Emergency Preparedness:

Update from the Virgin Islands

By Jack Egnatinsky, MD, AAHHS Board of Directors (Chair, 2017-18)

As a fresh-faced doctor in upstate New York, I experienced my fair share of swift weather changes and unpleasant conditions. So much so, in fact, my wife and I decided to pack up and head to the Caribbean for a more consistent, relaxing climate.

We could not have been more wrong. When we moved to St. Croix, we quickly learned that severe weather comes in all shapes and sizes, and to brave the storms effectively, healthcare providers must expect the worst and facilities must continually update their emergency preparedness plans.

Post-Hurricane Conditions

This last fall, St. Croix battled both Hurricane Irma and Hurricane Maria in a very brief period of time. Irma tunneled in and pummeled the island, followed swiftly by Maria blowing through to further damage infrastructure and property.

Our hospital in St. Croix, the Juan F. Luis Medical Center, sustained major damage from the hurricanes and has struggled to remain operational. Other updates include:

  • Inpatient and dialysis patients were evacuated to the mainland United States, as we could not maintain their care
  • Patients in need of long-term care services continue to be evacuated
  • Our newly constructed cardiac center attached to the hospital was temporarily converted from an ambulatory care center to a 23-bed inpatient area with an ICU
  • One of our operating rooms was restored back to working condition allowing for limited elective procedures

Luckily for me, one ASC on the island that has an eye center has been granted an extended certificate of need for multi-specialties and I was able to have a procedure done without any problems. But the patient population being cared for currently remains quite small.

Communication & Supplies

Despite the several day warning we usually have of an impending major hurricane, people often become complacent because so many storms are predicted to hit but veer one way or another, and the island infrastructure does not do well.  For example, on all three U.S. Virgin Islands over 8,000 telephone poles were damaged or blown over.

On St. Croix, the ongoing lack of functional phone service or internet connection hinders medical reports from being faxed, scanned or emailed among facilities. Most offices have resorted to using personal cellphones to share information. Unfortunately, if you are a patient in need and do not have access to these phone numbers, it becomes very difficult to schedule an appointment or access other information.

Much of the supplies and support received from Puerto Rico in the immediate aftermath of the storms have essentially disappeared for many weeks as the entire region felt the impact of the hurricane. Fortunately, laboratories, radiology services, a private dialysis center and ambulance service have been largely unaffected. In addition, the ER is up and running, despite being operated from an army tent right after the storms hit.

The persistent struggles we are experiencing on St. Croix underscore why healthcare organizations must make emergency preparedness a top priority to ensure the necessary precautions are taken and enough resources are available to keep patients safe in the worst of conditions.

Emergency Preparedness and Accreditation

As a board member of an accrediting body, I am in the unique position to fully appreciate all that the accreditation process has to offer an organization. During an accreditation survey, all healthcare facilities must demonstrate they have an emergency preparedness plan in place by meeting several requirements including:

  • A thorough plan with detailed instructions for all departments and stakeholders
  • Regular drills and exercises to ensure every team knows what to do when disaster strikes and also in the aftermath
  • Strategies to address a wide variety of possible disaster situations to prepare the healthcare facility for almost anything
  • Continual updates to meet evolving requirements and embrace the latest technologies and information
  • A risk assessment to identify potential hazards and analyze what could happen if a hazard occurs

By compiling a list of possible hazards or risks that may befall the facility, and assessing the probability of those risks and potential impact, it becomes easier to prioritize which emergencies to develop strategies around.

Because the accreditation emergency management standards are so thorough and specific, they should be used as guidelines for developing a comprehensive plan and integrating the protocol into all departmental training.

Strength in Teamwork

Through my experiences as a surveyor, I have gained valuable insight into what can make or break a strong emergency plan, and I learned the most effective strategies prioritize team cohesion across all departments and stakeholders. When teams work together to ensure a seamless emergency management strategy, the gaps in resources and communication are limited and patient safety is enhanced.

Accreditation standards emphasize the impact of every department on overall operations and efficiency, with unique requirements for each. Teams understand their roles and are aware of other departments’ requirements – learning where they fit within the “big picture”– to better anticipate needs as situations change.

But teamwork doesn’t stop with internal departments. Cooperation with local authorities is also key in any emergency preparedness plan. Healthcare facilities must coordinate with state, tribal, regional and local emergency management partners and community organizations when developing disaster plans – as these external stakeholders play vital roles in emergency response and recovery.

To use an accreditor’s emergency management standards meaningfully, a healthcare facility must establish a cohesive strategy across disparate teams – led by a centralized accreditation expert. This same approach should be utilized when practicing and updating the emergency preparedness protocol. Identify key leaders, develop a comprehensive disaster plan and run practice drills with all stakeholders involved. These steps are vital to achieving accreditation as well as preparing for any disaster brought on by Mother Nature or other emergency situation. Let’s continue to share our experiences, learn from each disaster and become more resilient moving forward.