Hurricane season runs from June 1 through November 30. Every few years, a big hurricane rips through the coastal areas of the United States, reminding us that we are at the mercy of Mother Nature. Recent past hurricanes such as Katrina, Matthew, Harvey, and Irma wreaked havoc on laboratory systems for weeks and, in some cases, months. But a lot can be done to prepare a laboratory for when a natural disaster like a hurricane hits, and alleviate the devastation and chaos that would otherwise ensue. Hurricane and disaster preparedness starts years before an event and never truly stops. “The laboratory, from an administration point of view, is negligent if they don’t have some sort of plan in place,” says Fred Rodriguez, MD, MASCP, professor of Pathology, LSU School of Medicine, and retired chief of Pathology and Laboratory Servcies at the Veterans Affairs Medical Center in New Orleans, Louisiana. Disaster preparedness plans should cover risk assessments and preparations for infrastructure, test menu protocols, staff coverage, and recovery efforts. Infrastructure According to Rajeevan Selvaratnam, PhD, at BayCare Health System in Tampa Bay, Florida, one of the first important infrastructure aspects to consider is the power supply. “One can expect increased frequency of instrument failures and, consequently, delayed laboratory test results if the lab is dependent on backup power for an extended amount of time.” Power failures can prove catastrophic for laboratory operations, so mitigating this risk needs to be a priority. Backup generators should not only be above ground level but on a higher floor of the institution. However, even that precaution doesn’t guarantee your lab will run smoothly indefinitely. “What happened at the VA during Hurricane Katrina: the power went out, and while we had generators that were high and dry, the electrical switch gear for the hospital was in the basement, which ended up with 20 feet of water,” says Dr. Rodriguez. “Even though we had juice coming in, it wasn’t being distributed to the building.” Dry generators and proper electrical switching doesn’t mean a power failure won’t affect operations, however, especially in the warm weather summer months of hurricane season. Inconsistent temperatures in the environment can affect instrument function and assay integrity. “Even with redundant instrumentation,” says Dr. Rodriguez, “without air conditioning, ambient temperatures in the laboratory can get above the thresholds for instruments to operate.” Another infrastructure concern is flood water. During a hurricane, flooding can damage instruments and buildings. Water can certainly affect the power supply, but it can also affect instrument and environment integrity. Mitigating damage from flood waters is crucial to maintaining laboratory services during and after a storm. “Given the role of the laboratory in aiding clinical decisions,” says Dr. Selvaratnam, “laboratory professionals should advocate to have lab operations and departments not only storm-proofed, but on higher ground.” Communication is an essential component of infrastructure that is frequently overlooked, but as it extends beyond a traditional phone tree that most laboratories have on file, it should be a top priority. How will lab administration contact staff members before and after the event? Who will be the liaison between the laboratory and hospital administration during the storm? And in the event of a devastating storm, how will evacuated staff be found and contacted once operations resume? These questions must be addressed in a robust disaster plan. “In my experience,” says Dr. Rodriguez, “the most important thing you have to maintain is communication.” This includes email and cell phones, of course, but if the power is out for an extended amount of time and cellular towers go offline, those might not be viable options. Satellite phones can provide a consistent method of communication after the event. Point-of-Care Testing During a Disaster The use of point-of-care testing should be addressed in any overall disaster plan. When a hurricane hits, it may be too late to implement point-of-care testing unless those contingency plans have already been made. Peggy Mann, program manager in the Clinics Administration department at the University of Texas Medical Branch in Galveston, Texas, highlights the primary concerns for using point-of-care testing during a disaster. Competency records Is the documentation of competency digital or on paper? If it’s digital, can it be obtained during downtime or power outages? If it’s paper, is it kept in an easy-to-access location? Ensure whoever is performing the test has the proper assessments performed and recorded CLIA certification The CLIA certificate needs to accurately reflect the testing being performed. Who is the listed lab director? What tests are covered by that certificate? Availability of instruments and reagents unaffected by the storm. This includes: Undamaged devices Reagents maintained at the proper temperature Instruments in areas unaffected by flood or water damage Loaner instruments and reagents Electronic management of instruments If instruments are connected to the LIS or HIS, databases will need to be updated if instruments are moved Testing and Staff Logistics Once you’ve addressed the