When hurricane Irma hit Florida in 2017, it churned its way up the western coast of the state and moved directly over the largest cluster of independent practices in the Florida Cancer Specialists (FCS) group. Nevertheless, the chain was able to reopen 86 of its 100 offices within just a few days of the storm’s passing, and it got the remainder open a couple of days later. Almost a year later, FCS narrowly avoided another direct hit when Hurricane Michael moved up through the Gulf with astonishing power and destructiveness, making landfall in the Tallahassee, Florida, area.
With hugely destructive storms now almost routine—3 of the 5 costliest hurricanes on record occurred in 2017—the secret to practice readiness is constant review and analysis, said Todd Schonherz, chief operating officer of FCS. “The plan isn’t about micromanaging every detail— it has to be fluid—but there are major things to be accomplished,” Schonherz noted. “It seems we have a hurricane or tropical storm hit a few times each year. We do a postmortem after each event to see what we could have done better.”
Across the country, many oncology centers have experienced major storms that forced them to take a hard look at their emergency planning. In some cases, practices have worked to ensure that patients are prepared in the event they are cut off from treatment.
Following Hurricane Katrina in 2005, which displaced over 1 million residents of the Gulf Coast, Children’s Hospital of New Orleans initiated an education program to make sure that families of oncology and hematology patients have supplies of medicine and evacuation plans in readiness when other storms hit. “Interventions instituted to allow greater access to care by our hematology/oncology patients after Hurricane Katrina resulted in better preparedness, easier acquisition of information, and possibly better continuity of care,” Raulji et al wrote in an April 2018 study of that effort (Table
Katrina devastated the New Orleans healthcare safety net, utterly transforming the city’s healthcare landscape and leaving many without access to care even a year after the storm. The storm’s impact reduced the number of hospital beds in New Orleans by more than half and forced nearly 4500 physicians to relocate, with just 1200 returning in the year after the storm. Shrinking patient volumes also caused healthcare centers to lose federal funding.2
The continuance of extreme weather events augurs similarly disruptive events. The year 2018 began with a crippling blizzard with unheard-of “thundersnow” that dumped more than 2 feet of snow on the East Coast. That was followed in April by tornadoes across the Midwest. An active hurricane season saw North Carolina and South Carolina battered by Florence in September and Florida taking the brunt of Michael’s force in October. In November, the largest and most destructive wildfires in California history devastated entire towns and killed dozens. “As the incidence of cancer and the frequency of extreme weather events rise, disaster mitigation is becoming increasingly relevant to oncology care,” noted the authors of a September climate report in Lancet Oncology
Table. Post-Katrina Surveys Show Impact of Hurricane on Patient Emergency Planning1
Robert “Bo” Gamble, director of strategic practice initiatives for the Community Oncology Alliance (COA), said the association works to prepare its member practices for adversity. The best way to do this is to educate them with examples of practices that have overcome such challenges. “That’s probably the most enlightening,” Gamble said. “Some people think about disasters and say, ‘I have to back up my computer system and keep my fingers crossed.’ It’s so much more than that.”
Practices need to be ready to field unexpected requests for assistance from their patients. These may take the form of needs that go well beyond the scope of oncology care. Gamble has found that some patients turn to their doctors for guidance and help with issues beyond treatment, such as coping with an imminent storm. “The role goes beyond caregiver because of the relationship they have with patients,” he said.