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Florida storms: Flip phone training and other lessons learned from hurricanes past


November 2, 2019

By A.J. Plunkett (aplunkett@decisionhealth.com)

As Hurricane Dorian gained strength in the Atlantic in late August, hospitals and other healthcare organizations in Florida and other parts of the southern U.S. prepared for what then appeared would be a direct hit. Emergency management plans were broken out and reviewed, vendors and suppliers alerted, patient evacuation plans updated, phones and other communication devices charged.

Then those in Florida breathed a sigh of relief as the hurricane curled north and then east. While it would flood significant parts of the North Carolina shoreline and spawn numerous tornados, the direct hit from Dorian was largely averted on the mainland.

It did prove to be a good exercise in preparedness, though, as all such events should for hospitals, say consultants and preparedness experts.

For Renaissance Behavioral Health System (RBHS), headquartered in Jacksonville, Florida, the near miss was a test of lessons learned and implemented from past events, and it produced even more opportunities for improvement should the next storm come ashore.

RBHS provides management services to a variety of behavioral health and social services organizations under the umbrella of the Mental Health Resource Center Inc. (MHRC), including providing 24-hour behavioral health emergency services, inpatient services, and a variety of outpatient programs for several communities throughout Florida. Those programs include outreach for the homeless, forensic and in-jail services, and Assertive Community Treatment (ACT) programs for adults.

“Every hurricane, or other event, always offers some lessons learned — Something we didn't think about in our policy, preparation, response or other area,” says Leah Guthrie, MSN, MBA/HCM, BA, RN, director of quality improvement/risk management for RBHS and MHRC, who took out time from planning to answer questions by email for Healthcare Safety Leader.

Those past events have included several hurricanes or tropical storms that made landfall in or near Florida in the past few years.

The healthcare organization serves more than 8,000 individuals in various outpatient programs that include traditional outpatient services (medication management, counseling, care coordination), psychosocial rehabilitation, behavior care management (case management), forensic case management, and mental health court, says Guthrie.

The special needs of the behavioral health clientele make emergency planning particularly critical.
“We had Hurricane Matthew and then Irma, 11 months apart, affect Jacksonville. Both provided a number of learning experiences,” says Guthrie.

That included learning about flip phones for those too young to remember them.

“Cell phones were deployed to our inpatient areas that would shelter in [place]. We learned that we had to educate staff on use of the flip phones as most had no idea on how to operate them,” she says.

Other lessons learned and implemented from past events:

  • Fuel gauge checks

The organization now ensures they monitor generator fuel levels “very closely” and reach out “early on to our various fuel vendors to avoid running low or out of fuel. We required the facilities person to report fuel levels at every conference call,” says Guthrie.

“We also determined that we needed to get extra fuel storage tanks for our generators as most often we have to wait for fuel to be delivered from out of town when evacuations are ordered throughout the state. It is also very difficult to get a MOU [memorandum of understanding] with a vendor since we are a small agency.”

  • Incident command staff (ICS) communication upgraded

“We developed an Incident Command Meeting Agenda that we now follow to ensure we cover all information necessary. Since we have ACT teams throughout the state as well as the two main inpatient and outpatient programs in Jacksonville, there is a lot of different moving parts to keep track of. Having the agenda helps the ICS when we are meeting face-to-face or via teleconference ensure we have considered every potential issue and have a pulse on what is occurring throughout the organization and areas of impact.”

  • Playbook developed to help backup players

“We also developed an Emergency Response handbook, both print and electronic, for the ICS with as much important information as needed for anyone to pick up someone else’s role if necessary,” says Guthrie. The handbook includes such things as how to log into the [Agency for Healthcare Administration’s] Emergency Status System, updating organizational information and census information, and important phone numbers and contact names.”

  • Ham radios employed

“We added HAM Radios to our Security offices to ensure capability of communication with the city's Emergency Operations Center and other hospitals if necessary.”

Dorian provided new lessons, as well, especially since it took such a quick but uncertain path.

“Hurricanes are really unpredictable,” notes Guthrie. “You need a dedicated person to keep sending out information from reliable sources. We joined the Northeast Florida Healthcare Coalition in Jacksonville and signed up for alerts from both the City of Jacksonville Emergency Operations Center and from the State of Florida Emergency Operations Center.”

The alerts now go directly to Guthrie, who sent them out throughout the duration of the storm. “These helped us to navigate where Dorian may impact and make much better decisions on whether programs should close or stay open,” she says. The alerts are especially important since the organization has programs “on the east coast, west coast and in the middle of the state.”

There are several individuals on the ICS who get the City of Jacksonville alerts. The state alerts go to both her phone and laptop, to ensure she gets them.

In the future, MHRC will need to “develop a plan with time frames for activating and deploying phones to avoid last minute actions,” says Guthrie. That will include developing standard templates for communicating the organization’s status through its website, Facebook page, emails, and hotlines. One tip from Guthrie: “I found it was much easier to write these out and then read them off on the hotlines versus just recording it off the top of my head.”

As a behavioral health organization, there are several facets to MHRC’s emergency preparations that account for their clientele.

“We have ACT programs throughout the state; these teams have 100 clients on each team. They have to contact all 100 clients, ensure they have one week’s worth of medications deployed prior to the storm, determine what the client's plan is for evacuation or sheltering in, having up-to-date contact information and emergency contacts, and assist with transportation if needed to a shelter,” says Guthrie.

“Following the storm, they have to make contact with each of their clients to see if there is any needs. There is an on-call person who handles issues while offices are closed.”

Other steps the organization takes in advance of a storm:

  • Outpatient programs try to verify that clients have enough medications. If not, they get the licensed independent practitioners to write prescriptions and contact the individuals to pick up the medications.
  • Staff who work with the homeless program try to assist with getting the homeless individuals into shelters.
  • Inpatient programs look at staffing “and all the normal stuff related to sheltering in. They try to discharge as many people as possible but remain open to the police bringing in other individuals on an involuntary basis.”

Throughout the events, the organization does an “a lot of educating and monitoring of weather events. Staff provide explanations to the clients about what is occurring and what we need to do to ensure they (and we) are safe,” she says.

“We've only evacuated once in the 31 years I've been here. We had a large bus and took everything we needed to a military training base barrack we had an agreement with. There were no difficulties at that time. We are able to shelter in at both facilities, which are across town from each other, so we have that ability to evacuate to our own facility if needed,” says Guthrie. “Probably the most difficult thing is ensuring we have a contact person for each individual and can reach them to tell them about our plans. We do have hotlines, website and Facebook where we post facility status.”

The goal is always to keep patients and clients safe, she says. “Our inpatient units are ligature resistant and staff continue to do assessments and observations per our normal routines. Outpatient clients know that we have the 24/7 emergency services and in several programs there is an on call person that they can call. Everyone is provided with the National Suicide Hotline number as well.”

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