Resources & Information

This June, while pondering what to write in this edition of the Forum, I got an urgent message. At the time, the Midwest was awash in floodwaters. I was advised that I could be deployed to assist in Iowa.

This was not a particularly unusual or unexpected circumstance. As some of you know, my “day job” is with the New Hanover Public Health Department, where some of my work focuses on disaster planning and preparedness. As it turned out, I was not called to Iowa. But the prospect underscored for me, once again, how important it is for all citizens to be ready when disaster strikes.

Physicians and allied health providers may tend to think of health emergencies primarily as medical events, such as heart attacks or outbreaks of bacterial meningitis. Over the past several years medical professionals’ understanding of the term has evolved, as it has for all Americans. Today we are more keenly aware of the need to be prepared for acts of bioterrorism and disease outbreaks, as well as natural disasters that pose threats to practitioners, their families and their patients. Those of us who experienced Hurricanes Bertha, Fran and Floyd know firsthand the importance of preparedness — and the consequences of failing to plan ahead. More recently, Hurricane Katrina taught the nation the same lesson on a vast and sobering scale.

So are you prepared on a personal, business and professional level? A physician or health care provider must be prepared in order to serve patients while also taking care of family and personal priorities.

Being prepared has layers of meaning for health care professionals. First, we are private citizens with loved ones to protect and care for. Physicians in private practice are also employers and business owners. Finally, health care providers are also trained professionals with the desire, ability and duty to serve in a time of need.

Begin by focusing on family preparedness, specifically by creating a family emergency plan. Such a plan should partially consist of detailed plans for how you will contact one another, how you will get back together if separated and what you will
do in emergency situations. Every family should have a basic personal emergency kit (a list of recommended items follows this article). Ask what emergency plans are in place at work, school and daycare. Know who will care for your children,
elderly family members and other dependents.

In the event of an impending hurricane or known disaster make sure that you have cash, a full tank of gas in your car and arrangements for pet care, if needed. As a result of Hurricane Katrina, which stranded hundreds of displaced companion animals, some counties now operate shelters that allow families to evacuate with their pets.

Once you have a comprehensive family emergency plan in place, turn to your practice.

Does your practice have a disaster plan or a pandemic influenza plan? How about hurricane insurance? To begin, designate someone in your practice to take the lead on planning and keeping everyone informed. If you are in private practice, you will need to consider both your financial interests as a business owner as well as your responsibility as a provider of care. At minimum, you will need easily accessible back-up contact lists for patients and vendors, backup medical records, a communication plan and, possibly, plans for an alternative location.

If your practice must relocate, has a prolonged closure or loses its facility you will need a plan for ensuring continuity of patient care. You may need to notify patients to tell them how to access care, medical records and other important information. These decisions and plans are best discussed and made ahead of time.

It may seem unlikely that your practice will be forced to evacuate and set up in a new location. But it is worth taking the time to plan for this contingency. Consider the roughly 6,000 physicians who were among the more than 1.5 million people who evacuated the Gulf Coast due to Hurricane Katrina. Nearly a quarter of evacuated physicians were still displaced seven months after Katrina made landfall, according to an article in the journal Disaster Medicine and Public Health Preparedness, “Characteristics of Physician Relocation Following Hurricane Katrina.”

Templates for business emergency plans are widely available on the Internet. Access a sample business continuity and disaster preparedness plan. The North Carolina Pandemic Influenza Plan provides important information and guidance on drafting a plan for your practice. The federal government’s pandemic flu site is another valuable resource. It includes a checklist for health care planning that can form the basis for a medical practice pandemic influenza plan.

Finally, in addition to personal and business preparedness, the physician must prepare him or herself on a professional level to serve in times of disaster or emergency.

Physicians have a long tradition of volunteerism. However, such service exposes health care providers to increased risk of professional liability, as well as personal risk of injury. To help address these problems, the National Conference of Commissioners on Uniform State Laws in July 2006 drafted the Uniform Emergency Volunteer Health Practitioners Act (UVEHPA) and has urged all states to adopt it. It calls for a national system to facilitate the deployment and use of licensed volunteer health practitioners to provide health and veterinary services in response to declared emergencies. Managing liability risks to health care providers is one of many subjects covered.

The risk of exposure to liability for malpractice is substantial to volunteers providing health services in challenging and suboptimal conditions. Physicians may need to provide services with limited resources and may have to practice outside their usual fields of expertise. Physicians may be in the difficult position of allocating scarce health care resources. Health care providers also face greater personal risks of both physical and psychological injuries when providing emergency services.

North Carolina addresses these concerns through the Emergency Management Assistance Compact, the North Carolina State Registry of Volunteers and through state law.

All 50 states, Washington D.C., Puerto Rico and the U.S. Virgin Islands have entered into the Emergency Management Assistance Compact (EMAC), which provides qualified immunity from negligencebased claims to state and certain local government employees deployed in response to official disasters and emergencies.

The state of North Carolina protects health care professionals in certain circumstances, regardless of emergency conditions.

Volunteer medical providers working without compensation have qualified immunity from negligence-based claims while treating patients at a local health department, health center or free clinic or while treating indigent patients in their own offices.
Retired physicians who hold limited volunteer licenses are similarly protected. State law offers similar protection to physicians and others who render aid or emergency treatment when circumstances require prompt action and delay would seriously
worsen the condition of the patient.

In all cases, providers are expected to follow community standards of care. The law does not offer protection against claims of gross negligence, wanton conduct or intentional wrongdoing.

Under the North Carolina Emergency Management Act, providers who receive pay for their services have qualified immunity if they are operating as emergency management workers. Providers can take steps to ensure they are protected by the law by registering with the North Carolina State Registry of Volunteers or SERVNC, an online registration system for volunteer medical and health responders. Once registered with SERVNC, a provider becomes part of the State Medical Assistance Team and is thus afforded qualified immunity during a declared emergency unless there is willful misconduct, gross negligence or bad faith. Again, health care professionals are expected to follow community standards of emergency care.

In summary, physicians and allied health providers should prepare on a personal, business and professional level to protect themselves and their families, and to better serve patients during an emergency. I hope you never need to use your plans. But if the need arises, you will be glad you took the time to prepare, and so will your patients.
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1Full details of circumstances where qualified immunity is afforded are given in G.S. 90-21.16, G.S. 90-21.14, and G.S. 1-539.11.
2Terms of qualified immunity and a definition of covered professionals can be found in G.S. 166A-14.

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Be Prepared: What to put in a basic family emergency kit
A family emergency kit should include supplies to help you survive for at least three days without outside assistance. The list below includes items that belong in every emergency kit. Be sure to consider the unique needs of your family and supplement the kit with additional items. Consider keeping a full kit at home and smaller portable kits for work, the car and other places you spend time.

Basic supplies:
• Water, one gallon of water per person per day for at least three days, for drinking and sanitation
• Food, at least a three-day supply of non-perishable food
• Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert; Extra batteries
• Flashlight and extra batteries
• First aid kit
• Whistle to signal for help
• Dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
• Moist towelettes, garbage bags and plastic ties for personal sanitation
• Wrench or pliers to turn off utilities
• Can opener for food (if kit contains canned food)
• Local maps
• Prescription medications
• Additional food and water for pets

Additional Items to Consider:
• Important family documents such as copies of insurance policies, identification and bank account records in a waterproof, portable container
• Cash or traveler's checks and change
• Fire Extinguisher
• Matches in a waterproof container
• Mess kits, paper cups, plates and plastic utensils, paper towels
• Paper and pencil
• Books, games, puzzles or other activities for children