TAU MU SIGMA PHI

THOMASIAN MEDICAL STUDENTS' FRATERNITY

FOUNDED 1946

 

^{Rx for Hurricanes:}

 

^{Lessons Learned from Charley}

 

 

 

^{About the authors:}

^{Mark O. Asperilla, M.D., is past president of the Charlotte County Medical Society; David Rice, M.D., is the society’s current president; and David Klein, M.D., is its president-elect.}

 

  ^{When Hurricane Charley ripped through Charlotte County on August 13, 2004, one of its casualties was the medical community, an entity that has not fully recovered.}

 

 ^{Not much more can be said about the physical aspects of the devastation than was broadcast day after day on national television. It is not exaggeration to say that Charlotte County looked like a war zone.}

 

^{If you watched the news, you know the details: The Category 4 storm struck with sustained winds of about 145 mph, and gusts that were clocked at near 180 mph. A relatively fast-moving storm, Charley passed within a couple of hours. But that was all the time it needed to carve its swath of destruction, spiraling even the most affluent communities into a third world state, complete with military intervention.}

 

^{Residents were without power and telephone service for two to three weeks. In many cases, cell phones were also inoperable. Ice – tons of it – was needed to retard food spoilage, which was of special concern to mothers who had to keep baby formula from spoiling. In addition, there was nowhere to replenish food supplies; restaurants were out of commission, everything from supermarkets to corner groceries was shut tight. Forget travel if you didn’t already have gas, since the service stations that weren’t destroyed were unable to dispense fuel.}

 

^{A boil-water notice was issued to reduce the possibility of spreading infectious disease via contaminated water. Still, as days became weeks, there was a greater concern for the possibility of widespread illness.}

 

^{With standing water slow to drain, and windows open to combat the heat in homes that no longer have air conditioning, mosquitoes can be a problem. And with mosquitoes comes the threat of diseases such as West Nile virus and St. Louis encephalitis.}

 

^{The hurricane presented unique challenges to physicians as well, not only in the area of providing care, but also as business operators. The physicians of Charlotte County have learned that there are steps any area can take to mitigate the post-storm damage and stress occurring with a natural disaster.}

 

^{Perhaps in understanding the impacts of Charley, other physicians in Florida can better prepare in the event a natural disaster occurs in their area.}

 

^{The Sounds of Silence}

^{The first, most obvious loss felt by physicians and patients alike was the ability to communicate. The loss of a viable communications network presents immediate problems to any community that experiences the amount of devastation suffered by Charlotte County.}

 

 ^{Injured or otherwise needy residents can’t alert others of their plight or assure loved ones that they survived. One of the four deaths in Charlotte County occurred when a resident was lacerated by flying glass but had no way of contacting emergency services. His attempts to apply a makeshift tourniquet with a towel proved futile. He bled to death on his bed, where he was discovered the next day by a relative.}

 

^{It is even more devastating, from a medical standpoint, when patients are suddenly unable to communicate with their physicians. Those needing vital prescriptions refilled had to resort to obtaining them from emergency facilities. For this reason, physicians should contact their patients to make sure they have enough medications to carry them through the days of recovery.}

 

^{Before an impending disaster, it would behoove hospitals to invest in satellite phones for their key personnel, as well as physicians who would be most needed in the event of an emergency, such as surgical specialists.}

 

^{Nowhere to Go}

^{There is much taken for granted about the operation of the health care system, such as assuming there will always be medical facilities in the immediate area. Hurricane Charley changed that.}

 

^{The entire public health infrastructure was affected. Two nursing homes sustained enough damage to necessitate their closing. Ancillary services such as physical therapy clinics and pharmacies suddenly disappeared.}

 

^{Worse, the three hospitals that serve the Charlotte County area were forced to shut down; patients had to be evacuated. (As of a month following the storm, hospitals had only returned to 75 percent of their original operation.) Physicians and other health care personnel were forced to operate in tents and trailers, which also served as makeshift emergency rooms.}

 

^{Shock Wave}

^{On the medical side, physicians and hospitals should prepare for numerous patients suffering from injuries sustained during the hurricane. This parade of victims will begin as soon as the worst of the hurricane passes, and it will continue for weeks afterward, as wounds are sustained from post-hurricane cleanup efforts.}

