The Repetitious Cry: Don’t Wait for the Cavalry

Recently, I heard a local business owner who had been affected by the BP oil spill in the Gulf repeatedly state on a national TV interview that the government’s intervention to address this disaster has been minimal, disorganized and ineffective, often hampering the positive actions of the local inhabitants and volunteers. In essence, he was giving the same advice not only CHRISTUS Health, but others have given when facing disastrous events: Do not wait for the cavalry.

We first heard this cry when we visited New Orleans in 2007 on one of our learning journeys as part of Futures Task Force II. We heard over and over again from the leaders of a local hospital system that they got little helpful assistance in facing the significant negative results of the storm, including the large number of critically ill patients who needed to be evacuated. They, appropriately so, decided they needed to take control of the recovery plan and implement it themselves.

CHRISTUS Health had a similar experience in the Houston flood in 2004, Hurricane Rita in 2006 and Hurricanes Gustav and Ike in 2009. Our plans for evacuating patients, obtaining generators and garnering emergency supplies worked well because we had plans, teams and strategic relationships in place in the affected areas. Local systems that are efficient and effective appear to be easier for us to implement than the government, so we first and foremost rely on our resources and planning.

And unfortunately—but not unexpectedly—we experienced the same in Haiti. To overcome the lack of governmental plans, scores of volunteers have, and continue, to provide the most needed medical care and recovery efforts for those in need.

So what does this tell us as leaders in health care? First, it is imperative to have a well thought out and documented recovery plan in place. Second, these plans should be reviewed and drilled annually. Third, when disasters occur, get as much of the plan implemented as possible before the government intervenes. And fourth, don’t ever forget the leadership imperative: do not wait for the cavalry!

Preparing for Biological Disasters

I have blogged before about the CHRISTUS Health experience with hurricanes multiple times. As many of our facilities are located on the Gulf Coast, we learned first-hand the importance of having a clear disaster response strategy in place.

This commitment to a disaster response strategy extends beyond just hurricanes, though. The world’s experience with H1N1 flu last year reminded all of us how important it is to be prepared to offer an immediate, well-coordinated response to pandemic and biological disasters as well.

At the end of March, the CHRISTUS Health Pandemic Committee conducted a system-wide drill after several months of development and revisions of its influenza/biological pandemic plan. The mock scenario was an outbreak of unusually severe illness; specifically, a particular strain of H1N1 influenza that had been identified by the Centers for Disease Control as Phase 6 (widespread) in many states including Texas, Missouri, Louisiana, Arkansas, Georgia and Utah – all regions in which CHRISTUS Health operates.

The exercise, was launched by the system Senior Leadership Team in the corporate command center in Dallas, and we immediately began assigning and prioritizing incident response activities.

Team members quickly solidified our roles and began responding to approximately 35 mock requests for assistance that were being phoned in or made via e-mail directly to the command center from across our regions and facilities. Regional emergency preparedness coordinators from the CHRISTUS Health Southeast Texas, Southwestern Louisiana, Central Louisiana and Ark-La-Tex regions, as well as CHRISTUS Spohn, CHRISTUS Medical Group, CHRISTUS St. Vincent, CHRISTUS Santa Rosa, CHRISTUS Health Utah, Infection Control and Risk Management were among those participating in the drill.

Through this exercise, we aimed to build system-wide competency and familiarization of the revised CHRISTUS Health influenza/biological pandemic plan; provide an opportunity to exercise system pandemic reporting applications (EMResource, CHRISTUS Health emergency Website resources) with participating CHRISTUS facilities and the corporate command center; and practice emergency communications protocols by relaying vital information between responding entities.

The exercise lasted approximately three hours, including a debriefing and “after-action” review to identify what went well, opportunities for improvement, gaps in our emergency preparedness planning, and policies that will be addressed. We’re also investigating how to build social media tools into our existing disaster response communication plans, realizing the need for additional communication tools in our arsenal that can be quickly updated and are easily accessible by displaced Associates via home computers or mobile devices.

