Preparing for the Unexpected

Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN

Editor-in-Chief OncLive Nursing

Oncology Nursing Consultant, Adjunct Assistant Professor of Nursing Louisiana State Health Sciences Center in New Orleans, Louisiana

It’s hurricane season again for those of us who live in hurricane-prone areas, and time for us to review our preparedness plans. We all need to be prepared for weather-related events, regardless of where we live. No one is immune from a severe rainfall or snowstorm, ice storm, flooding, earthquake, tornado, or heat wave.

Oncology treatment centers have flooded from raging rivers, as well as from broken pipes inside the building. Major snowstorms have kept patients and staff in the facility overnight. One nurse I know remembers stepping over a deep gap in the floor, caused by an earthquake, when evacuating patients.

A Well-Defined Plan

We’ve all heard the saying “Prepare for the worst,” and it’s good advice when planning for the unexpected. In cancer treatment centers large and small, it’s best to be proactive and have a defined plan.

The first step is to identify the kinds of events that have the potential to affect your facility, keeping in mind that fires can be caused by things other than wildfires and power outages can occur even in the nicest weather. Consider every possibility, no matter how remote it may seem. Next, list some immediate actions, followed by short-term actions, and then long-term actions. Include the key players—patients, people accompanying the patients, and staff—and don’t overlook others who might be in the facility, such as delivery personnel, volunteers, and even pet therapy animals.

Immediate actions may involve evacuation of a treatment area, or even evacuation of the building. It’s imperative that facilities have an evacuation plan that includes a variety of scenarios, such as evacuating in darkness, using the stairways instead of elevators, or evacuating without the assistance of first responders, which could be necessary if a widespread disaster occurs.

Depending on the situation, the short-term plan may be to shelter in place. In this scenario, what resources are available—or might not be available—to patients, staff, and others? Think first about basic needs, such as food, water, shelter, and toilets. Is enough food available or accessible to feed the group overnight? Is there sufficient drinking water on hand? If the power goes out, and there is no heat or air conditioning, how will patients be kept warm or cool? If the sewage system stops working, what is the plan?

The short-term plan also may involve continuing cancer treatment somewhere else, until repairs are made and/or the facility is safe to return to. Logistically, moving the treatment area is a huge project and requires careful planning. Larger facilities generally have more resources than small ones, but even in small facilities there are options, such as contacting other small oncology providers or community hospitals to identify resources. For example, when a small oncology practice flooded when a pipe froze and broke, another oncologist invited the practice to use his office in the afternoons.

Lessons From Hurricane Katrina

Longer-term plans may involve a move to a new or different facility, and in some cases, permanent transfer of patient care to new providers. This occurred in New Orleans, where I live, after Hurricane Katrina. It was not uncommon for patients to resume cancer treatment in facilities far from home. In many cases, though, patients did not have their medical records, and in some cases, had limited knowledge about their disease and treatment history. Complicating the situation was the inability to contact the patient’s provider, since cancer treatment facilities in New Orleans were shut down for weeks, and some never reopened. Remote access to electronic medication records is now more commonplace, and essential for oncology providers in disaster-prone areas.

Disaster plans also need to include staffing considerations. In the event of a widespread weather event, staff may want to leave to check on their families and homes. How will staff respond if patients and others—including staff—are injured during the event? It’s a lot to think about, and not at all pleasant; however, a well thought-out plan prepares and reassures the staff, comforts the patients, and minimizes cancer treatment interruptions and delays.