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What is disaster preparedness in health care? How can hospitals plan for mass casualties? What are mass casualty incidents (MCIs)?
John Armstrong, MD, vice speaker of the AMA House of Delegates and vice chair of surgery at the University of South Florida, discusses why emergency preparedness is important in health care, the recovery from Hurricanes Milton and Helene and the IV fluid shortage. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- John Armstrong, MD, vice speaker, AMA House of Delegates
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're checking in on the recovery efforts in Florida after hurricanes Milton and Helene, and how we can prepare for these events going forward.
Our guest today is Dr. John Armstrong, the vice speaker of the AMA House of Delegates and vice chair of surgery at the University of South Florida in Tampa, Florida. I'm Todd Unger, AMA's chief experience officer in Chicago.
Dr. Armstrong, thank you for joining us. And I'm sure it's a very busy time for you.
Dr. Armstrong: Well, thank you, Todd, for having me.
Unger: It's been a couple of very difficult months for Florida and nearby states, of course, in the wake of hurricanes Milton and Helene. How's the recovery going?
Dr. Armstrong: Well, I will say that on aggregate, we were probably fortunate with the last storm. But having two major hurricanes back-to-back really has devastated a large number of communities in the Gulf Coast. And while the lights and cameras were on the Gulf Coast as the storm was hitting, now not so much press. The reality, this is a recovery that's going to take years. And an important part in this recovery is rebuilding to be more hurricane-resilient.
So I have confidence in Floridians that we're going to get through this. But we have to appreciate the magnitude of the challenge, and particularly with the storm-logged houses where now on the curbs are debris piles. Formerly, that was known as furniture.
Unger: That's a tough situation, and it seems like the magnitude is getting bigger. So your resiliency plan makes a lot of sense there. Of course, there's a huge problem in addition to the destruction, which of course, is the loss of the factory that produced a significant amount of the IV fluids for health care.
You spent four years as Florida's Surgeon General. Have you ever seen anything like this? And how are you and your colleagues dealing with it?
Dr. Armstrong: Well, the reality is that much of what happens is a predictable surprise, meaning we could anticipate that something was going to happen. And then we decide not to actually be ready. And poof, it happens. And suddenly, it's a surprise.
So after Hurricane Maria hit Puerto Rico in 2017, we had substantive issues with medications and with small volume IV bags. And so that should have been the harbinger of a more flexible, adaptable supply chain.
We can acknowledge that in COVID, we had issues with PPE that surfaced repeatedly. And so now we have the IV fluid situation where Helene did damage in North Carolina where there's a major IV fluid factory. Interestingly enough, 50 years ago, Hurricane Camille did exactly the same damage in Appalachia, the Carolinas and Virginia that we're now seeing in the aftermath of Helene. So again, a predictable surprise.
What are we doing? We are considering how we can be more judicious in the use of IV fluids, using oral rehydration. In some cases, deferring elective surgery. But I'm convinced that out of this challenge, we're going to innovate. We're going to learn some things, and we're probably going to change the way we look at IV fluids moving forward.
Unger: That makes a lot of sense. And I should have figured out where that sense of preparedness comes from. Because in addition to being a physician, you also have an extensive military background and are a global leader in mass casualty readiness training. I'm interested in hearing more about how these experiences—how do you apply them to medicine? It sounds like you're getting a lot of practice.
Dr. Armstrong: Well, I am getting a lot of practice. What's interesting, Todd, is that my experience actually started with an earthquake in California growing up, and then living within 30 miles of Three Mile Island, which was a near nuclear meltdown in 1979. And subsequently, dealing with a hurricane in Hawaii, and now a bunch of hurricanes and other events here in Florida.
And I then took all of this with me into my Army career, where we think about readiness as a daily reality, as we work to have systems of care where we save the lives of wounded heroes. So I put all that together to say that, first and foremost, you have to consider the worst-case scenario.
I think we have a tendency to believe that it will never happen. And the reality is we live in hazardous areas much more now than we used to. And we need to consider not only weather, but we need to consider industrial events. And unfortunately, man-made events to include shootings.
We need to practice—in other words, drill for these events. And so often in the Army we would say, train as you fight. Well, I suggest it's train as you care. And so that means doing drills with teams.
And the third piece to this is considering how a mass casualty is different from what we do every day. It's just not another busy Saturday night in a trauma center, for example. The rules are different.
And so one of those is triage—how we find the most seriously injured and salvageable casualties, and then apply resources to them while taking care of the broader population. So I think those are really three lessons that I've had from my collective experience in disasters and mass casualty management.
Unger: Well, I'm thinking earthquakes, potential nuclear meltdown and hurricanes. Moral of the story is I'm not moving anywhere where you're living. There's a pattern there. And I'm just curious, is there any place that isn't vulnerable from these kinds of extreme weather or mass casualty events?
Dr. Armstrong: No, we live in high hazardous areas. And one thing that is important is to do what's called a hazard vulnerability analysis. That's a fancy phrase for basically saying, look at where you're living, and identify the risks, and then figure out how you're going to be ready, in general, and for some of the specific areas.
So in the Armstrong household, we do this every year. We do our little readiness drill in the run-up to hurricane season. The same thing needs to happen for all of us as professionals, and particularly in our organizations, whether it's in our practices or in what we do in the hospital.
Unger: Excellent. Any further thoughts on what we need to be doing to basically do what you said, which is resiliency in the face of a disaster and preparing up front?
Dr. Armstrong: Well, I would step back first and say, what are the main things now that cause me concern in terms of readiness? I think one is flooding that can come from a variety of events. It can come from hurricanes, clearly surge. It can come from the breakdown of levees.
And we have hospitals that are fixed. And so they can actually flood. And we've had too many examples of that. So that diminishes health care capacity, which is a problem.
And then on the other side is just being ready as health care organizations for a mass casualty. I think too often we don't understand what a mass casualty means and think that we can handle almost anything. And the reality is that depending upon your circumstances, sometimes even one seriously injured casualty is a mass casualty.
So I would want our health care organizations to really step back and look at the plans that are in place and drill those plans. And physicians and medical students need to be part of this. Physicians and medical students are leaders in readiness. And I think that the more we can put a spotlight on their roles, the better we are going to be at driving readiness.
Unger: It seems like sometimes these events—you can do a lot of planning, and everything seems to be working, except that one thing that you didn't anticipate goes wrong. And then it kind of sweeps away all your preparedness. How do you anticipate every scenario like that?
Dr. Armstrong: Well, you have to adapt. Many say that the most important part of the planning process is the actual process of developing the plan, not necessarily what you have initially. And you can think of a final plan, but it actually is a rough draft. And when the event happens, you demonstrate your resiliency by being very adaptable and flexible to circumstances.
And you get that kind of muscle memory through drills—formal simulations that test the entire hospital, for example, and the interface between the hospital and the community. Absolutely essential to pick up on those things that you might otherwise miss, and then you build those into the plan.
Unger: Well, Dr. Armstrong, thank you so much for joining us. Your perspective here is so insightful, and we really appreciate you taking the time to talk with us today. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join.
That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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