Rethinking the Unthinkable for Homeland Defense

As tragedy struck New York, Washington, DC and Pennsylvania on September 11, 2001, members of St. Barnabas Health System's senior management asked themselves, "What could be next?" and "Are we prepared?" They realized that the healthcare organization, located within 100 miles of the Somerset, Pennsylvania plane crash, could have been the victim of attack or asked to serve as an emergency relief site. Within hours of the first disaster, St. Barnabas' officers assembled for an emergency meeting.

The group discussed the implications of the recent attack, particularly if its focus had been, accidentally or by design, one of the seven St. Barnabas communities. They were briefed on terrorist tactics by a vice-president who is also an Air Force lieutenant colonel. By the meeting's end, emergency procedures had been discussed, each officer knew his or her role should disaster strike, and all rushed to their offices to review and revise the existing Y2K and other disaster plans in light of the new danger.

The next day each officer carried at all times the St. Barnabas Health System Crisis and Emergency Manual-a compilation of plans, procedures and contact information. Also, the organization's chaplain was featured on WPXI-TV in Pittsburgh, offering tips for discussing the "attack on America" with elderly parents and loved ones (see "Talking About It, page 20"). The chaplain also conducted prayer services throughout the week for residents and, with social services workers, individually counseled those in need of comfort. By week's end, thousands of resident families, employees, volunteers, donors and community members received a letter from the Health System's president indicating that a top-down review of operations had been conducted and that St. Barnabas was poised to handle any emergency.

Although most healthcare facilities have a disaster plan, for most, the only time the plan is consulted is during mock drills, annual accreditation surveys and following the occasional havoc raised by Mother Nature. Now that most organizations realize that the time is ripe for a top-to-bottom review of disaster planning and response, St. Barnabas Health System, on the basis of its recent experience, offers the following suggestions.

As first steps, hold a planning session, form an emergency response team and designate a planning group. The planning group's mission statement must be concise and direct. Assume that the recent events are not once-in-a-lifetime experiences, but will be repeated. Within this context, develop plans to ensure the well-being of residents, patients and staff, and the survival of facilities and how they can function as a community resource. Review essential functions of your or-ganization to ensure that they can be performed, regardless of the nature or scope of the disaster. Clearly identify key personnel who are responsible for implementing the plan. Don't assume that
existing manuals dictate who is in charge. Speak to individuals personally and confirm their roles in writing.

Next, review disaster plans, create a crisis kit, resurrect your Y2K response plans, and have the planning group review them and all emergency and disaster policies currently in place. Many of these plans will, hopefully, contain detailed information for dealing with a va-riety of misfortunes. However, revise dis-aster plans to accommodate large-scale crises to include patient transfer agreements; the local community's emergency response plans, and policies and procedures for evacuations, fire drills, tornadoes and bomb threats; and disruptions of food, water, supplies and utilities.

The plans should be incorporated into a "Crisis and Emergency Information Kit" that is distributed to key personnel (e.g., corporate officers and facility managers). The kit should include phone listings and addresses of essential personnel (internal and external), government and community emergency resources and utilities, local maps, revised disaster plans for each building, security manuals, a media response plan, and critical vendor listings. Kits must accompany key personnel at home and at locations away from the facility so that pertinent information is readily available at a moment's notice.

Appropriate personnel should be issued special identification cards identifying them as "critical" healthcare personnel. The cards should request authorities to permit their movement in the event of an emergency and allow for access to their facilities should public roads be blocked, etc.

One obvious problem for the long-term care industry is that evacuation might not be an option. Facilities are the residents' homes. Unlike people at an office or factory, residents do not have somewhere else to go. Another consideration is that during a disaster of significant magnitude, long-term care facilities-especially nursing homes-might be required to accept overflows or diversions from hospitals or to serve as community resource centers. The disaster plan must provide for this new role. Two particular concerns emerge: backup communications and transportation/supply.

Fortunately, the United States is blessed with an abundance of volunteer relief organizations. Take advantage of them. The Red Cross provides training in first aid. Organizations such as Air Search Rescue, based in Western Pennsylvania, provide air/maritime/overland search and rescue and other assistance to law enforcement and emergency authorities. This organization maintains an impressive radio network and has several aircraft at its disposal. Several of its vehicles are designated by the state as emergency vehicles, ensuring that they have gasoline in the event of major disruptions of supplies. (But you should also check with local petroleum retailers regarding possible supplies for your facility, because a shortage of gasoline, fuel oil and other resources can happen very quickly.) The Air Search Rescue organization is also affiliated with one of our area's aeromedical transport services; this provides an opportunity for a facility to be designated as a certified landing site and obtain priority service for residents. Or-ganizations should explore similar opportunities in their areas.