 

^{The psychological effects of trauma are evident after any disaster, and Charley was no different. There were high incidences of post-traumatic stress disorder and depression affecting much of the population. This unfortunately also led to an increase in domestic violence cases.}

 

^{Even physicians have not been immune, since many either lost or suffered damage to their homes – another source of worry and stress added to the intrinsic pressures they face every day.}

 

^{Charley has been referred to as a “senior citizens’ disaster” because of its impact on the elderly. Port Charlotte was once primarily a retirement community, and, even though the median age has dropped over the years as younger couples began moving to the area to start families, Charlotte County still claims one of the oldest populations in the United States.}

 

^{Another common side effect of Charley was the increase in respiratory disorders such as bronchitis, asthma, pneumonia and infections due to the presence of mold in water-damaged homes.}

 

^{Physicians Without Walls}

^{Serving a countywide population of roughly 155,000, about 300 physicians practice in Charlotte County. By late afternoon on Friday the 13th, 35 percent of them would have their offices demolished; many others suffered significant damage. A good number of offices will not be completely repaired for a year. This immediately put a premium on office space, as other businesses that had lost their locations were also quickly snatching up available properties. Many had to settle for relocating out of town.}

 

^{In many ways, the experience has been similar to starting a new practice from scratch.}

 

^{Of course, insurance coverage plays a large part in the successful recovery of a medical practice, as some Charlotte County physicians discovered. Some had adequate insurance for their physical buildings – but not their contents.}

 

^{Some of the unforeseen casualties of the storm turned out to be patients’ medical records. For this reason, it is recommended that doctors use a professional medical record preservation service, which stores documents in a refrigerated unit to keep them from damage by the climate. At the very least, doctors should back up their computer files and store that data in a safe location.}

 

^{Just as with a home, physicians should keep a detailed list of the items in the office that need to be replaced. It’s also good to carry cash, as banks were unavailable.}

 

^{Business interruption insurance – which compensates for the loss of income caused by the cessation of a practice’s operation – is also highly recommended. Too many doctors are suffering economically, unable to work and lacking the funds to pay their medical staffs.}

 

^{It’s a good idea to meet with their insurance agent once a year to assess if they had adequate coverage. It wouldn’t hurt to revisit disability and life policies as well.}

 

^{Some physicians chose to hire public adjustors, rather than wait for their own insurance company to assess the damage. A public adjustor, however, is paid for by the physician – usually about 5 percent of the recovery. On the positive side, the adjustor works for you and will try to haggle more funds out of your insurance company.}

 

^{Be prepared for an economic downturn due to a decreased population. Escape is a natural reaction to a hurricane, even after it has passed. Some people will choose to move away out of fear; others will decide they do not want to rebuild the shattered remains of their lives. (Broward County’s population decreased by 10 to 15 percent after Hurricane Andrew.) The result is that patient volume goes down.}

 

^{Couple that with the ongoing battle against exorbitant premiums for medical malpractice insurance, and you have some physicians choosing to move out of state or even retire.}

 

^{A Chance to Shine}

^{Charlotte County was able to stand because of many individuals and agencies that refused to let it fall. The help provided by the American Red Cross, disaster management teams, Federal Emergency Management Agency, Gov. Jeb Bush and many others infused the area with help and hope when both were at a premium.}

 

^{Another great contributor to the effort was the medical community of Southwest Florida.  Physicians are sharing offices so that practices can remain open. The medical societies of Sarasota, Lee and Collier counties provided volunteer physicians and supplies.}

 

^{In addition, many area physicians donated their time and other resources to provide pro bono services in the areas of emergency care, distribution of medication and HIV/AIDS care. Members of the medical community suffered the worst that nature had to offer and responded with their best.}

 

^{It is hoped that the hard lessons learned through tragedy and adversity will benefit others, especially those in the medical field. By understanding what lies ahead, it’s easier to plan for the future, even if that future brings with it the advent of natural disaster – because disaster can always be followed by hope. Just ask the physicians of Charlotte County.} 

 

 

^{Accepted for publication Florida Medical Association Quarterly Journal September 2004.}