Disaster Planning

January 2018

​​When Disaster Strikes, How Will We Respond? 

It took only 45 seconds for an EF5 tornado to destroy two floors of St. John’s Hospital in Joplin, Missouri in 2011. 

“We tend to think disasters are rare, and that it’s unlikely a disaster would overwhelm our system,” said Jason Persoff, MD​, SFHM. “In Joplin, it only took a few minutes for everything to change.”

The event launched Dr. Persoff, MD, SFHM, into disaster-response mode. He joined forces with Charles Little, DO​, FACEP, who has been working to prepare University of Colorado Hospital for potential disasters since 2005. (Pictured left-right, Charles Little, DO and Jason Persoff, MD)

“Historically, we assumed everyone would show up and do the right thing,” said Dr. Little, medical director for Emergency Preparedness and associate professor of emergency medicine and public health. 

That’s just what professional storm chaser Dr. Persoff did in Joplin. He’d been in the area taking photos. Knowing St. John’s had taken a direct hit, he reported to the only hospital still standing in the city, knowing it was about to be overrun with casualties. 

As an internal medicine physician, he helped where he could. He was asked to create a ward with several nurses to treat patients from St. John’s. 

While the emergency department and surgery unit had plans in place to triage and treat casualties as they arrived, Dr. Persoff realized there was a big hole in their response. 

“I realized internal medicine can play an important role in these disasters,” Dr. Persoff said. “Patients continue to have diabetes, heart attacks and strokes. And with the patients of one hospital being transferred to another, we needed to help medically-fragile patients who didn’t need traditional emergency department care.” 

He also noticed how important succession planning was in the hospital’s overall efforts. 

“Everyone wants to help when a disaster starts. But those early volunteers burn out during the first 12 hours. I came to UCH wondering how we could better plan for the second and third shift. How do we maintain a marathon-like presence?” 

Emergency Department Preparedness 

As an emergency medicine physician, Dr. Little has long been part of emergency preparedness planning. In recent years, he's helped to coordinate the administrative and medical response of the hospital’s other clinical units. 

The challenge lies in ensuring that each clinical unit develops a plan that integrates with the hospital’s overarching plan. 

“Typically our units plan in silos,” he said. “Areas aren’t aware of what is getting planned in other areas. Our response to emergencies is less effective when departments incorrectly assume an aspect of care is being handled by someone else.” 

To combat this, Dr. Little and his team work through simulations that put their plans to the test. 

“We recently simulated an Ebola outbreak, and walked through the entire process, thinking deliberately about each step. We learned what seems simple on paper gets complicated in real time.” 

He cites the example of a real situation in which the hospital’s computer systems went out. 

“We learned during a real downtime event that many of our new physicians and nurses don’t know how to write patient prescriptions and orders on paper,” he said. 

This realization made them go back to their original plan, and rescript everything. 

The Role of Internal Medicine 

Dr. Persoff is helping to develop an emergency plan for internal medicine that outlines the role of hospitalists. Though they are in the beginning stages, the first priority is to understand the role they will play in moving patients out of the ED to increase capacity. 

“In August, we were notified of an incident at DIA. It was the middle of the night and we didn’t have any idea of how many patients there would be. Since I had an idea of how the plan would work, internal medicine got involved right away. We were able to clear out an additional 10 beds in the ED in the first hour of the disaster, which greatly improved the flow for incoming patients.” 

As Dr. Persoff and his team expand the plan, they will look at ways to help provide consultations, rapidly discharge and act as a safety net when surgeons are in the operating room. 

“We’re also looking at how we can involve our outpatient clinics and staff in very large disasters, such as epidemic flu and bioterrorism,” he said. 

Both Dr. Persoff and Dr. Little believe hospital systems must be prepared for sudden, large influxes of patients. Both say these situations are not ifs, but whens. 

As Dr. Persoff saw firsthand, situations can change in a minute. 

“Having a robust, planned response reduces stress on our doctors and nurses and helps us provide productive care despite the marked change in workflow,” he said. 

Dr. Little said the planning that’s taking place at UCH is a great opportunity for all School of Medicine clinical faculty to engage with how their units would respond to an unusual event. 

“This will be our big push in the next few years,” he said. “Everyone needs to be involved and integrated into our planning.” 

Jean Kutner, MD​, MSPH, chief medical officer, said UCH is fortunate to benefit from the experiences of Drs. Little and Persoff. 

“It is essential to plan ahead so that we are able to meet the needs of our existing patients as well as those who are affected by the event and our community,” she said. ​​