Maurice A. Ramirez, DO, CNS, CMRO

Hunker Down Again

It is 2007.  It is summer.  The sky is blue.  The sun is shining again over central Florida and you are enjoying one of Orlando’s beautiful spa and resorts.  The kids have met Mickey and Minnie, Pluto and Donald, Shamus and every character in Universal Studios.  You know because you have had to walk every inch of every park.  As you nestle in for a much deserved evenings rest you turn on the Weather Channel and there before you are the two red flags with those ominous black squares. 

Hurricane!

Your mind races.  What do you do? 

You are miles from home.  All your worldly possessions are safe but your most precious possession, your family, is here. 

Are you prepared?  I have a disaster plan for home.  You followed the D.I.S.A.S.T.E.R. acronym. 
* You know how to Detect. 
* You know how to find out who is In charge. 
* You know how to be Safe. 
* You know how to Assess the situation
* You know how to get Support. 
* You understand the concepts of Triage and Treatment, how to decide what is most important and how to get help if I need it.
But…
* You do not know how to Evacuate.
* And you are not part of any Recovery plan here. 

You are just a tourist. 

At home you are R.E.A.D.Y. 
* You know what you Rely on. 
* You have Educated yourself and your family. 
* You have learned to Appreciate those around you and those who will help you. 
* You have Drilled, Drilled and Drilled again.
* But in the end any disaster plan comes down to You and here you are in a strange place far from everything that you need; everything that you rely on; everything that is familiar. 

The P.L.A.N. acronym is all you have left. You have to start all over again. You need a new plan.
* Take inventory of the People participating, your family. Prepare each person for the disaster. If you have small children, you may need to talk to them about what is happening, and reassure them that everything will be all right.
* If instructed to Leave, when and how will you leave (evacuate)? Where will you go and how will you get there? Will your family or fellow evacuees meet before you leave or when you arrive at your destination? The decision to leave makes communication and your contacts outside the disaster zone critically important. How will you communicate while you evacuate and after you arrive at your destination? What are you going to do if you get separated? Operate on a buddy system; no one should be left alone. When you and your family or business associates become mobile, make sure everyone knows the plan.
* Anticipate plan failures and plan for the “what ifs.” This is a chance to brainstorm. Make a list of all the possible failures. What if the phone lines go down? What if your basement floods? What if you get caught in traffic? No “what if” is too extreme to consider. The only possibility that you can’t plan for is the one you didn’t think of. Once you’ve brainstormed possible failures, you need to Adapt to each one with an alternate plan. If the phone lines go down, can you use your cell phone? If your basement floods, can you seek shelter with a neighbor or in some other nearby location?
* Make sure you account for all your Needs for seventy-two hours. Be prepared to be self-sufficient during this time. Each one of your family members must have personal identification and photos of all others in your plan, one quart (liter) of drinking water, seventy-two hours of food, seventy-two hours of clothes, two weeks of medications, two weeks of toiletries, a supply of cash (credit/debit cards can’t be verified if phone lines go down), a flashlight, a portable radio, batteries, a signal whistle, white/silver duct tape, a first aid kit, prepaid calling card, and a list of emergency phone numbers.

Take heart my traveling friend.  As a professional speaker as well as a disaster responder, I travel every week. I can tell you that you are better prepared on the road than you are at home. 

First, you are already packed.  All those worldly possessions that you could not bring with you are waiting safely at home and all the things that you need to get through a trip whether for pleasure or disaster are already in conveniently packaged in suitcases, backpacks, duffle bags and we hope not a steamer trunk.  What you need is right there. 

Second, everything else you will need is conveniently located in one place, the nearest pharmacy. Flashlights and radios are easily obtained at any of the local drugstores and even at the local attractions.  Stay away from candles.  While they are safe at home where you know the environment and you control the environment, in a hotel you might get wet and not from the hurricane but from a sprinkler system. An inexpensive first aid kit is also a quick and easy item to obtain while on the road.  Again a simply trip to the pharmacy and you have what you need. 

Don’t forget water. You might be on your own for as much as 72 hours.  Most hotels have water in the room at an obscene price but while you are at the pharmacy or drug store picking up your handcranked radio and flashlight, your toiletries and filling any medications that you may need to have transferred in from back home, do not forget to pick up a liter of water per day per person and then you are ready to go. 

Pack it all in your suitcase and give up the items that may not be so important.  Leave them for the hotel to take care of. 

