Chaos Control

Put People First

Rheumatologists first should consider the role they might play following a disaster, says Jane El-Dahr, MD, head of the section of pediatric allergy/immunology/rheumatology at Tulane University School of Medicine in New Orleans. The extent of their direct involvement depends on the type of event, size of the group and whether the physicians practice in a freestanding office, hospital-based clinic, or university setting. Rheumatologists typically take a supporting role to critical care specialists and surgeons in the wake of a disaster unless patients must be seen in outpatient clinics.

“You’ll have to handle at least basic primary care issues—not just rheumatology—during a widespread disaster,” Dr. El-Dahr says.

The welfare of family, staff, and patients is the next priority in disaster planning, so communications are key. Compile emergency phone numbers for physicians, staff, and patients, including contact numbers for their nearest out-of-town relatives. Create a detailed phone tree and store it in a secure location.

“Many rheumatology patients have disabilities, so make sure they have basic information about government services,” Dr. Feldman says, suggesting the list include telephone numbers for the Red Cross, Alzheimer’s Association, and local Council on Aging.

Similarly, rheumatologists should advise patients to keep an “evacuation kit” in a waterproof bag with a list of their medications, the doses of each, the date of their last refill, and the contact information of their retail or mail-order pharmacy.

“Katrina was not just a disaster that came and went,” Dr. El-Dahr points out. “The entire city shut down, and we had no power for months. Patients scattered all over the country. One way we found patients was to track their location when they refilled their biologic medications.” Passing such information to prescribing physicians does not violate the Health Insurance Portability and Accountability Act, she adds.

Develop an Integrated Strategy

Use your website as a message board where you can post updates about office hours and provide contact information for staff and patients, Dahl suggests. Use text messages or create an online chat group in a secure area of your website to distribute schedules and arrange meetings. Notify media contacts at the local television station, radio station, and newspaper about the status of your office.