Respiratory Care Issues in Disasters


In a healthcare facility, the role of the staff is to stay a few steps ahead. In the treatment of any disease or infection, preparedness is half of the battle – but what about a situation that is completely unpredictable? For respiratory therapists a disaster scenario can quickly become a matter of life and death. How can respiratory professionals and their corresponding facilities stay prepared enough to be ready for anything and flexible enough to adapt in the event that something happens.

Of course, while healthcare facilities and respiratory departments are constantly in the process of developing procedures and protocols for emergency preparedness, their roles are very different in both the preparation for and in the event of an actual emergency. The facility as a whole tends to be concerned with the overall task of coordinating each department during an event. The department, on the other hand, focuses more on setting individual standards in terms of priorities in patient care.

“Administrators have a very different set of responsibilities than the medical staff, for example, or versus the nursing staff,” said Amesh Adalja, MD, FACP, senior associate at the University of Pittsburgh Medical Center’s (UPMC) Center for Health Security. “So, everyone has to be available, but they’re each going to have different responsibilities. From an administrative standpoint, there’s making sure that all the pieces of the puzzle are in place and active before, during and after the event. From a medical standpoint, there’s making sure that patients are taken care of – that they’re getting the necessary medications and treatment.”

Adalja noted that hospitals tend to have a committee with representatives from all areas of the staff in order to prepare for each individual situation. Meanwhile, Camilo Ruiz, DO, clinical assistant professor of internal medicine at Nova Southeastern University in South Florida, commented that, although facilities rely on a general outline or plan, each department is really responsible for staying updated, prepared and setting its own protocols in case of a disaster. In the respiratory department, the primary concern of the RTs is, as always, to care for the respiratory patients in order of importance – especially those on ventilators.

“The RT would continue to have the same role that they would have with managing the patients who are on lung ventilators and administering the drug aerosol treatments that they do,” continued Adalja. “I think everyone’s role would be heightened during a disaster.”

Emergency preparedness varies from location to location as certain aspects change depending on things like region and population, but overall, Ruiz noted that most facilities operate on the same basic plan. Although different disaster scenarios – like tornadoes in the Midwest, wild fires in California, hurricanes or tropical storms in the Southeast and, of course, blizzard conditions all over the country – require different responses, the job of the facility is to coordinate the appropriate responses. For example, when, if at all, is the best time to evacuate?

“The general procedure of the incident command structure is probably pretty similar across hospitals, but obviously there are definite geographical and other issues that may impact on how these principals are actually applied on the ground,” explained Adalja. “Certain hospitals have certain known risks based on where they’re located or based on their patient population, whereas other ones have different risks.”

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For respiratory departments, a fundamental concern comes from the possibility of a power outage. Although the majority of facilities operate with back-up generators specifically in case of a loss of power to the unit, the decision to keep patients on electronic assistance like ventilators versus who will receive non-powered therapy options and breathing treatments is left up to the RT staff. In the event of an evacuation, RTs must also decide when and how to move patients ranging in severity while accounting for the circumstances.

“The problem is the unexpected – losing power,” said Ruiz. “How do you get supplies to the hospital? How do you get patients in and out if you need to do so? How do you triage patients as they’re coming in? How do you open up available beds?”

Healthcare facilities are constantly evolving and revising the procedures and policies put into place to ensure that they remain in control even when the situation is uncontrollable. Another potential issue facing respiratory centers in a crisis is the prospect of a situation more directly related to respiratory care. In an event like a massive fire where patients are coming in with smoke inhalation issues, the RT staff could find themselves stretched too thin and have to pull staff from other areas of the facility. Like the rest of the staff, RTs must be quick on their feet in situations like this to prevent further catastrophes during a disaster.

Michael Jones is on staff at ADVANCE. Contact: MJones@advanceweb.com

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