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Kate Rathbun, MD, MPH. Concentra Medical Center 3235 Perkins Road Baton Rouge, LA 70808 225-387-3030 dr-kate@dr-kate.com 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

Kate Rathbun, MD, MPH

Concentra Medical Center

3235 Perkins Road

Baton Rouge, LA 70808

225-387-3030

dr-kate@dr-kate.com

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