Are you prepared for disaster? My notes on storm survival

If you’ve seen the news recently, you know that emergencies can happen unexpectedly in communities just like yours, to people like you. We’ve seen tornado outbreaks, river floods and flash floods, historic earthquakes, tsunamis, and even water main breaks and power outages in U.S. cities affecting millions of people for days at a time and now Hurricane Irene is coming. Health care professionals need to be prepared for unexpected weather and emergencies.

I was never concerned about weather patterns beyond the four seasons of the New York City atmosphere. It’s worth noting that my grandmother was born just off the Savannah River in the night of a storm, she's lived in New York for over 75 years, but continues to pay close attention when joint pain and a distinct stiffness combine with an inner sense telling her body that a storm is coming soon. I remember her strict commands that all electrical appliances should be shut off and no one should talk on the phone. We’d sit quietly and still, far away from windows with shutters closed. When the clap of loud thunderstorms came, she’d say "hush now God's talking" eventually there would be storytelling about dark nights, lightening strikes, flooding, other disasters and lives lost in the her South Carolina homeland. We’d also listen to radio reports.

The changing temperatures and severity of recent natural disasters around the world now have me following weather patterns and my storytelling prompt is the memory of Hurricane Ivan. My reflective essay is published in The New Physician magazine conveys early reflections on the traumatic experience of Ivan. While many years have passed, a residue of emotions and feelings still surface under the right conditions. The sudden approach of certain hues of grey in the sky, the hint of a sweet smell of moisture in the air, winds whistling gently stirring trees refresh my memory. It was a warm, clear, blue sky day filled with sunshine when the forecast of Hurricane Ivan was announced. In the early hours looking at the dopplers on CNN, we thought the storm might pass despite technological and sensory intelligence to the contrary. Within moments, the daylight disappeared, darkness emerged and the power failed soon thereafter. The results:

“Catastrophic damage to Grenada and heavy damage to Jamaica, Grand Cayman, and the western tip of Cuba. After peaking in strength, the hurricane moved north-northwest across the Gulf of Mexico to strike Gulf Shores, Alabama as a strong Category 3 storm, causing significant damage. Ivan dropped heavy rains on the Southeastern United States as it progressed northeast and east through the eastern United States, becoming an extratropical cyclone.”

Ear-popping pressure systems created by the wind should not be under-estimated, you can be blown away, physically. The effect of continual downpours with rising tides can trigger a real threat to life when water is everywhere. Storm surges, high winds, tornadoes, and flooding are the hallmarks of hurricane hazards.

Are you prepared for disaster? “ Preparing for the Unexpected” is the course that I taught for the American Red Cross course, I continue to serve on a volunteer medical reserve corps and have Advanced Disaster Life Support certification. National Preparedness Month is in September, here's a foretaste using the resources and tools provided.

"Individuals and families are the most important members of the nation's emergency management team.” Craig Fugate, FEMA Administrator 

Here are my notes on family disaster plans:

• Discuss the type of hazards that could affect your family. Know your home's vulnerability to storm surge, flooding and wind.
• Locate a safe room or the safest areas in your home for each hurricane hazard. In certain circumstances the safest areas may not be your home but within your community.
• Determine escape routes from your home and places to meet. These should be measured in tens of miles rather than hundreds of miles.
• Have an out-of-state friend as a family contact, so all your family members have a single point of contact.
• Make a plan now for what to do with your pets if you need to evacuate.
• Post emergency telephone numbers by your phones and make sure your children know how and when to call 911.
• Check your insurance coverage - flood damage is not usually covered by homeowners insurance.
• Stock non-perishable emergency supplies and a Disaster Supply Kit.
• Use a NOAA weather radio. Remember to replace its battery every 6 months, as you do with your smoke detectors.
• Take First Aid, CPR and disaster preparedness classes.

Visit http://www.ready.gov for additional details follow these three steps.

1. Get a Kit: Keep enough emergency supplies on hand for you and those in your care – water, non-perishable food, first aid, prescriptions, flashlight, battery-powered radio – for a checklist of supplies visit Ready.gov.

2. Make a Plan: Discuss, agree on, and document an emergency plan with those in your care. Work together with neighbors, colleagues and others to build community resilience.

3. Be Informed: Free information is available to assist you from federal, state, local, tribal, and territorial resources. You can find preparedness information by: Accessing Ready.gov to learn what to do before, during, and after an emergency.