Disaster Response: What we Learned from Haiti

As I mentioned previously, CHRISTUS’ 20-member team worked in Haiti from Feb. 20-27 and performed 85 surgeries, hundreds of procedures and outpatient visits and delivered nine babies.

We have since debriefed with team members who traveled to Haiti as well as with the task force that worked to identify and vet partner organizations in Haiti and select, organize, orient and commission the Haiti team. I believe our findings are so important that they are worth sharing. We will take these learnings with us if we pursue future trips to Haiti, and know they will also be useful when our facilities situated on the Gulf Coast face future hurricanes.

The principles of CHRISTUS’ successful mission in Haiti include:
• Command - From inception to operation (mobilization and demobilization), command of the task force and team in Haiti were clear.
• Control – Leadership established control via regular conference calls, daily operational updates and by ensuring the team was composed of the right number and type of personnel to meet the mission requirements. Span of control was maintained with appropriate number of workers to supervisors.
• Communication – Planned conference calls and regular communication before, during and after the mission facilitated information exchange and flow (up & down the organization, across functional areas and to/from external partners). This provided opportunities for real-time information to be passed on to appropriate teams so correct responses to changing needs of the mission could be anticipated and planned for and so the CHRISTUS family remained informed.
• Coordination – The coordination amongst partners on the ground in Port-au-Prince, between internal CHRISTUS departments, external government entities, and private resources was notably welcomed.

Members of the team that served in Haiti expressed an overall feeling of pride and accomplishment. They said that the team worked together flawlessly, and they were grateful for the opportunity to care for the people of Haiti. However, many also expressed angst over leaving so much undone, describing their work as a “drop in the bucket” of what would be needed throughout the city.

Almost all team members expressed interest in traveling to Haiti again, and many suggested that the task force consider sending another CHRISTUS team. It was also suggested that we consider a more long-lasting way to respond to disasters by working with CHRISTUS to identify early responders now. We are considering this suggestion and may implement an early response team to provide “intellectual capital” and care to devastated regions.

A few also expressed that one week in Haiti was not long enough, and that they were able to get into the rhythm of the work around the third day, but then had to leave 3-4 days later.

Team members expressed that CHRISTUS’ inclusion of chaplains in the team and their administration of spiritual care were central to our ministry there. “We not only operated on people, but were able to love and care for other needs,” one team member said.

While in Haiti, the wound care team started a Haiti Google group with suggestions and a list of items helpful to pack (sharpies, pens/paper, etc.). New team members emailed and posted questions regarding vaccinations, medications and what personal items to bring, and asked what they could bring to help families and what equipment was needed (connectors for wound vacs, sponges, etc.). This helped old team members keep in touch with local workers and continue the aid process from home.

Many believe that CHRISTUS’ leadership and organizational skills were pivotal to the work there. Team members unanimously expressed that the task force did a wonderful job, especially with organization and supplies.

Additional supplies they would like to have seen include:
• Postoperative needs such as wheel chairs, walkers and crutches
• Mosquito nets
• Additional walkie talkies or a way to facilitate easy communication between all caregivers and not just triage/ER staff
• More bottled water
• Foam hand wash (as there was no running water, we used antibacterial hand gel to sanitize our hands, but some team members felt it was sticky and made getting gloves on and off difficult)
• Extension cords
• Chairs
• Chux pads
• Drapes for tables
• Blue booties to use over dressings on feet
• Small autoclave
• Suction machine and canisters

Team members also mentioned that they discharged many Haitians to the streets, as they were without permanent shelter. They suggested continuing to send tents if possible.

Truly, our time in Haiti was just one more way that members of the CHRISTUS family lived out the CHRISTUS mission to extend the healing ministry of Jesus Christ around the globe. I am proud of each and every one of our CHRISTUS healers, and remain proud to be the team leader for CHRISTUS.

CHRISTUS Team to Serve in Haiti Feb. 20 - 27

After the devastating earthquake in Haiti on Jan. 12, I commissioned a Task Force on Haitian Relief to coordinate CHRISTUS’ response. The task force has now finalized plans to send a 20-member team and medical supplies to Port-au-Prince to provide clinical care and spiritual assistance from Feb. 20-27 in partnership with the University of Miami Miller School of Medicine.

