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Kate Rathbun, MD, MPH. Concentra Medical Center 3235 Perkins Road Baton Rouge, LA 70808 225-387-3030 [email protected] www.dr-kate.com. PRIMARY CARE IN DISASTERS. Winter storms HAZMAT Floods Fires Heat Emergencies Tornados Hurricanes Nuclear Power Terrorism Epidemics

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Kate Rathbun, MD, MPH

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Kate rathbun md mph

Kate Rathbun, MD, MPH

Concentra Medical Center

3235 Perkins Road

Baton Rouge, LA 70808

225-387-3030

[email protected]

www.dr-kate.com


Primary care in disasters

PRIMARY CARE IN DISASTERS

  • Winter storms

  • HAZMAT

  • Floods

  • Fires

  • Heat Emergencies

  • Tornados

  • Hurricanes

  • Nuclear Power

  • Terrorism

  • Epidemics

  • Earthquakes?


Disaster

DISASTER

  • WHEN NEEDS EXCEED RESOURCES

  • Every Saturday night in the ER

  • 24 / 7 / 365 for the Uninsured

  • Demographic War


Katrina

KATRINA

  • 1 million people evacuated

  • 20% had chronic diseases

  • 29th of August

  • 250,000 in shelters

  • River Center 25,000 people

    • 80% turnover per day

    • first aid only


Private response

PRIVATE RESPONSE

  • Ad Hoc clinics in shelters

  • St James Church maternity program

  • Dialysis – nephrology groups

  • Ochsner opened the first day

  • Baton Rouge Clinic on the 8th day

  • All hospitals in Baton Rouge and major hospitals in New Orleans stayed operational


Government response

GOVERNMENT RESPONSE

  • The federal government arrives in 3 days and leaves in 3 weeks

  • State government provides immediate response which ends after 3 to 6 weeks

  • Recovery requires 3 to 10 years


Myths

MYTHS

  • Local physicians are busy with their own problems

  • PMAC – 800 beds - the largest field hospital in history

  • National Guard to the rescue

  • FEMA sent a lot of money

  • USNS Comfort in Biloxi


Reality

REALITY

  • Local doctors got abuse and interference when they tried to respond

  • PMAC – 30 beds on the basketball court -120s beds in the field house

  • Governor’s orders, the National Guard blocked access to New Orleans

  • DH&H kept the money

  • The Comfort saw 8 patients per day per physician and were a thorn in the side of the Ocean Springs Hospital


Primary care preparation

PRIMARY CARE PREPARATION

  • As a medical society – demand a seat at the table at the county and state levels

  • Availability of primary care should be the main focus

  • Coordinate with other doctors to maintain continuity of care

  • Make sure your own practice is prepared


Prepare at home

PREPARE AT HOME

  • Get a guide and follow it

  • Prepare to leave in 30 minutes or stay 7 days

  • Make preparedness part of the household routine

  • Make arrangements with family and friends before the event

  • Communication is critical


Prepare at work

PREPARE AT WORK

  • Phone tree & out-of-town contacts

  • Emergency bags

  • Flashlights, can openers, etc

  • Business supplies for 2 weeks

  • Lunches

  • Weekly closing procedure


Prepare the business

PREPARE THE BUSINESS

  • Good insurance

    • Casualty, liability, business interruption

  • Computer billing records

    • Off-site back-up

  • Alternative sites of practice

    • Mutual aid agreements


Prepare your patients

PREPARE YOUR PATIENTS

  • Problem list & Medication list

    • New copy at each visit

  • 30 days of medications

  • Where to go if you aren’t there

  • Electronic medical records

    • Only for prearranged mutual aid


Prepare the medical community

PREPARE THE MEDICAL COMMUNITY

THE GOAL IS RESILLIANCE

  • Mutual aid arrangements with shared records for OB, Oncology, Dialysis, etc.

  • Hospitals need urgent care centers away from the ER

  • Volunteer through the medical society not the health department


During the disaster

DURING THE DISASTER

  • Decide where and how you can be of the most value - go there and do that.

  • Decide when you will reopen your practice and what services you will provide

  • Know if you and your people will be paid


After fema leaves

AFTER FEMA LEAVES

  • Plan so your practice stays viable

  • Waves of leaving – What to avoid

    • can’t come back

    • can’t rebuild

    • can’t face the next 10 years

  • Remember, you only get your insurance payment once


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