Remember to train and retrain. There is no substitute for training. When an emergency hits, it is doubtful that anyone will consult a lengthy, detailed plan; they might, however, be grateful for a checklist. Further considerations: Are your nurses adept in first aid? Can they assist in the treatment of burns and other disaster-related ailments?

Don't keep your disaster readiness a secret. Communicate your readiness to managers, employees, volunteers, residents, resident families, suppliers and outside supporters. The knowledge that your organization is prepared for crises will be a comfort to them and provide, as well, the positive public relations that all facilities seek. Offer the expertise of your emergency team to the media for their advice and tips for response. Broadcast your message through written word, e-mail and all available venues. Hold meetings for in-house personnel and residents to discuss your organization's stance on crisis management and to assuage fears.

St. Barnabas Health System President William V. Day often advises his managers to "plan your work and work your plan." By carefully and thoughtfully planning for the "worst-case scenario," you are establishing a clear and concise crisis procedure that can save lives and property and maintain a community despite the gravest challenge. NH

Hugh E. Teitelbaum, JD, MS, is assistant vice-president and general counsel, and Valerie Day Wilden is assistant to the president for St. Barnabas Health System, Gibsonia, Pennsylvania. St. Barnabas Health System includes three retirement communities, two nursing homes, an outpatient medical center, an assisted living center and a charitable foundation. It is a faith-based, charitable and nonprofit organization founded in 1900. For further information, phone Valerie Day Wilden at (724) 444-5511 or visit
Talking About It

The fallout from the September 11 terror-ist attacks on America was widespread, affecting the sense of security of people of all ages. At St. Barnabas Health System, social workers and the provider's chaplain, Father Joseph Wazo, met with all residents individually, held group meetings and prayer groups, and offered suggestions through the media for anyone counseling elderly persons. From this emerged the following recommendations for counseling elderly residents in times of crisis:

1. Recognize the elderly's connection to war and similar devastation.
They have lived through at least four or five wars; they have lost brothers, sisters, parents, friends, sweethearts, husbands, wives and children. Some of them served in wartime. Many contributed to the war efforts at home.

2. Be a good listener.
Let residents vent, share emotion, shed tears. They will want to discuss memories of previous disasters. Listen to understand what they are feeling, what they fear, so that you can tailor your responses to what they are experiencing. Understand that the elderly often have a long roster of friends and family members, and they fear that this crisis could affect them.

3. Anticipate a sense of confusion and depression.
Many reports of the tragedies compared them with the attack on Pearl Harbor. Most elderly residents recall that event quite vividly and might experience an initial or added degree of confusion. They might become overwhelmed with feelings that they are unable to shake and feel depressed. If residents experience extreme anxiety, if depression persists or if they are afraid to leave their residences, consider arranging professional counseling for them.

4. Encourage them to pray.
Their faith in God can serve as a great strength and comfort. They can pray alone and at church services, or attend group prayer and religious literature studies where attendees can share memories and coping mechanisms. If your facility doesn't have a full-time chaplain, invite members of the clergy to the facility to conduct group sessions and bedside consultations.

5. Help them call friends and family.
Residents are particularly vulnerable because they are separated from families and friends at a time when they need those relationships to cope. They might need assistance to make telephone calls to receive that special reassurance that only a family member can provide.

6. Recommend a limit on TV watching.
The television is, to many elderly, their main source of companionship and entertainment. During the days after the attacks, it was difficult to escape the horrific scenes unfolding, often repeatedly, before everyone's eyes. Residents should be encouraged to take breaks from TV viewing and to participate in activities or to have meals in a social setting whenever possible.

7. Discuss ways that they can help others.
The elderly's concern extends beyond their friends and family to unknown victims and survivors. Residents might have experiences and insight that could be helpful to others trying to cope. They should feel free to help those impacted by the situation by discussing their feelings, as well as participating in relief efforts by donating money, participating in blood drives and writing letters.

8. Understand that their concerns and fears will remain with them indefinitely.
The elderly now have a new outlook for themselves and their friends and family in terms of travel, financial stability, and security at home and abroad. Keep this in mind through the weeks and months ahead, and be understanding of their reluctance to try new ventures or to visit new areas.


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