Disaster Relief: Planning at MUSC
Guest: Dr. Eric Larson – Emergency Medicine, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Eric Larson, who is a physician in the emergency department here at the Medical University of South Carolina. Dr. Larson, I understand you are also the director of our Disaster Preparedness program here at MUSC.
Dr. Eric Larson: I’m also one of the medical managers of South Carolina Task Force 1, which is South Carolina’s only urban search and rescue team.
Dr. Linda Austin: Interesting. Now, let’s start, actually, with the latter; that group. Tell us what sorts of emergency preparedness we have going on here in Charleston.
Dr. Eric Larson: Okay, here in Charleston, specifically MUSC, what we’ve been doing recently is redoing our disaster plan at MUSC. Before I came aboard, our disaster plan tried to pick each specific disaster there was and then come up with a plan for every disaster that you could imagine. As you could imagine, coming up with every disaster that’s possible is a daunting task. Therefore, Brian Fletcher, who is the clinical coordinator of Disaster Preparedness, and I have come up with what we call and all hazards approach.
Dr. Linda Austin: Hmm. As opposed to earthquakes vs. fires, vs. manmade, vs. whatever?
Dr. Eric Larson: Right.
Dr. Linda Austin: Ah-hah.
Dr. Eric Larson: We’re trying to make our disaster plan so that it is written for any disaster that comes about, that we’re prepared for. So, we’ve done the disaster plan from there.
Dr. Linda Austin: So, tell me, what are some of the major elements of that disaster plan?
Dr. Eric Larson: Some of the major portions of that disaster plan are being prepared for any disaster, so, when a disaster happens, we can mitigate the circumstances: i.e. we have the supplies necessary to sustain ourselves without our contracts; we have the necessary personnel that can maintain the hospital without bringing other people in; that we have the appropriate hardwired supplies, such as generators, and gasoline, and personal protective equipment for disasters that may hit MUSC.
Dr. Linda Austin: Hmm. So, walk me through, then, a worst case scenario disaster. I’m sure that there could be a disaster like a nuclear attack that would exceed the capabilities of any hospital, ultimately. But, what would be the worst case scenario, and what preparations could we actually get through reasonably well?
Dr. Eric Larson: We have many worst case scenarios. One we’ve looked into recently is an earthquake. As you may or may not know, we are on one of the major fault lines on the North American continent, so we’ve looked at that. We actually went to a training session up at the National Firefighters Academy for a week-training with all the hospitals in Charleston County to prepare for that earthquake. That certainly was a daunting task.
Dr. Linda Austin: Let’s imagine that we had an earthquake such as what just happened in China. What kinds of preparations are in place for that? What would happen here at MUSC?
Dr. Eric Larson: Good question. The first thing that would happen, we would have to find out the structural stability of our hospital. One of the problems, if we were hit by one of the big earthquakes, like the one that happened in 1886, is, most likely, older portions of the hospital would not be structurally stable, so we’d have to evacuate that hospital. We’re hoping that the new ART building will be structurally more stable and will hold up to an earthquake like the one they had in 1886.
Dr. Linda Austin: And, what would that be like on the Richter scale? Do we know?
Dr. Eric Larson: They do have estimates. I believe, and I’m guessing now, it’s out there; I think an 8.6.
Dr. Linda Austin: So, pretty big.
Dr. Eric Larson: Oh, it was a big earthquake in 1886.
Dr. Linda Austin: Yeah.
Dr. Eric Larson: And, apparently, they say, whoever they are; the experts, every 100 years, you can expect an earthquake. So, the last one was 1886. So, we’re past due, they say.
Dr. Linda Austin: Yeah.
Dr. Eric Larson: Hoping that the ART building does maintain its integrity, what we do is evacuate the critical patients that we have from the other portions of the hospital into the ART building and maintain there. We have generators, and fuel for the generators, for a three-plus-day supply. In addition, we have the necessary supplies for food and medicines for those patients.
Dr. Linda Austin: For how many days?
Dr. Eric Larson: We’re shooting for three right now.
Dr. Linda Austin: Uh-huh.
Dr. Eric Larson: The government has set the bar at three. Now, we’re starting to say that you may have to be prepared for five.
Dr. Linda Austin: Presumably, after three days, by then, the national government; the feds, could get something in here: FEMA? Or, the National Guard could help us?
Dr. Eric Larson: Yes, that is the plan; that you can count on national resources after about three days. Unfortunately, since Katrina, many of the hospitals learned that the government wasn’t there within three days, and they ran out of supplies. We’re starting to prepare for longer time frames.
Dr. Linda Austin: I see.
Dr. Eric Larson: Right now, one of the things we’re working on is the avian influenza, or Pandemic Flu.
Dr. Linda Austin: What are our preparations for that?
Dr. Eric Larson: Well, we’re working within the entire community. We’re working closely with DHEC, and local DHEC, to prepare for avian influenza. We’re trying to set up places where we would take care of people who have avian influenza, or potential avian influenza; what we call ILI, or influenza-like illness, in a separate area from where we take care of our regular patients.
What we’re trying to do is mitigate the spread of the virus to the entire population. So, if we can, we’re going to set up other areas to take care of the flu patients, separate from the areas where we take care of the transplant patients, the kidney/dialysis patients, or other immunocompromised patients. What we’re looking at right now is, actually, a place in Rutledge Tower and turning that into our avian influenza hospital.
