1. Kate Rathbun, MD, MPH Concentra Medical Center 3235 Perkins Road Baton Rouge, LA 70808 225-387-3030 dr-kate@dr-kate.com www.dr-kate.com

2. PRIMARY CARE IN DISASTERS  Winter storms  HAZMAT  Floods  Fires  Heat Emergencies  Tornados  Hurricanes  Nuclear Power  Terrorism  Epidemics  Earthquakes?

3. DISASTER  WHEN NEEDS EXCEED RESOURCES  Every Saturday night in the ER  24 / 7 / 365 for the Uninsured  Demographic War

4. KATRINA  1 million people evacuated  20% had chronic diseases  29 th of August  250,000 in shelters  River Center 25,000 people 80% turnover per day first aid only

5. PRIVATE RESPONSE  Ad Hoc clinics in shelters  St James Church maternity program  Dialysis – nephrology groups  Ochsner opened the first day  Baton Rouge Clinic on the 8 th day  All hospitals in Baton Rouge and major hospitals in New Orleans stayed operational

6. GOVERNMENT RESPONSE  The federal government arrives in 3 days and leaves in 3 weeks  State government provides immediate response which ends after 3 to 6 weeks  Recovery requires 3 to 10 years

7. MYTHS  Local physicians are busy with their own problems  PMAC – 800 beds - the largest field hospital in history  National Guard to the rescue  FEMA sent a lot of money  USNS Comfort in Biloxi

8. REALITY  Local doctors got abuse and interference when they tried to respond  PMAC – 30 beds on the basketball court - 120s beds in the field house  Governor’s orders, the National Guard blocked access to New Orleans  DH&H kept the money  The Comfort saw 8 patients per day per physician and were a thorn in the side of the Ocean Springs Hospital

9. PRIMARY CARE PREPARATION  As a medical society – demand a seat at the table at the county and state levels  Availability of primary care should be the main focus  Coordinate with other doctors to maintain continuity of care  Make sure your own practice is prepared

10. PREPARE AT HOME  Get a guide and follow it  Prepare to leave in 30 minutes or stay 7 days  Make preparedness part of the household routine  Make arrangements with family and friends before the event  Communication is critical

11. PREPARE AT WORK  Phone tree & out-of-town contacts  Emergency bags  Flashlights, can openers, etc  Business supplies for 2 weeks  Lunches  Weekly closing procedure

12. PREPARE THE BUSINESS  Good insurance Casualty, liability, business interruption  Computer billing records Off-site back-up  Alternative sites of practice Mutual aid agreements

13. PREPARE YOUR PATIENTS  Problem list & Medication list New copy at each visit  30 days of medications  Where to go if you aren’t there  Electronic medical records Only for prearranged mutual aid

14. PREPARE THE MEDICAL COMMUNITY THE GOAL IS RESILLIANCE  Mutual aid arrangements with shared records for OB, Oncology, Dialysis, etc.  Hospitals need urgent care centers away from the ER  Volunteer through the medical society not the health department

15. DURING THE DISASTER  Decide where and how you can be of the most value - go there and do that.  Decide when you will reopen your practice and what services you will provide  Know if you and your people will be paid

16. AFTER FEMA LEAVES  Plan so your practice stays viable  Waves of leaving – What to avoid can’t come back can’t rebuild can’t face the next 10 years  Remember, you only get your insurance payment once