Disaster planningDisaster planning saves lives

There are a lot of scary threats in the world—extreme weather, terrorist attacks, deadly infectious diseases, mass shootings—but if health care organizations plan ahead for such disasters, lives can be saved.

That was the key message from emergency preparedness expert Paul Biddinger, who spoke to a Harvard T.H. Chan School of Public Health audience in Kresge G-2 on 31 July 2018 as part of the Hot Topics summer lecture series.

Biddinger is director of the Center for Disaster Medicine and Vice Chairman for Emergency Preparedness in the Department of Emergency Medicine at Massachusetts General Hospital (MGH); Medical Director for Emergency Preparedness at MGH and Partners Healthcare; and director of Harvard Chan School’s Emergency Preparedness Research, Evaluation & Practice (EPREP) Program.

The first step for health care organizations preparing for emergencies is to accurately assess the kinds of hazards they may face, such as flooding, power outages, or violence, Biddinger said. They have to develop a plan that takes those hazards into account. They need to train staff about the plan and hold exercises that simulate disasters. “No plan ever looks in practice the way it looks on paper,” said Biddinger. “You have to train and exercise constantly—and everybody has to know what the plan looks like.”

Harvard notes that in 2005, Biddinger and colleagues learned from consultants from Israel—who’d dealt with bombings that resulted in mass casualties—that the average time from when a bomb goes off until the first person reaches the closest emergency department is four minutes. Experts from other places that had dealt with bombings, including London, Madrid, and Mumbai, confirmed that events unfold incredibly quickly during a disaster. Realizing that once a disaster struck there wouldn’t be time to do much of anything—such as clear space in emergency departments for incoming wounded, or call doctors and nurses in to help—Biddinger and his colleagues developed a plan so that hospital staff would know what to do during a disaster without having to be told. “It becomes muscle memory,” Biddinger said.

In 2013, the Boston Marathon was bombed, injuring 275 and killing three. “None of us ever thought someone would bomb the Boston Marathon,” said Biddinger. “Why would you bomb a road race?” But Boston-area emergency responders’ planning and preparation helped—not a single person who wasn’t killed at the scene died later at a hospital, Biddinger said.

Fostering coordination among health care organizations that normally operate independently of each other is an important factor in good emergency preparedness, Biddinger said. It’s also important during a disaster for hospitals and health care centers to maintain primary care services such as dialysis or cancer treatments.

When Biddinger meets people at cocktail parties and they realize he works in emergency preparedness, they invariably ask: “Well, are we prepared?” He said there’s no “yes or no” answer to the question.

“We will never have enough money, enough time, enough resources, to be fully prepared for everything,” he said. “Therefore, we have to do the best we can with what we have…. We try to identify our greatest threats, identify our greatest vulnerabilities, improve our plans, test our plans, learn lessons—and do it all over again.” Ideally, he added, the plans are guided by the best available science, “so that hopefully we get better and better and better.”