Dr. Linda Austin: I see; a whole, different, building altogether?
Dr. Eric Larson: Yes; segregate the population.
Dr. Linda Austin: Yes.
Dr. Eric Larson: And then come up with a special medical team that’s been trained in taking care of avian influenza, and have them specifically designated to take care of those patients.
Dr. Linda Austin: So, presumably, would that sort of plan hold, also, for other kinds of infectious agents? Say there was bioterrorism, or something, that we might not foresee, we could segregate those patients in that way?
Dr. Eric Larson: Exactly. That’s the all hazards approach. So, while we’re focusing, now, on avian influenza, because it is on the radar screen, any infectious disease could then fit into the same model.
Dr. Linda Austin: I see. So, keep going. What other sorts of disasters have you thought about?
Dr. Eric Larson: Well, we’re in Charleston, so, the disaster we all talk about is a hurricane. It’s a matter of time till we get hit by another hurricane. Hopefully, with the Hugo experience, and with the Katrina experience, we’re quite prepared for that. The new Ashley River Tower building has been built to sustain up to a Category 4 hurricane. In addition, as we’ve learned from Hugo, and from Katrina, our generators aren’t on the first floor anymore. So, with the flooding, we can sustain the hospital at that point.
Dr. Linda Austin: I was actually in the hospital, here, for Hurricane Hugo, which was back in ’89. It was quite an experience; a very interesting experience, actually, and fun, in a bizarre kind of way, to just be hunkered down in a hospital with patients and doctors, and sitting out a hurricane.
Dr. Eric Larson: That’s what people tell me. I heard it was quite an experience. I heard the generators went, and they had trouble getting fuel to the generators, and keeping electricity going. I heard the HVAC system was gone, and it was very warm in the hospital, and there were all sorts of problems.
Dr. Linda Austin: Well, to be perfectly honest, I was here, and I, as well as other people, were ushered into center rooms of the building, and I slept through the whole darned thing. It was actually very quiet. I was in a lead-lined radiology suite, so that was pretty interesting. Now, what other sorts of disasters have you thought about?
Dr. Eric Larson: Well, they have us make a list of the ones we’re worried about the most. And certainly, when we make that list, hurricane is at the top of the list, followed by earthquakes, and then avian influenza, and then terrorist attacks. We are a major port city, so you have to think about manmade attacks such as dirty bombs and radiation exposures, and that sort of thing.
Dr. Linda Austin: And, how would we respond to that?
Dr. Eric Larson: Well, once again, with the all hazards approach; with modifications to that all hazards approach. We do have a radiation team that’s on-call, with detectors. We have decontamination rooms and decontamination showers that are set up outside the hospital. What you try to do in situations like that, much like the infectious disease population, is to not contaminate our hospital; so you try to keep that outside the hospital. Get the people decontaminated and then bring them in the hospital. So, we have decontamination showers that are outside the hospital. We have special tents that we can set up that are outside the hospital, and that sort of thing.
Dr. Linda Austin: What does our current communication system consist of?
Dr. Eric Larson: To be honest with you, communications is Brian Fletcher’s, one of his, favorite pastimes, so I’m not as intimately involved as he is. But we’ve worked closely with DHEC to use the 800 megahertz system so we can communicate within our hospital here. We have numerous handheld 800 MHz radios that we store in the emergency department that can be distributed throughout the hospital once we do lose communication within the hospital.
In addition, we have an 800 MHz system amongst all the hospitals in the Lowcountry, in the Tri-County area, which is a grant from DHEC, and they have an 800 MHz system that’s tied into that. In addition to that, we now have ham radio antennas that are set up throughout the state. So, if all else fails, as we learned in Katrina, the ham radio system seems to work. And we have volunteers who will come in and work the ham radios.
Dr. Linda Austin: Well, what sorts of strategies are in place now, anticipating the most likely disaster, which would be a hurricane, and to help out at the local shelters? Certainly, that was one of the most horrifying aspects of Katrina, and, frankly, was a difficult aspect even here in Charleston. It’s no fun to be in an unairconditioned school building or gym, especially one that’s flooding with water during a hurricane. Are we planning to man or staff those sites too?
Dr. Eric Larson: Of course. We work closely with DHEC on that. DHEC takes the lead on the shelters, working with the Red Cross with the shelters. What we do, working with DHEC, is then help them if they need medical personnel within the shelters.
Dr. Linda Austin: You know, you have a very calm presence, and you convey that, were there a disaster, it’s all been thought out, actually, remarkably well, especially compared to Hugo. I was here for Hugo and remember how little thought and preplanning there actually was.
Dr. Eric Larson: I hope we are. I think one of the things we learned from Hugo, and then disasters subsequent to that, is that we have to be planned. I think it was President Eisenhower who said, plans are useless, but planning is invaluable. Meaning, sitting down with the people who are going to be involved in the disaster, and knowing who those people are, and knowing the relationships with those people are going to be important.
No matter how much we plan for these disasters, they’re disasters. They’re called disasters because it’s a disaster. It’s not going to work perfectly. Our plans aren’t going to be flawless. But, hopefully, we have the plans in place that are going to work well enough that we can adjust on the fly, and it will go smoother than it has in the past. We’ll, see.
Dr. Linda Austin: Dr. Larson, thank you very much.
Dr. Eric Larson: You’re welcome.
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