Hurricane Irma intensified into a Category 5 storm on 4 September 2017. One of the largest hurricanes on record, it cut through the Atlantic leaving a path of destruction across 14 geographic regions and taking over 100 lives. Evacuations out of Florida were unprecedented, and Georgia declared a state of emergency.
None of this should come as a surprise — the news covers hurricane devastation thoroughly. But what happens after a hurricane? How do government agencies learn from their successes and challenges?
Over the past 22 months COR has collaborated with the Gwinnett, Newton and Rockdale County Health Departments (GNR) and Georgia’s Department of Public Health on mass sheltering clinical operations processes.
Our hot shot of the month is Mark Reiswig. Mr. Reiswig graduated from Baylor University’s Hankamer School of Business and has served in many advisory roles across disaster response. As Director of Emergency Preparedness he is responsible for all emergency preparedness efforts — budgeting, staffing, training, exercising and responding — for a three-county public health district serving over 1.2 million people in metro Atlanta.
COR: What has been your approach to ensuring that GNR district staff feel both competent and empowered to serve in a disaster?
My everyday job, as well as that of my six-member team, is to anticipate potential disasters and prepare for them. However, although also expected to respond during emergencies, this is not the day-to-day job of the other 300 GNR employees. It is my team’s task to analyze our hazard vulnerabilities, develop plans to address them, train all staff in plan implementation, and conduct exercises that test the viability of those plans.
After every exercise or real-world event it is critical to conduct an After Action Review. This analyzes the strengths and challenges, identifies planning or resource gaps, and develops an Improvement Plan. My approach boils down to three things: make sure my own team is strong and empowered to make decisions; train people in the roles they are likely to play and drill them, because brain capacity drops significantly under stress and people need muscle memory; and accept that no response will ever be perfect — learn something from every single event.
COR: Can you explain how multiple entities collaborate to meet medical needs in an emergency?
Volunteers are a critical component of what we do. Our health department has about 300 total employees, and only about 10% of those are nurses. Depending on the type of disaster, we may be required to dispense life-saving medication to as many as 1.2 million people in less than 48 hours. That is not possible with just our staff.
Sheltering is another example. While Public Health is the agency charged with coordinating health and medical needs in an evacuation shelter, that does not mean it can fill all the roles — let alone the Red Cross shelter managers, DFCS personnel, security and inspectors who fill the non-health needs.
COR: Why did you feel it was important to aggressively revamp the mass sheltering protocols?
Just after Hurricane Matthew hit Georgia in 2016 we sent a team of five public health nurses to assist in a Red Cross shelter in Savannah. To be blunt, it did not go well. Our nurses felt overwhelmed by extensive medical and behavioural health needs, many of which went well beyond the scope of practice for a public health nurse. They had no logistical support and spent most of their time performing tasks that could have been done by non-medical staff. Most importantly, they did not feel safe.
We knew we needed a new model, so we developed the Shelter Support Task Force — nurses, epidemiologists and logistical support staff deployed as a unit. We were still developing the concept when Irma bore down on Georgia in 2017. We put together a team of four public health nurses, two volunteer MRC nurses with significant acute care experience, two environmental and logistical support members, and one epidemiologist. Most had never met.
Unbeknownst to me, our two MRC nurses were also … from COR Consultants, and happened to be extremely skilled in studying processes and operations and identifying ways to improve them.
We sent that team to a 650-person shelter in Columbus, Georgia, and they made a huge impact. Despite the lack of training, shelter medical operations improved greatly. Through their feedback we developed new rounding processes, forms that improved our ability to track residents’ health needs, a shelter supply kit, and training curricula for staff and volunteers. I honestly feel we are light years ahead of where we were three years ago.
COR: What steps should healthcare professionals take to volunteer?
There are over 900 local MRC units nationwide. They all need more medical and non-medical volunteers. Find one in your area and find out the process to join. Disasters differ by region, but they exist everywhere, and you can be part of making a great impact on people’s lives in a difficult time. Few things are more rewarding.
The COR perspective
Preparation is key. Although the GNR district is only one of 18, it has proven itself one of the leading districts in the state. Mark has gone above and beyond to ensure his district is up for the task of mass sheltering.
As with all of our clients, we focused on two elements throughout this engagement: the end-user experience — is it both the best it can be and feasible — and the patient experience — are we helping provide safe and effective care for the community.
