Hurricane recovery in Florida, IV fluid shortages and health care emergency preparedness

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What is disaster preparedness in health care? How can hospitals plan for multiple injuries? What are multiple casualty incidents (MCIs)?

John Armstrong, MD, assistant speaker of the AMA House of Delegates and assistant chair of surgery at the University of South Florida, discusses why emergency preparedness is important to health care, Hurricane Milton and Helene recovery and IV water shortages. AMA Chief Experience Officer Todd Unger welcomes guests.

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Speaker

• John Armstrong, MD, deputy speaker, AMA House of Delegates

Unger: Hello and welcome to the AMA Update video and podcast. Today, we look at 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, assistant speaker of the AMA House of Delegates and assistant chair of surgery at the University of South Florida in Tampa, Florida. I’m Todd Unger, chief experience officer for AMA Chicago.

Dr. Armstrong, thanks for joining us. And I’m sure it’s a very busy time for you.

Dr. Armstrong: Thanks, Todd, for having me.

Unger: It’s been a very difficult few months for Florida and surrounding states, of course, after hurricanes Milton and Helene. How is the healing progressing?

Dr. Armstrong: I will say overall, we probably got lucky with the last storm. But having two major hurricanes back to back has devastated the Gulf Coast. And even though lights and cameras were on the Gulf Coast as the storm hit, there wasn’t much press. In fact, this is a recovery that will take years. And an important part of this recovery is rebuilding to withstand the hurricane.

So I have faith in Floridians that we will get through this. But we have to appreciate the magnitude of the challenge, especially with the houses destroyed by the storm where there are now heaps of rubbish around the edges. Previously, that was known as furniture.

Unger: It’s a tough situation, and it seems like it’s getting bigger and bigger. So your volunteer plan makes a lot of sense there. In fact, there is a big problem in addition to the destruction, which is, in fact, the loss of the factory that produced a large number of IV fluids for health care.

You spent four years as Florida’s Chief Medical Officer. Have you ever seen anything like this? And how do you and your colleagues deal with it?

Dr. Armstrong: Well, the truth is that most of what happens is a surprise, which means we can expect something to happen. And then we decide not to be ready. And poof, it happens. And suddenly, it’s amazing.

So after Hurricane Maria hit Puerto Rico in 2017, we had a big problem with medicine and small IV bags. And so that had to be a sign of a flexible, flexible supply.

We can accept that in COVID, we have had problems with PPE that have arisen repeatedly. And then we have the IV fluid situation where Helene destroyed North Carolina where there is a large IV fluid factory. Interestingly, 50 years ago, Hurricane Camille did exactly the same damage to Appalachia, the Carolinas and Virginia that we are seeing now after Helene. So again, an early surprise.

What are we doing? We’re thinking about how we can be smart about using IV fluids, using oral rehydration. In some cases, to prevent special surgery. But I am sure that from this challenge, we will emerge. We will learn more, and possibly change the way we view IV fluids going forward.

Unger: That makes a lot of sense. And I had to think about where that sense of preparation came from. Because in addition to being a doctor, he also has an extensive military background and is a world leader in multi-disaster preparedness training. I’m interested in hearing more about how these experiences – how do you use them in medicine? Sounds like you’re getting a lot of practice.

Dr. Armstrong: I’m still practicing a lot. What’s interesting, Todd, is that my experience began with an earthquake in California growing up, and then I lived 30 miles from Three Mile Island, which was close to melting. nuclear in 1979. And later, dealing with a hurricane in Hawaii,’ now a group of hurricanes and other events here in Florida.

Then I took all this with me to my work in the Army, where we think about being ready as a daily reality, while we work to have care systems where we save the lives of wounded heroes. So I put it all together to say that, first of all, you have to think about the worst case scenario.

I think we tend to believe that it won’t happen. And the truth is that we live in more dangerous places now than ever before. And we should not only think about the weather, but we should also think about industrial events. And unfortunately, man-made events include shooting.

We need to practice – in other words, practice for these events. Even in the Army we often said, train while you are fighting. Well, I suggest it be a train as much as you care. And that means doing drills and classes.

And the third part of this is to think about how mass killing is different from what we do every day. It’s not just another busy Saturday night at the trauma center, for example. The rules are different.

So one of them is triage—how we find the most seriously injured and savable victims, and then we use the resources for them while we’re taking care of more people. So I think these are the three lessons I learned from my combined experience in disaster and multi-accident management.

Unger: I think of earthquakes, nuclear meltdowns and hurricanes. The moral of the story is I’m not going anywhere you live. There is a pattern there. And I’m curious, is there any other place at risk of such bad weather or high risk incidents?

Dr. Armstrong: No, we live in very dangerous places. And another important thing is to do what is called a risk assessment. That’s a fancy phrase for saying, look at where you live, and identify the risks, and then figure out how to prepare, in general, and for specific areas.

So, in the Armstrong household, we do this every year. We do less of our training during hurricanes. The same thing should happen to all of us as professionals, especially in our organizations, whether in our practices or in what we do in the hospital.

Unger: It is excellent. Any thoughts on what we need to do to do what you said, which is to be resilient in the face of disaster and to be prepared in advance?

Dr. Armstrong: I would go back and say, what are my main concerns about preparation? I think one is the flooding that can occur from different events. It can come from hurricanes, clearly rising. It can occur due to the deterioration of levees.

And we have prepared hospitals. And so they can be drowned. And we’ve had too many examples of that. So that reduces health care capacity, which is a problem.

And then on the other hand it’s just preparing as health care organizations for more victims. I think we often don’t understand what mass killing means and think we can handle anything. And the truth is that depending on your circumstances, sometimes even one seriously injured casualty is a big casualty.

So I want our health care organizations to step back and look at the plans that are in place and design those plans. And doctors and medical students need to be part of this. Physicians and medical students are leaders in preparation. And I think if we focus on their work, we will be ready to drive.

Unger: It seems that sometimes these events—you can do a lot of planning, and everything seems to work, except for one unexpected thing that goes wrong. . And then it almost takes away all your preparation. How do you anticipate each situation?

Dr. Armstrong: Well, you have to adapt. Many say that the most important part of planning is the actual process of developing the plan, not necessarily what you have in the beginning. And you can think of a final plan, but it’s actually a rough plan. And when an incident occurs, you show your resilience by adapting and adapting.

And you get that kind of muscle memory through exercises – structured simulations that test the whole hospital, for example, and the link between the hospital and the community. It is very important that you take the things that you might miss and put them in the plan.

Unger: Well, Dr. Armstrong, thank you so much for joining us. Your comments here are insightful, and we really appreciate you taking the time to speak with us today. If you found this discussion valuable, you can support more programs 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 sign up for new programs and find videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please be careful.

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Description: The opinions expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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