Healthcare

Worst-Case Scenarios: Sudden & Total Isolation

by Joseph Cahill

Cornwall, New York, is a mid-sized town in the Hudson River Valley, served by a volunteer ambulance corps and two volunteer fire departments. During Hurricane Irene in 2011, a critically important bridge washed out and most major roads in the area were flooded, leaving the town separated from the vital resources and services essential to any community. The Cornwall situation played out over and over again throughout the entire northeastern United States, in areas ranging in size from single homes to crowded neighborhoods, and from small towns to medium-sized and larger cities.

Key Goal: Maintaining Access to Emergency Services From the perspective of EMS (Emergency Medical Services) teams and individual volunteers, this sudden isolation meant not only that local residents were unable to reach aid stations, shopping malls, and other community centers, but also that hurricane victims, and others requiring urgent medical care, could not be quickly and safely transported to hospitals or other medical facilities.

In some situations when the local transportation infrastructure is impacted, no medical facility is accessible. In other situations, though, medical facilities may be accessible and functioning but are not equipped to provide full-scale responses. Although many community hospitals have on hand the medical resources needed to cope with a flood or other natural disaster, other facilities – particularly those in remote or sparsely populated areas – are more susceptible to “isolation” risks than the more fully equipped facilities in larger and less remote communities.

Under those circumstances, outpatient clinics, urgent care centers, and other non-emergency facilities must do the best they can; but there are certain risks involved. These facilities have the ability to treat and stabilize patients, for example, but they usually do not have the same quantity or variety of medical resources that community hospitals possess. This means that critically ill or injured patients must be transported – by a medevac helicopter, for example – to other facilities for the more complicated/advanced care they might need. Use of that option shortens the transport time, but also entails other risks, particularly in difficult weather conditions.

Flooding is not the only hazard that may isolate a community immediately after a natural or manmade incident. Any factor that disrupts the efficient functioning of one or more of a community’s “lifeline” sectors – energy, water, communications, transportation, or emergency services – could create what for all practical purposes would be a virtual island. For that reason alone, it is important to: (a) fully evaluate each facility in a given jurisdiction during the planning process; and (b) use the findings to determine how the loss of services from each lifeline sector might adversely affect the response and recovery phases of an incident.

Plan for the Worst, Hope for the Best Even in towns or other communities that do not have the geography or topography conducive to being almost literally cut off from the outside world, emergency response agencies must have a useful planning tool forentifying all potential risks and developing the contingency plans needed to cope with various incident scenarios. In larger jurisdictions, this “thought exercise” could be applied when considering smaller areas within the jurisdictions that lend themselves to being cut off. By postulating a scenario of total isolation from the outside world – including such resources as hospitals and/or mutual-aid centers – emergency managers can create effective action plans robust enough to respond when either a single resource or multiple resources are lost.

In the late 1990s, the New York City Fire Department deployed spare paramedic equipment sets by following, in part, this same type of analysis. The Department deployed the equipment by using several factors based not on population or call volume but, rather, on the likelihood that a particular area could become isolated, and/or one of several bridges was lost or at least temporarily not accessible.

By involving other agencies in the planning process, emergency managers can both gather and evaluate the information needed to develop mutually acceptable interagency agreements and procedures. For example, the Department of Public Works may use the information to determine the priority levels required for opening specific routes based on such factors as: (a) the usefulness of each route; (b) the ease of access available to emergency vehicles; and/or (c) the relative isolation of the various areas served by each route.

Isolation is one risk that planners must evaluate, and a scenario they should plan for even if it seems unlikely. Although most U.S. communities may never experience the “island-effect” that Cornwall lived through, planning for such worst-case situations can nonetheless improve the overall response effort needed when any or all resources are no longer fully available.

________________________ Joseph Cahill is the Director of Medicolegal Investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Prior to that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s Paramedic Program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.