I will attend as part of the team, and we plan to serve at a hospital that was opened by the University of Miami in Port-au-Prince after the quake left the city without a functioning medical institution. The 240-bed hospital is a four-tent compound at the edge of the Port-au-Prince airport. With four operating rooms, dialysis and X-ray machines, telemedicine capabilities and sleeping accommodations, it has become a beacon of life for the country's critically injured residents.

We expect to care for approximately 150 – 200 patients per day and provide anesthesia, orthopedic and general surgery services for both adults and children as well as spiritual care. We will perform many procedures currently needed in Haiti, including re-operating, wound debridement (cleaning/removing foreign objects form a wound), care of burns and infections, and many others. We will bring supplies for these procedures and medication for our patients as well as Meals Ready to Eat (MREs) and water for our team.

Our team and supplies will be transported in a plane secured by Congressman Rodney Alexander and Meyer Seligmann, a member of the congressman’s staff in Washington, D.C. They worked with former Ambassador at large Henry Crumpton, who made arrangements for a charter Boeing 737 aircraft to remain available for the trip to Haiti. Congressman Alexander represents the 5th Congressional District of Louisiana, which includes CHRISTUS St. Frances Cabrini Hospital and CHRISTUS St. Joseph’s Home.

We expect to have internet access while in Haiti, and plan to provide reports as regularly as possible on my blog here, so please check back for regular updates.

Lessons Learned from Hurricane Rita

In the aftermath of Hurricanes Katrina and Rita, CHRISTUS Health leaders were asked to debrief and share learnings of how we could be better prepared to address hurricanes or other natural disasters going forward.

We witnessed many wonderful examples of our Associates simply doing whatever it took to extend the healing ministry of Jesus Christ during the hurricanes and afterward. These incredible efforts involved overcoming challenges of nature, bureaucracy and some of our own processes. Therefore, while our memories were still fresh, we took time to look at what we did right and what we could improve upon. The debriefing work also helped us approach our government advocates regarding storm relief efforts and future planning.

To organize their thoughts, leaders were asked to reflect on 11 areas:
1. General hospital operations and community preparedness
2. Evacuation issues, including staff evacuation
3. Before, during and after storm patient care and transfer, and patient tracking
4. HR and staffing issues, including Associate housing
5. Communication: CHRISTUS internal; CHRISTUS entity and governmental; intergovernmental; public safety
6. National Disaster Medical System (NDMS) and Federal Emergency Management Agency (FEMA) issues
7. Logistics, Materials, Supply and Transportation
8. Financial and Claims: tracking expenses; reimbursement; funding for storm costs; documenting and valuing insurance claims
9. Regulatory issues, including waivers
10. Decision making: authority, leadership at CHRISTUS, local, state and federal levels
11. Public health issues

A hurricane debriefing report was compiled from over 30 sources and comments in an effort to identify commonalities. Based on this report, an extensive planning document that detailed important duties relative to emergency preparedness and the local/regional responsibilities and system responsibilities in response was prepared, and has been very helpful in our ongoing preparations.

We were also able to identify areas that would probably be issues during and after major storms in the future. These included many activities which must be coordinated through other entities (such as state and federal agencies), like transporting patients, power concerns (including securing generators as well as fuel) and transporting necessary supplies to our affected facilities following a storm. In addition, we know that staffing may be a concern, as many of our Associates were ready and willing to come back to work, but unable to return to the area because of blocked or damaged roads. In addition, if the affected area is without power, we must find a way to provide housing, food, etc. to Associates who stay or return immediately following a storm.

In addition, our Risk Management department has also devoted much time to the study of our response to Rita. As a result, we have gathered many resources and materials that have been on hand during the following hurricane seasons and have implemented disaster preparedness training as well as an alert system.

Obviously, in any disaster or large-scale emergency, much of our planning will be rendered ineffective, no matter how well thought-out it may have been. However, it is ultimately the resourcefulness and commitment of our CHRISTUS leaders and Associates that allow us to continue our mission of extending the healing ministry of Jesus Christ even under the most difficult circumstances.