Kate Rathbun, MD, MPH

1. Kate Rathbun, MD, MPH Concentra Medical Center 3235 Perkins Road Baton Rouge, LA 70808 225-387-3030 dr-kate@dr-kate.com www.dr-kate.com

2. PRIMARY CARE IN DISASTERS • Winter storms • HAZMAT • Floods • Fires • Heat Emergencies • Tornados • Hurricanes • Nuclear Power • Terrorism • Epidemics • Earthquakes?

3. DISASTER • WHEN NEEDS EXCEED RESOURCES • Every Saturday night in the ER • 24 / 7 / 365 for the Uninsured • Demographic War

4. KATRINA • 1 million people evacuated • 20% had chronic diseases • 29th of August • 250,000 in shelters • River Center 25,000 people • 80% turnover per day • first aid only

5. PRIVATE RESPONSE • Ad Hoc clinics in shelters • St James Church maternity program • Dialysis – nephrology groups • Ochsner opened the first day • Baton Rouge Clinic on the 8th day • All hospitals in Baton Rouge and major hospitals in New Orleans stayed operational

6. GOVERNMENT RESPONSE • The federal government arrives in 3 days and leaves in 3 weeks • State government provides immediate response which ends after 3 to 6 weeks • Recovery requires 3 to 10 years

7. MYTHS • Local physicians are busy with their own problems • PMAC – 800 beds - the largest field hospital in history • National Guard to the rescue • FEMA sent a lot of money • USNS Comfort in Biloxi

8. REALITY • Local doctors got abuse and interference when they tried to respond • PMAC – 30 beds on the basketball court -120s beds in the field house • Governor’s orders, the National Guard blocked access to New Orleans • DH&H kept the money • The Comfort saw 8 patients per day per physician and were a thorn in the side of the Ocean Springs Hospital

9. PRIMARY CARE PREPARATION • As a medical society – demand a seat at the table at the county and state levels • Availability of primary care should be the main focus • Coordinate with other doctors to maintain continuity of care • Make sure your own practice is prepared

10. PREPARE AT HOME • Get a guide and follow it • Prepare to leave in 30 minutes or stay 7 days • Make preparedness part of the household routine • Make arrangements with family and friends before the event • Communication is critical

11. PREPARE AT WORK • Phone tree & out-of-town contacts • Emergency bags • Flashlights, can openers, etc • Business supplies for 2 weeks • Lunches • Weekly closing procedure

12. PREPARE THE BUSINESS • Good insurance • Casualty, liability, business interruption • Computer billing records • Off-site back-up • Alternative sites of practice • Mutual aid agreements

13. PREPARE YOUR PATIENTS • Problem list & Medication list • New copy at each visit • 30 days of medications • Where to go if you aren’t there • Electronic medical records • Only for prearranged mutual aid

14. PREPARE THE MEDICAL COMMUNITY THE GOAL IS RESILLIANCE • Mutual aid arrangements with shared records for OB, Oncology, Dialysis, etc. • Hospitals need urgent care centers away from the ER • Volunteer through the medical society not the health department

15. DURING THE DISASTER • Decide where and how you can be of the most value - go there and do that. • Decide when you will reopen your practice and what services you will provide • Know if you and your people will be paid

16. AFTER FEMA LEAVES • Plan so your practice stays viable • Waves of leaving – What to avoid • can’t come back • can’t rebuild • can’t face the next 10 years • Remember, you only get your insurance payment once