Program Director’s Corner – June 2018

When Disaster Strikes…

Susan Samson MD PhD FRCPC FACE
Program Director, Baylor College of Medicine and Affiliated Hospital/ University of Texas MD Anderson Cancer Center, Houston,Texas

Being of Canadian extraction, my early experiences with “storms” were of blizzards. When the snow clears and melts, your house is still standing and the situation normalizes. Not so with Hurricanes. Just after moving to Houston, I experienced the aftermath of Katrina, peripherally, with so many displaced people from New Orleans. Baylor adopted the Tulane Medical School at that time, whose students continued to be educated in the basement of our main campus, and whose residents were able to carry on with rotations in our Houston hospitals.  When the Tulane trainees could finally return home, months later, they left us with a gift that still touches me deeply when I walk by it in the hallway. It is a photo of the “Weeping Angel” sculpture from the Metairie cemetery in New Orleans, signed by all of the trainees, with a quote from “Winnie the Pooh and the Blustery Day”:

Christopher Robin: “Piglet….What will you do if your house is blown down?

Winnie: “He would come and live with me.”

Piglet: “Thank you Pooh, I should like to.”

Since Katrina, I have experienced Rita, Ike (no electricity in my home for 2 weeks), and Harvey (four feet of water in the house). With Harvey, the Texas Medical Center was not traversable by normal routes, and there were stories of dedicated doctors using boats to get to the hospitals to help. If you don’t live in a hurricane-prone area, you may say “How are you not ready for this?” I have learned that storms like Harvey can look benign on Tuesday, concerning on Wednesday, and become a life threatening monster by Friday. It happens very quickly, so you have to be prepared.

So how do you take care of patients in these disastrous circumstances? In Houston, our hospitals have “ride out” teams… as in riding out the storm. The teams consist of faculty and trainees on the surgery and medicine teams who are packed and ready to stay at the site before the storm starts and for many days after. They are the points of contact for those of us not on site. There is an open line of communication among the consultants and the in-house teams for access to specialty advice.

Here are some of the points to discuss with your trainees:

• Disaster Kit: For trainees jointing the program from another geographic area, and not versed on potential weather threats, emphasize the personal “Disaster Kit” at orientation: first aid kit, non-perishable food and a can opener, water, flashlight, batteries, radio, toiletries, cash, etc. in a water-resistant carrier. A portable cell phone charger (always maintained) is invaluable when the power goes out. Cell phone power was the most precious resource during Hurricane Ike, and even if you wanted to charge your phone in your car, you risked running out of gas, which also is hard to find before and after a Hurricane. As a storm approaches, the gas gauge needs to be on full.
• Establish a channel of communication: We start with a common text thread on orientation day, with all cell phone numbers entered in everyone’s phones. Other applications, such as “WhatsApp” also are useful for a group chat. During Ike and Harvey, cell service was still in place in most areas, even though WiFi was gone. We all checked in periodically regarding our personal safety status and location. Social media also played an important role, to keep us informed of potential evacuations among the fellows and to communicate with rescuers (that’s how we got our boat rescue in my case). Our institution has an emergency preparedness alert to receive automated communications about the disaster. We ensure that our new fellows have registered.
• Remote Access to Electronic Medical Records: Ensure that all fellows have remote access to electronic medical records (five different systems in our case) on their personal computers (Citrix, VPN), and phone if possible. With the EPIC system, the Haiku application on the phone is invaluable for quick access when a computer is not available.
• Disaster Plans for Patients: Educate your fellows to educate their patients on having a disaster plan. Patients need to have enough medication for several days, as the access to pharmacies can be limited for many days. Here are a few links to patient handouts and information.
• ADA http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/tips-for-emergency-preparedness.html
• AACE http://www.mydiabetesemergencyplan.com/
• CDC https://www.cdc.gov/diabetes/managing/preparedness.html
• Endocrine Society https://www.endocrine.org/about-us/announcements/hurricane-resources

Finally, be an emotional support to faculty and fellows who are personally affected by the storm. At Baylor, free counseling services were offered, and there were financial resources available. I have learned this year, that “this too shall pass…”, at least for most Houstonians, but we still need to keep our colleagues in Puerto Rico in our thoughts and prayers.