As wildfires rip through the West Coast, they've forced the region's hospitals to open their emergency playbooks and draw up plans in the dirt to meet their patients' needs.
Mid-Valley Hospital, a 44-bed acute care hospital in rural Omak, Wash., has dealt with widespread communications problems, power outages, dreadful air quality and staffing shortages throughout the disaster. The hospital set up an incident command to manage its wildfire response, just like it did with COVID-19.
"I've been in the healthcare industry for over 40 years, and I haven't been through a situation where we've had two incident commands operational at the same time," Mid-Valley Hospital CEO Alan Fisher said.
The new unit has mostly focused on addressing communication issues after the hospital lost its phone and computer lines in recent weeks. A radio tower also burned down, cutting off communication with the local EMS provider. Fortunately, Mid-Valley's emergency preparedness plan provided staff with guidance about communicating with their cellphones when the usual channels were out of commission. The hospital worked with emergency management and local communications providers to resolve the issues.
Like other providers coping with the raging fires, the hospital must address severe air quality problems that threaten the health and safety of patients and staff. Mid-Valley repurposed scrubbers from its respiratory wing to improve air quality inside the hospital since it's not currently treating any patients with COVID-19, which significantly improved the situation.
The wildfire's affect on air quality hampered the hospital's ability to deliver surgical services for elderly patients, especially those with chronic obstructive pulmonary disease, Fisher said.
"If you're in an area where you're going to have to evacuate … you want to stop your elective procedures, stop your ambulatory care," said Dr. Janis Orlowski, chief healthcare officer for the Association of American Medical Colleges. "So … in the event you get an evacuation order, you're moving just a few people."
The wildfires also knocked out power at the hospital for several hours, forcing Mid-Valley to run at reduced capacity.
"But enough was hooked up that we were actually able to do an emergency appendix operation," Fisher said. "We were very fortunate."
Mid-Valley—like many rural hospitals—was understaffed before the COVID-19 outbreak and wildfires began. When the hospital's communications systems broke down, staff was dispatched to track down other staff members to help at the hospital. Administrative staffers have also gone well beyond the scope of their usual duties, going so far as to make sandwiches for the hospital's dietary department.
California-based SoHum Health developed its emergency preparedness plan to deal with the state's reoccurring fires, using the California Hospital Association's guidance as a starting point. So it was ready when it received an evacuation warning for its main facility, Jerold Phelps Community Hospital.
"We've got a real problem because our hospital basically backs up to a forest," SoHum Health CEO Matt Rees said. "There are only two or three buildings between us and the forest. It's a real threat to us."
The warning prompted the hospital to transfer its less mobile patients to neighboring facilities in preparation for an evacuation. But SoHum Health needed to be careful when transferring patients with COVID-19 to ensure there was no transmission of the virus between facilities, which could worsen the situation for the entire area. The hospital prepared for wildfires, but the pandemic is ratcheting up the degree of difficulty.
"When we were looking for placement for patients, we needed to make sure that we were transferring them into a place that could isolate a wing in their facility or at least isolate some beds in their facility," Rees said. "It's a terrible situation."
All hospitals must have an emergency preparedness plan. The Joint Commission assesses hospitals' emergency preparedness plans during their accreditation review process to ensure those plans meet each hospital's needs, which vary based on geography or other factors. Several states do similar reviews.
Many hospitals also carry out emergency preparedness exercises in coordination with state and local officials. After each exercise, participants meet to discuss potential issues that could arise during an emergency and how to address them.
"Those exercises were always tremendously helpful," Orlowski said.
After 9/11 and Hurricane Katrina, Congress created HHS' Office of the Assistant Secretary for Preparedness and Response to prevent, prepare for and respond to the health impact of public health emergencies and natural disasters. The agency's Hospital Preparedness Program is the only source of federal funding for healthcare delivery system readiness, according to the ASPR. But the grant program's annual funding has fallen from $515 million in 2004 to $276 million in 2020. President Donald Trump's 2021 budget proposed to cut funding for the grant program by $18 million, down to $258 million.
Hospitals must spend those grant funds on emergency preparedness, erasing the trade-off between emergency planning and hospitals' other priorities. With fewer dollars available for preparedness, hospital executives face tough choices.
"For a hospital administrator, it always becomes hard to say 'Do I spend money on preparedness for something that may or may not happen? Or do you spend money today on replacing a room or a ventilator? You're always balancing between your preparedness dollars and your just-in-time," Orlowski said.