Trying to Reason with the Hurricane Season

Its hurricane season in Florida and the Southeast of our country. Some years are not as bad as others, but a “bad” hurricane season can include major disruptions to travel and business operations, damage to businesses and buildings, lost and ruined equipment, and even destroyed homes and loss of life. The DME industry has seen its share of missteps and mistakes with regards to preparation for these catastrophes, but they’ve also seen many successes. Seeing an organization work their way through a hurricane (or any major disaster) can be impressive. Let’s look at the two extremes in preparation.

Steve & Jim’s DME (a fictional organization, but based on actual observations and experiences our surveyors have seen countless times) is a large multi-branch DME in Florida—ground zero for hurricanes. Steve & Jim pride themselves on their attention to detail and have planned for a hurricane. To prepare, they have done the following:

• Developed a written plan that outlines their emergency preparedness.
• Taught staff extensively to prepare them for the worst-case scenario.
• Lined up contingency suppliers for back up medical equipment, particularly tank oxygen, in the event their normal supply chain is disrupted.
• Informed their patient/customers of how the company will operate in an emergency/disaster. This includes talking to them when they are admitted to service, but also reinforcing that education, especially in the days and weeks leading up to hurricane season each year.
• Maintained a list of patient/customers, categorized by equipment type, liter flow, and backup systems available. This “patient priority list” is available to all staff so that they will know who needs care and service first during a hurricane.
• Designated a location or locations where staff can meet in the event the office is destroyed, damaged, or unreachable.
• Made sure that their information management systems including patient billing and clinical records, patient priority list, and suppliers contacts are all backed up in the cloud to ensure seamless operation in the event their physical locations (and computers) are destroyed or unavailable.
• Become properly licensed by their state (a state HME license) and learned and adhered to all state licensure regulations and rules with respect to disaster preparedness.
• Ensured they have adequate staff ready and willing to work.

Joe’s Easy-Going DME (also fictional, but we’ve seen examples like this as well) is also a multi-branch DME similar in size and scope to Steve & Jim’s. Joe’s prides itself on a laid-back attitude and “friendly faced” customer service. But the reality is that friendly customer service isn’t enough in the face of a storm. They have not done all the things that Steve & Jim’s has done to prep. And when the hurricane comes to town---well, they are totally unprepared. Suddenly, the friendly faces aren’t there and a bunch of home oxygen patients are left to their own devices as power outages ravage a large swath of the organization’s service area. Joe’s doesn’t know how to respond. They don’t have a redundant system to obtain tank oxygen and their main supplier’s plant has been destroyed. Their ability to even contact the patients is limited to numbers that they remember from customers that frequently called in for service. Patients on home oxygen from Joe’s find themselves with limited oxygen and no plan to replenish. Many end up in hospital emergency rooms. They aren’t smiling anymore and Joe has opened himself up to significant liability and put his patient/customers at risk.

Accreditation standards hold organizations responsible to maintain all the things that Steve & Jim’s company has done to prepare. Joe is free to sling his easy-going customer service, but in order to maintain accreditation, he needs to be prepared. HQAA has several standards that deal directly with emergency preparedness. Those specific standards are:

ICS 7 – DISASTER PLAN

This standard requires a written plan “to ensure the safety of staff and clients in the event of a disaster or emergency”. At a minimum, the plan must contain and include:

• Plan should be tested annually
• Plan should identify high risk patients (that “priority list” mentioned earlier)
• Plan should identify services likely to be disrupted
• Plan should describe how staff will get to work and ensure adequate staffing in the event of a disaster
• Plan should list alternative suppliers

ICS 8 – EMERGENCY PREPAREDNESS

An organization must have an emergency preparedness plan for securing and/or evacuating all business locations in the event of an emergency or disaster. This plan should always include:

• Preparation procedures in both the business location and also patient homes
• Staff preparedness
• How the equipment will be replaced
• Fire evacuation routes
• Alternate sites to operate from in the event the main location is destroyed or becomes inaccessible
• How the organization will ensure data and patient information is secure

In addition to ICS 7 & 8, there are numerous accreditation standards that touch upon disaster and emergency preparedness. For instance, ORG 2 talks about following rules and regulations from state licensing bodies. Florida in particular has a rigorous set of standards that address how DME organizations need to prepare for disasters. Noncompliance with these state regulations is an ORG 2 issue. MM standards also touch on disaster readiness. Standards that reinforce the importance of adequate backup systems are a good example.

With all the standards including the ones we’ve talked about, remember that they need to be reviewed at least annually. Disaster preparedness is a classic example of why policies & procedures need to be reviewed. How our industry looks at issues related to these disasters is constantly changing. The Covid pandemic is the most recent example. In some areas, the pandemic certainly was an emergency. Access to certain geographic areas was limited and a sudden influx of patients needing oxygen (and the ensuing equipment shortages) had the potential to be a “disaster”. Organizations that had a plan weathered the storm, while those without good planning had a much harder time.

The bottom line with dealing with these disasters and any emergency is to be prepared. Plan for the worst and know how to deal with it and you’ll be more than ready when the hurricane makes land. Like Steve & Jim’s –the example company above—make a plan, educate staff and patients about their role, test the plan, and consider yourself fortunate if you don’t have to use it.