Third, make contact with the hotel.  Find out what their disaster plan in.  I assure you they have one.  They are responsible for you.  They no more want the bad press or the liability of someone getting hurt than you want to be that someone who is hurt. Ask them if their staff is trained in Disaster Life Support, the “CPR” of disaster response. This training is available throughout the United States. It is offered nationally by High Alert, LLC and several major universities. Here in Florida, this training is offered by National Disaster Life Support of Florida and several state universities.

Rely on your hotel.  They will provide for you.  Our central Florida hotels provided their guests extraordinary service and comfort during the last two seasons of hurricanes.  There is no reason to believe it will be any less so now.  In fact every facility is more prepared now than they were two years ago.  There was even a major medical convention last year during Hurricane Wilma and the convention went off without a hitch.  So will your vacation. 

Finally, resist the urge to try to go home.  Do not jam the airport full.  The airport is the last place you want to try to hunker down through a hurricane.  If you can get out and get on, do so.  Check out by phone after you get home.  This way you have a hotel room to come back to.  If your hotel checkout is already preplanned and the storm is some distance away, consider leaving for home early, before the travel rush.  Whatever you do, don’t rent a car and try and drive out of the state of Florida.  Unfortunately there are only a few major highway exits from our state.  We have been credited with the largest traffic jams in world history during the last several years’ hurricane seasons.  Only Hurricane Rita misplaced us from that number one position as Houston evacuated 1.2 million people over 48 hours on the highway.  If the airport is a bad place to weather a storm, a rental car is worse. 

So enjoy your vacation.  Stay.  See the sites.  When the weather turns bad listen to what the officials tell you to do. 

We are good at this.  Trust in the people that have made the pleasurable part of your trip so great and remember in Central Florida the sun always shines again.  The sky is always blue again and we are

The Implication of Another Round of Bombings

Many awoke this morning to the news of a major Counterterrorism success. Conspirators in London were arrested for alleged participation in an apparent plot to blow-up an unknown number of American aircraft at an uncertain date in the not too distant future, perhaps even on the anniversary of
September 11th.

My short introduction points up the very nature of terrorism and disaster preparedness.  “Alleged participation” and “apparent plot” juxtaposed to phrases like “unknown number,” “uncertain date,” not too distant,” and “perhaps” emphasis the uncertainty of the information on which we must act and the need for vigilance and preparedness.

Six short weeks ago, the National Academies of Science here in the United States published 3 reports which pointed out just how unprepared America’s hospitals and healthcare industry is to deal with the type of mass carnage thwarted today or the catastrophe that was hurricane Katrina.

I am among that group of disaster response experts who lost colleagues and family when the towers fell. It is infuriating to know that five years later we who prepare the nation must still argue with corporations and healthcare institutions before they take responsibility for their part in our nation’s safety, security, and preparedness.  Those who teach these most critical skills remind our students that the goal is not to pass a test or gain career advancement. The goal is to go home alive at the end of the day. 

On those occasions when corporations and healthcare institutions bring in “the experts,” it is discouraging to see the room more than half empty.  In a nation whose businesses pride themselves on customer care, to see so few people interested in preserving the nation’s safety is demoralizing beyond words. 

Equally disturbing is the recent trend towards territorialism among medical specialties.  Since 9/11, every specialty has sought to proclaim itself the “Masters of Disaster”.  They fail to realize that most of the healthcare delivered after a disaster is simply the daily practice of medicine in more austere of conditions.  They also fail to understand that the majority of disaster medicine is practiced before disaster ever strikes.  Disaster Medicine specialists are essential to the integration of healthcare into the community disaster response, and the elimination of profession-specific silos of authority and knowledge.  What these other specialties fail to see is that in the planning, preparation, response and recovery from disaster, the healthcare community must be a seamless team, not a collection of egocentric individuals.  Rather than embracing the concept of board certification in the new specialty of Disaster Medicine, these territorial and fractious groups seek to stake their claim in this most critical part of our brave new world.  In short, they have learned nothing over the last five years. 

There is encouraging news. Disaster Life support (DLS) has become the de facto national standard for disaster preparedness of individuals, families, businesses and healthcare professionals and Healthcare First Responder training (HFR) has become the ruler by which hospitals and other healthcare institutions are measured.  It is immensely rewarding when participants “catch the bug” and understand how important it is to be prepared to protect themselves, their families, their communities, and their patients.  Much like the early days of CPR, it will take time for the nation to understand the importance of every man, woman and child knowing what to do when the wind blows, the buildings falls or the whole planet sneezes at once.  Until then, those who teach these most precious skills will continue to strive to ensure that everyone goes home at the end of the day.