CMO Dr. Jonathan Perlin details the health system's disaster preparedness programs and protocols for disasters and the ongoing pandemic.
According to the National Oceanic and Atmospheric Administration Climate Prediction Center, the 2020 Atlantic hurricane season is slated to be "extremely active." The Atlantic hurricane season typically runs from the beginning of June to the end of November. Between May 16 and September 21, 21 tropical storms have already formed.
Adding to that, the ongoing pandemic complicates things more. Last month, Axios reported that a recent study found "large-scale hurricane evacuation could lead to somewhere between 6,000 and 60,000 new coronavirus cases." On September 24, there were over 2.5 million active coronavirus cases in the United States, according to worldometer.
In the face of these natural disasters and COVID-19, healthcare systems and hospitals need to be prepared to protect their patients and facilities. HealthLeaders talked to HCA Healthcare President of Clinical Services and Chief Medical Officer Dr. Jonathan Perlin about the health system's strategy for disaster preparedness. HCA Healthcare serves 20 states.
When it comes to implementing its disaster preparedness plan, the health system focuses on what it already knows. "We start with what we call a 'universal hazards approach,' so that we don't have to reinvent what we haven't practiced," Perlin says. This keeps the health organization well-equipped to face disasters.
"Operational plans are something that we think about 52 weeks a year," Perlin says.
The following are three ways that HCA Healthcare stays prepared in the face of disaster.
1. Install and maintain rigid protocols
HCA Healthcare relies on the protocols it already has in place for disaster preparedness.
The moment when "the first indication that a tropical depression is turning into a tropical storm and hurricane, we begin to embark on a 120-hour vertical," Perlin says. Through a contract with a national weather service, the organization has help tracking the storms.
"There are things that as a hurricane gets too close, you can't do anymore. Five days out, we begin to go through an absolute rigid protocol. Do we have enough staff? Do we have enough medications, supplies, and food? Enough water, enough electricity?" he says.
All of HCA's facilities have generators and the capability to mobilize generator trucks when the power is out for a sustained period of time. Diesel trucks are deployed to ensure there is enough fuel to run the generators, and water supplies are backed up with the implementation of "water buffalo" or trucks carrying fresh water. HCA also prepares for the possibility of deploying emergency transportation.
Through aviation contractors, patients who need to be evacuated can easily be moved. "In the heat of battle, the team has been so creative as to even contract for amphibious vehicles, to be able to traverse land and water" when air travel is too risky, he says.
Post-disaster protocols are also important. "Our post-disaster activities start pre-disaster," Perlin says. "There are general aspects of how we approach emergencies and their specific aspects tailored to the type of emergency: hurricane, wildfire, pandemic, mass casualty event, etc."
The health system implemented these procedures after it started to anticipate the potential impact of the pandemic at the beginning of the year.
"After we got through the initial first few weeks of the pandemic, we began to integrate our learnings into our more normal cadence of operations. When hurricane season began to provide imminent threats, such as Hurricane Laura … we had used our emergency operations as an organizing principle at the outset for COVID and had success [by implementing] a well-practiced emergency operations protocol for hurricanes.
"[COVID-19] was like emergency preparedness for hurricanes on steroids, where we had to think: 'How do we keep the isolation principle as intact as possible, while simultaneously, not losing speed?' " he says.
2. Create an emergency operations center
"One of the great advantages of the scale of HCA Healthcare is the ability to have a world-class emergency operations program," Perlin says. The enterprise program is run by Michael Wargo, health system vice president of enterprise preparedness and emergency operations, and his team, at HCA.
"This is essentially a war room that has capability to monitor many different sorts of inputs for situational awareness," Dr. Perlin says. The program gives the health system "the ability to bring together all the different disciplines under our Enterprise Emergency Operations Center to systematically evaluate what is the status of the threat, be it a hurricane, a wildfire, or pandemic," he says.
The Emergency Operations Center is based underground, and has redundant power, information systems, telephones, and a room full of monitors dedicated to "each of the different disciplines."
"It's orchestration to the highest order, and it doesn't stop when the hurricane is clear, because we will have already pre-positioned, if necessary, in remediation … to be able to restore function," he says.
"We approach every storm with humility. However fortunate we've been on the basis of prior preparation, we know that there may be unforeseen contingencies," Perlin says. "We just feel that humility in the face of the uncertain is the best posture to respond to what might be new, what might be different, what may not be anticipated, in any particular emergency event."
Not only does the health system support its patients through disasters and the pandemic, it also supports its employees through employee assistant programs and the HCA Healthcare Hope Fund and 501(c)3 charity, "which allows individuals who may have had cataclysmic distress to receive additional financial support," and has been a financial source during the pandemic.
3. Use data analytics and technology
HCA Healthcare utilizes a data science program called EvacuNATE for risk management during disasters. EvacuNATE is an algorithm that "helps [HCA Healthcare] reduce evacuation time using real-time triage data," according to the HCA Healthcare 2020 Impact Report.
"We use our national data systems and a data science program called NATE, which helps us to evaluate what the census of patients are in a particular facility, and if that facility is in the potential path of the hurricane. We can do some risk evaluation on what patients can be moved later, [and] what patients might be more resource intensive in terms of their support needs and might need to be evacuated earlier."
"It's helped us make informed decisions," Perlin says.
"I want to give credit to our Chief Data Scientist [Officer] Dr. Edmund Jackson and the terrific team that put this [program] together," he says. "It's part of our planning for hurricanes, for COVID, for wildfires, in terms of risk management.
“We just feel that humility in the face of the uncertain is the best posture to respond.”
— Dr. Jonathan Perlin, president, clinical services, CMO, HCA Healthcare
Melanie Blackman is the strategy editor at HealthLeaders, a Simplify Compliance brand.
Photo credit: HCA Healthcare employees keeping track of data in the Enterprise Emergency Operations Center. Photo courtesy of HCA Healthcare.
Utilizing familiar protocols during the unfamiliarity of the COVID pandemic enables HCA Healthcare to focus on staying ahead of each disaster instead of reinventing the wheel.
The health system works to stay a step ahead of natural disasters by starting to track weather five days ahead.