Police, fire and rescue may not always be able to reach you quickly, such as if trees and power lines are down or if they're overwhelmed by demand from an emergency. The most important step you can take in helping your local responders is being able to take care of yourself and those in your care; the more people who are prepared, the quicker the community will recover.

On the Rise: Women in Leadership

We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:

“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession anywhere in the world.

The fault line is in the family and life balancing act women must do to survive in the workplace.  To be clear this is true for men too. Women are more likely to face challenges when long work hours, travel and the business of professional networking keep them away from families.

Furthermore, the profession of medicine requires a commitment to patient care, education and research, but the climb to the top has additional milestones. While many put in extra time and sweat their persistence still places them outside the closed doors of  hospital board rooms, department chair offers, academic medicine positions or physician-leader roles.  Data and research are scant on measures for progress.  I always look at the pictures on the walls in medical center hallways and conference rooms, it’s rare to see anyone who resembles me in those pictures. I do see women moving through up the ranks who are awesome role models.

For the last 10 years medical school classes have held equal portions of men and women, but those who teach medical students and lead institutions are predominately men.  Recent research published by Dr. Borges and others indicate that “women physicians choose their careers because of the perceived quality of life, earnings potential, and organizational reward. They are less likely than men to identify role models for professional–personal balance.”

Women do need to seek out role models early in their careers, but it’s not enough. More significant is the understanding that if there’s no institutional, top-down approach to addressing the complexity of these issues, meritocracy alone will not break down barriers nor will change occur.

Dr. Karen Sibert’s recent op-ed in the New York Times inspires my blog post along with other offline discussions, including the talk with Michele Martin on NPR’s Tell Me More, which aimed to further the conversation about part-time career choices women are making in the face of doctor shortages, decreasing health care budgets and a moral obligation. Dr. Sibert and others make it clear about the sacrifices for both men and women when it comes with a commitment to patient care, but Dr. Au and others make the case for our right to choose, wisely and carefully.

I follow the career paths by reading the literature as well as over the years books written by women in medicine, here are just a few from my bookshelf:

Treatment Kind and Fair: Letters to a Young Doctor by Perri Klass

Zenzele: A Letter for My Daughter by J. Nozipo Maraire

Final Exam: A Surgeon’s  Reflections on Mortality by Pauline Chen

Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside by Katrina S. Firlik

Medicine in Translation: Journeys with My Patients by Danielle Ofri

Almost Home: Stories of Hope and the Human Spirit in the Neonatal ICU by Christine Gleason

The Country Doctor Revisited: A Twenty-First Century Reader edited by Therese Zink

Stories of Illness and Healing: Women Write Their Bodies edited by Marsha Hurst and Sayantani DasGupta

On a historical note Dr. Virginia Apgar’s story is endearing as she was set on becoming a surgeon, but gender discrimination led her to a career in anesthesiology after training she went on to head a new division of anesthesiology where she developed the Apgar score. As the medical school’s first female division head, she built a residency program and, in 1949, became the first woman appointed to a full professorship at the Columbia University College of Physician & Surgeons.  No, I’m not interested in a career anesthesiology, I am looking for opportunities where innovative ideas are supported regardless of gender, race or ethnicity.

A few pointers, I’ve heard from those listed above and elsewhere:

• Relationships and family matter, try to avoid undermining your anchors to move ahead, you may find short-term success and long-term misery with the loss of your family and friends and a more demanding job.
• Don’t turn your head or look way when you see real harm done to women especially if it’s you in the hot seat, choose battles worth fighting.
• Read and review the policy handbook at your institution. Knowledge is power.
• Honor and respect women physician-leaders in their roles and get to know their stories.
• Tell your own stories so that others might know of your success and/or be warned of your pitfalls.
• “Lift as you climb” so that you enable collective success in the profession.
• The road is long so make good friends for the distance.

U.S. Surgeon General Regina Benjamin, Secretary of Health and Human Services, Gov. Kathleen Sebelius and First Lady Michelle Obama are at the helm efforts to improve health and health care in America and these women are all phenomenal. We should continue our look up stream and push for policies and practices that allow for a more balanced profession for men and women, which in my view enables better patient care and improves quality of life for both patient and physician. There should debate, divergent points of view as well as common ground to stay focused on more progress.

7/12/2011 blog cross-post on KevinMD.com