power supply, instrument environment concerns, and communication hurdles, the next essential step toward preparedness is addressing the test menu, supplies for those tests, and people to perform them. How are these details handled? Shipments of extra reagents and supplies—such as CO2 tanks for microbiology incubators and water storage tanks for analyzers that require clean water—should be in place 48 hours before the storm. “For the chemistry department, we made sure we had an adequate supply of reagents, QC material, and calibrators on hand,” during Hurricane Irma, says Dr. Selvaratnam. “We also moved to 12-hour shift operations with a down-time process and limited test menu. We didn’t perform more specialized assays such as serum protein electrophoresis or allergen testing, for example.” The number of patients who remain hospitalized will help determine the number of staff members needed. “For the patients who can’t be discharged or transferred,” says Dr. Rodriguez, “the laboratory needs to work with hospital staff to determine the necessary core lab studies. That workload will dictate your staffing needs. You’ll want to include a few supervisors and a pathologist as well, to facilitate coordination with hospital staff during the event.” Some laboratories have a tiered system that requires everyone to take a turn while others recruit volunteers. John Petersen, PhD, director of the Victory Lakes Clinical Laboratories at the University of Texas Medical Branch in Galveston, Texas, says his laboratory operates this way during emergencies, as exemplified during Hurricanes Harvey and Ike. “We have what’s called emergency levels one, two, three, and four. The E-2s work to ensure the lab is stocked and ready for the storm, and E-1s staff the laboratory while the disaster hits. After the event, E-1s become E-4s and everyone else moves up the list.” This ensures everyone knows their role when a disaster looms. According to Aaron Odegard, a clinical laboratory scientist in the microbiology department of the Mayo Clinic in Jacksonville, Florida, their department solicits volunteers. “Each year we can add our names to a volunteer pool. As Hurricane Matthew approached, my supervisor let me know I’d be working the storm. The other volunteers and I attended a storm briefing, and had time to gather our own supplies and clothes before reporting back to work.” What does it feel like to actually work a disaster event? “Watching the weather makes you a little anxious, so being at work was actually a nice distraction,” says Mr. Odegard. “We were there for our patients when they needed us. It’s three days of working and sleeping and working again. It was exhausting, but rewarding, and afterward I had a close bond with my coworkers.” After Katrina, Dr. Rodriguez had an even greater appreciation for his staff. “Their resiliency and commitment were amazing.” Recovery Efforts Once the rains stop, the clouds part, and the sun emerges—the event is over, right? Not quite. Laboratories may be without power for days or weeks, buildings may be flooded, and staff may be living far away from home. Outpatient clinics might be ready to open before the main lab, or vice versa. Laboratory information systems may need to be updated to reflect this reality. Supply lines from distribution centers may be disrupted due to flooding or destruction, so you may need to secure other avenues to obtain reagents and other supplies. Instrument service providers may not be able to repair analzyers until the airports reopen, which could be several days. “It’s not just about surviving the event, but starting the recovery afterwards,” says Dr. Rodriguez. “Part of the preparation is building relationships with other entities. If your system is going to open but you aren’t ready, do you have referral agreements with other laboratories in place?” Once everything returns to some semblance of normal, it’s time to review the disaster plan to see what worked, what didn’t, and what needs updating or improving. “After Irma, we realized we didn’t provide a consistent way to tell off-site staff to return to work once our disaster protocol was deactivated. With non-functioning communication towers, some staff were unaware they needed to return to work,” says Dr. Selvaratnam. “That was a lesson learned.” By doing this assessment—a postmortem of sorts—your laboratory will be better equipped to handle the next disaster. “The key is to look back at what didn’t work,” says Dr. Petersen. “After Ike, there’s nothing in Galveston that can be flooded. Nothing is on the first floor, and even the first floor of the hospital is 20 feet off the ground. We were better prepared for Harvey because we’d experienced Ike.” Disaster plans need to be re-evaluated, updated, and disseminated to laboratory personnel each year. It’s also worthwhile to perform drills throughout the year so all departments can sure their systems are ready to go. While Mother Nature is unpredictable, with smart preparation, adaptability, and teamwork, laboratories can weather any storm that comes their way. © American Society for Clinical Pathology, 2018. All rights reserved. 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Critical Values – Oxford University Press
Published: Apr 1, 2018
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