Kate Rathbun, MD, MPH

1
Kate Rathbun, MD, MPH

• Concentra Medical Center
• 3235 Perkins Road
• Baton Rouge, LA 70808
• 225-387-3030
• dr-kate_at_dr-kate.com
• www.dr-kate.com

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PRIMARY CARE IN DISASTERS

• Winter storms
• HAZMAT
• Floods
• Fires
• Heat Emergencies
• Tornados
• Hurricanes
• Nuclear Power
• Terrorism
• Epidemics
• Earthquakes?

3
DISASTER

• WHEN NEEDS EXCEED RESOURCES
• Every Saturday night in the ER
• 24 / 7 / 365 for the Uninsured
• Demographic War

4
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

5
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

6
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

7
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

8
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
• Governors orders, the National Guard blocked
  access to New Orleans
• DHH kept the money
• The Comfort saw 8 patients per day per physician
  and were a thorn in the side of the Ocean Springs
  Hospital

9
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

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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

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PREPARE AT WORK

• Phone tree out-of-town contacts
• Emergency bags
• Flashlights, can openers, etc
• Business supplies for 2 weeks
• Lunches
• Weekly closing procedure

12
PREPARE THE BUSINESS

• Good insurance
• Casualty, liability, business interruption
• Computer billing records
• Off-site back-up
• Alternative sites of practice
• Mutual aid agreements

13
PREPARE YOUR PATIENTS

• Problem list Medication list
• New copy at each visit
• 30 days of medications
• Where to go if you arent there
• Electronic medical records
• Only for prearranged mutual aid

14
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

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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

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AFTER FEMA LEAVES

• Plan so your practice stays viable
• Waves of leaving What to avoid
• cant come back
• cant rebuild
• cant face the next 10 years
• Remember, you only get your insurance payment
  once