Wen Dombrowski, MD, MBA Chief Medical Information Officer & Vice President for Connected Health VNA Health Group

Transcription

1 Wen Dombrowski, MD, MBA Chief Medical Information Officer & Vice President for Connected Health VNA Health Group

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3 Vulnerable even more so after disaster (physical & cognitive limit + chaotic environ) Difficult to locate & track vulnerable Limited shelter options & difficult to access Limited geriatric specialists to provide care Foster cooperation beforehand among clinicians + community orgs + city agencies Address post-disaster, long-term needs: food, housing, healthcare, entitlements

4 Key issues Basic needs: shelter, fuel, clothing, bedding Mobility: disability, transport, assistive devices Health: access to services, food, water, sanitation, psychosocial needs Family & social: separation, dependants, security, changes in social structures Economic & legal: income, land, information, documentation, skills training

5 What can I do to prepare my patients for an emergency?

6 Failure of Networks: Electric, Communications, I.T., Transportation, Water

7 Network with city/state EM officials & community orgs Stockpile supplies; review vendor contracts Plan for water & electric failures Back up records Identify funds if normal payment interrupted Have alternate communication devices Establish phone tree & staff contact list Plan alternate transportation routes See Business Continuity Planning resources

8 Family plan for communication & evacuation Staff plan for communication & who works Cell phone + landline phone + contact lists Supplies in car: cash; gas; maps; crank charger bottled water & food; medical supplies booster cables, tire patch kit, flares, flashlight, shovel, blankets, gloves, clothes

9 GeriGoBag: fanny pack or attachable to wheelchair Medication list & 7-day supply Medical history in 1 page & description of baseline mental/physical status Personal info (name, address, phone, insurance #, adv directives) Contact info for family, neighbors, police/fire, PCP, pharmacy Devices & Equipment **Power generators, car adapters, & backup batteries Glasses, hearing aids & batteries, dentures Canes, walkers, wheelchairs, prostheses Respirators, oxygen, other equipment Simple instruction labels Signs stating deaf or don t know English Evacuation plan Where are shelters that can meet special needs & how get there Options if not able to evacuate with assistive devices

10 Identify frail & disabled before & after disaster Your patient list: backup EMR Family caregivers & neighbors Homecare agencies, community orgs, fire dept., ER Volunteer outreach Opt-in registries too limited (but if your local region has one, consider joining it) Insurance claims & SSD databases more likely to be comprehensive (need data sharing agreements) Beware of exploitation & abuse

11 Mental Health: sleep, delirium, depression, PTSD Dehydration: limited water, avoiding urination Nutrition: difficulty chewing (hard & dry foods), appetite loss, inability to feed self, special diets Mobility: transport, assistive devices, pressure sores, inaccessible bathrooms Infection Control: hygiene, close quarters Comorbidities: cardiac, respiratory, etc Advanced Directives: e.g. discuss w/ terminally ill patients who wish to be Do Not Hospitalize

12 Ethical Duty to Plan: more than organizing resources, find ways to deal w/ dilemmas in advance Information sharing & privacy Clinicians reluctant to work when personal risk Life & death decisions Allocation of scarce resources (e.g. bed or ventilator) Age discrimination Loss of personal autonomy Decision-making capacity Advanced directives (e.g. DNH) Prognosis uncertainties Withdrawing life-support

13 Wen Dombrowski, MD, MBA Chief Medical Information Officer & Vice President for Connected Health VNA Health Group

14 Wen Dombrowski, MD, MBA MedicalProcedures/HomeHealthandConsumer/UCM p df page_guidelines.pdf