Hospitalists in a Disaster

By: Mark Shapiro, MD, Hospitalist Medical Director at Santa Rosa Memorial Hospital; Associate Medical Director for Hospital Services with St. Joseph Health Medical Group-Sonoma County

There are few experiences more formative and challenging for any hospitalist than working during a disaster. Be it natural or man-made, a disaster brings challenges that are immediate, profound, disorienting, and frightening. I learned this firsthand in the early morning of October 8, 2017, when my wife woke me to tell me there was a wildfire burning in Santa Rosa, California. The Tubbs Fire would prove to be one of the most destructive wildfires in California’s history. It claimed 23 lives, burned over 5600 structures, and devastated residential neighborhoods in the City of Santa Rosa.

In my role as medical director for the Hospital Medicine division at Santa Rosa Memorial Hospital and as someone born and raised in Santa Rosa, I saw firsthand the many challenges our hospital and community faced, all of which required unique and dynamic problem-solving from the division and the institution. Displacement was a huge disruptor and challenge: 56 physicians in my medical group lost their homes, 3 of my hospitalist teammates lost their homes, and 17 of my 23 teammates at the time (myself included) were forced to evacuate. Many of you are probably reading these first few sentences and recalling the disasters you’ve suffered and worked through.

I feel honored to share some of my team’s experiences and lessons learned in the Tubbs Fire at the upcoming Society of Hospital Medicine Annual Conference, Hospital Medicine 2019 (HM19), in a Rapid Fire session entitled “Hospitalists in a Disaster.” This is a very special opportunity for us to come together as a community of hospitalists to share stories and best practices. Every disaster is unique; every lesson is valuable. What I learned in the wildfire experience is in some ways different from what you learned in a hurricane, a flood, a tornado, or a mass shooting. There are also some fundamentals that apply to any hospitalist in a disaster.

We’ll step through some key learnings, we’ll also decompress a little bit, and help one another get ready for the next one. Full disclosure: I will probably tear up a few times. My hope is we all come out of the session a little more prepared with a few ideas to bring home and secure in the knowledge that we’ll be working hard and pulling the right levers.

Some of the topics we’ll discuss revolve around:

• The importance of drilling
• Creating a communication strategy that is flexible, durable, and redundant
• Staffing in a disaster
• Preparing friends and family
• Identifying and cross-training around key roles
• Rumor mitigation
• Team care and self-care

The reality that we all must face is that there will be more disasters. Whether it’s due to climate change, a mass casualty event, or something totally unforeseen, they will happen, and hospitalists will be at the sharp edge of dealing with whatever comes. Just as a key principle of disaster management is to drill, we can make this session part of our drilling and preparation. I look forward to learning alongside you.