disaster management: lessons learned from hurricane...
TRANSCRIPT
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DISASTER MANAGEMENT: Lessons Learned from
Hurricane María
Melvin Bonilla-Félix, MD, FAAPUniversity of Puerto RicoDepartment of Pediatrics
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Disclosures
Disclosure of Off-Label and/or investigative
Uses
I will not discuss off label use and/or investigational use in my presentation.
Disclosure of Relevant Financial
Relationships
I have no financial relationships to disclose.
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Objectives
• Describe experience with Hurricane Maria in Puerto Rico
• Describe lessons learned in the main academic medical center and only pediatric ESRD center
• Make recommendations for preparation of dialysis units prior to natural disasters
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Preparation
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DISASTER MANAGEMENT FLOW
Identifying resources and expertise in advance, and planning how these
can be used in a disaster
Actions taken to return to a normal or an even safer situation
following an emergency
Prevent an emergency, reduce the chance of an emergency happening, or reduce the
damaging effects of unavoidable emergencies
Actions taken to save lives and prevent further property damage in
an emergency situation.
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After
Before
La Parguera
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Immediate Challenges
Fuel Crisis
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Electric Power• Hospitals and Physician’s
offices• Medications, Vaccines,
Medical equipment• Hospital Personnel and
responders homes• Traffic• Safety at night
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Non-Dialysis Patients
• Nephrotic syndrome and other Chronic GN
• Advanced stages of CKD • Transplant patients• Neuropathic bladders
• Not able to get their routine laboratory tests
• Limited access to medication refills
• Some of the patients had to temporarily switch to a different medication of the same class because pharmacies were closed
• Limited access to their primary physicians
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Dialysis Population• Extremely vulnerable
• Direct physical damage to healthcare facilities• Lack of electric power• Lack of tap water• Shortage of disposable products• Inability to get to treatment centers• Inability to get chronic medications
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Hemodialysis Population: Preparation• Identify patients at risk
• Proactively admit to the hospital patients who live in vulnerable areas
• Preemptive Dialysis• Providing early dialysis in advance of the disaster
is the first step• This prevents missed treatments• Reduces rush in the dialysis unit after the
hurricane• Preemptive dialysis can help patients avoid
serious complications such as hyperkalemia and fluid overload, if their treatments are delayed after the disaster
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Hemodialysis Population: Preparation
• Preparation of Hemodialysis Unit• Emergency generator
• Fuel for the generator• Water tanks• Contingency plan to move patients to another center should be prearranged
in case the unit majorly suffers and is rendered nonfunctional after the storm
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Water Crisis• Hospital hygiene and infection
control• Patient needs
• Catheterizations• Home dialysis
• Personnel needs• Personal hygiene• Food
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Peritoneal Dialysis: Electricity
• Review technique for manual exchanges
• Risk of peritonitis
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Peritoneal Dialysis: Tap Water
• Water safety should be reinforced
• Water for dialysis patients should meet Environmental Protection Agency drinking water standards• If safe for consumption,
then it may be used
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Communication Crisis• Hospital
• Personnel• Patients
• The rest of their families
• Family• Within Puerto Rico and Outside
• Coordination of rescue efforts
No Internet, mobile phones, radio, TV
People stop on the highway looking for mobile phone signal
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Approach to Communication Challenges• Registry
• Updated contact information for patient and relatives• Hard copy kept accessible to personnel as EHR may not work
• Physical address• To dispatch rescue unit if necessary
• US DHHS Internet tool• Identifies, by municipality, Medicare beneficiaries who rely
on electricity-dependent medical equipment
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Communication Crisis
• Use non-technological tools• Analog phones
• POTS(Plain Old Telephone Service)
• Blackboard• POBB, not the Software
• Maps• Share resources
• Hospitals will go back to normality before other institutions or homes
• Good choice for headquarter
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People lining up at gas stations for hours to buy fuel for their cars and
generators
Fuel Crisis
• Generators for hospitals, medical offices, homes
• Gasoline for hospital personnel and responders
• Call schedule
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Responders and Volunteers
• Support• Exposed to heartbreaking
scenes• Breakdown
• Debriefing
• Sense of fulfillment• Energy and drive
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Organizing Efforts
• Establish a Headquarter• Hospital
• Frequent meetings• Divide in working groups• Organize volunteers
• Too many volunteers could be a problem
• Coordinate with other rescue teams
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• Government• Need to coordinate major issues
• Access to airport, Fuel for medical facilities, Mass communication
• Don’t depend totally on local or federal government
• Complex bureaucracy• Better to ask for forgiveness than to ask for permission
• Most politicians are always politicians
Government
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Private Sector and Non-Profit Organizations
• Private Sector• Significant donations• Facilitate their resources
• Non-profit organizations and volunteers• Have an organized structure• Use to work with disadvantage communities
• Puerto Rico• US• International ….
• Document and be grateful
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MiamiYale
Texas ChildrenDoctoras Boricuas
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Collection and Distribution Center University Pediatric Hospital
Organization and Distribution
Medical Students and Residents are THE
BOMB
Donations
“Fundación Hospital Pediátrico”
Volunteers
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Shelters’ Visits to perform the needs assessment and provide education, clinical care, emotional support and basic needs
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Needs Assessment
• Continuous process• Identify new needs every day• If the community receive assistance from
government or non-profit organizations• Identify communities that you need to revisit
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Dialysis Units
Bonilla-Félix M, Suárez-Rivera M. Blood Purif 2018; 5: 1- 6
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El Yunque Rainforest
October 2017
September 2018
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