedented disaster that unfolded during Hurricane Katrina, emergency experts in the state and others nationwide have learned from it and call the regionalized response in Louisiana a success.
“Our regionalized approach to emergency management certainly could not keep the levee from breaking, but it did establish an infrastructure of health care resources and staff who were – and are today – better prepared to coordinate and communicate throughout a crisis,” says Jeanice. “Against great odds, the hospitals that remained open continued serving in some capacity. I don’t know what would have happened if we hadn’t already spent a couple years planning. You like to think that since we work in a state of constant emergency, we have the physical and mental resources and staff to handle anything – but you still have to prepare. This experience taught all of us about the value of regionalization and the need to constantly refine our preparedness.”
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Erin Downey, MPH, ScD
Adjunct Faculty, Tulane School of Public Health and Tropical Medicine
Senior Health Systems Analyst, I.E.M.
New Orleans, Louisiana
Kerry Jeanice, RN, EMT-P
Clinical Manager of Emergency Preparedness and Flight Nurse, West Jefferson Medical Center
Marrero, Louisiana | 
