Gulf Coast providers show value of disaster planning preparation

As we endure the continued squabbling and controversy over the government's response to the late-summer Gulf Coast hurricanes, it is almost refreshing to look at medical facilities and see how well they responded by comparison.

A fairly extensive look by Diagnostic Imaging at medical facilities and radiology departments that survived the Gulf Coast hurricanes found generally that they were remarkably well prepared and resilient. Certainly, they were not able to prevent all problems. Magnets quenched, buildings and equipment were damaged, and some sites had to be shut down. But when you compare our account with the chaos that hit much of the Gulf Coast, and especially New Orleans, our subset of the community seemed to be several steps ahead of everyone else, including those government agencies charged with disaster management.

Some of that difference is to be expected. Managing a disaster in a hospital is a small task compared with managing a disaster in a state or city. But it is also true that medical facilities take their disaster preparedness mission more seriously than many communities.

As contributor Cynthia Keen, who researched and wrote this month's cover story, put it, we expect hospitals to be fortresses of invulnerability that will perform despite any disaster. Hospitals take this mandate seriously, and disaster planning is an intrinsic element of their operations.

In looking at how radiology departments dealt with Katrina and Rita, we observed three essential points:

- Having a disaster plan, and updating it frequently, is key. Five years ago, a terrorist attack would likely not have been thought part of a disaster plan; today it should be. New technologies are increasing power demands and altering records preservation and equipment protection strategies; disaster plans need to be changed accordingly.

- Maintaining power is crucial. Generally, the more emergency power capacity available, the better the hospital will function. Most facilities have backup generators, but as the Gulf crisis wore on, some there had to limit generator use. A VA facility in Biloxi, however, never lost power and even kept the air conditioning operating during and after Katrina.

- Shifting to digital records and images can save records that might otherwise be destroyed. As we went to deadline, we found no facilities with digital records that could not be recovered. One facility even lost a new PACS, but its digital records were intact.

Other tidbits were revealing: Teleradiology can help provide service when conditions are so bad that radiologists cannot get to a facility, vendors can provide valuable assistance in helping a facility recover from a disaster, and the dedication of healthcare workers is a valuable asset.

The Gulf Coast has unique aspects, as does every region. Some medical facilities along the Gulf are designed to cope with flooding, a feature not needed, for example, in most of the San Francisco Bay Area, where earthquakes are a far greater hazard. Rural hospitals probably do not need to worry as much about terrorist attacks as hospitals in big urban settings.

But disasters do have some common elements, and the need for planning never goes away. Continuity of care must be maintained to the greatest extent possible. Records must be preserved. If a facility must be shut down, it should be done in a way that allows a quick startup when conditions permit.

In the months ahead, we'll look closely at disaster planning in radiology. We welcome your thoughts on what happened in 2005 and what needs to be done now. Please send your suggestions to me. Disaster planning is a process that never ends. With your ideas, we can all share information about how it can be done better.