I originally wrote a version of this post for our medical society, hoping doctors would consider how practice might change after a disaster. But everyone should look at how they use healthcare now, and then imagine it after a disaster.  Planning often ignores outpatient medical care if clinics close down.  Hospitals plan for disasters, but usually for the most serious problems. What will we need besides hospitals?

What Are Your Current Medical Needs?

Medical Problem List

Sample of one year’s medical problems.

Start by listing your own medical problems. List everything you sought care for in the last year or two. Don’t forget multiple diagnoses treated at one visit. Reviewing your medication list or medical bills may help jog your memory. For each problem, ask these questions:

  • How long could you have waited for medical care ? A day, a week, a month, a year … or maybe forever?
  • What would have happened to you without care – risk of death, permanent disability, major or minor symptoms, missed curable illness, worsened chronic illness…. or perhaps  “not much”?

Now imagine the same problems in a severe disaster recovery scenario. Patients seek care for a variety of urgent, routine, and chronic needs. I’ve divided it up into several categories to help guide your thoughts.

Acute Medical Needs

These are  new problems, or major worsening of old problems. Life-threatening injury and illness will be top priority in a disaster. If you have a heart attack or are rescued from under a fallen beam, you’ll be high on the treatment list (providing you can get to the hospital). Urgent injuries or illnesses that are serious but not immediately life-threatening (think broken leg or major pneumonia) will also probably get hospital treatment, but might be delayed for hours, or even a day or so. For lesser acute needs (traditionally seen in 1-2 days), options are uncertain. Emergency rooms might be too busy with serious problems and open medical offices may be few and far between! This is where we need volunteer medical teams!

Chronic Medicine

Our long-term health problems – cancer, high blood pressure, diabetes, lung disease, ulcerative colitis, etc., etc. – use up most current medical services.  Consider two stages in chronic disease – diagnosis and active treatment vs long-term management and monitoring. It is hard to predict chronic needs in disaster recovery. In the active stage (cancer chemotherapy, poorly controlled diabetes), treatment shouldn’t be postponed for long. Some people may need to evacuate to get this care. In the long-term phase, when people usually see their doctor every few months, postponement might not be too bad. Chronic disease treatment depends on medical records, which are hard to get if your clinic is closed. Keeping your own updated copies could be key!

Preventative Medicine

Healthcare does a lot to prevent problems instead of treating them, including physicals, women’s exams, and well baby checks. Many visits counsel on weight control, smoking, and healthy living. Birth control, immunizations, blood pressure checks, and disease screening (mammograms, colonoscopies) are also preventative. What happens without preventative care? Society slowly gets sicker, but in a super-disaster, much could be postponed for weeks, months, or longer. Some “bad” health habits, like excessive food, alcohol, and tobacco, might be less available after disaster. Some services like birth control, blood pressure checks, and immunizations could be handled through temporary clinics. Disaster recovery announcements could include community health education on things like sanitation and nutrition. Of course, this all takes advance planning! Most importantly, we will need to take more responsibility for monitoring our own health.

Palliative Care and Symptom Management

Drugs and Medications. Photo by Keith Ramsey, RambergMediaImages

Drugs and Medications. Photo by Keith Ramsey, RambergMediaImages

Palliative care usually means providing comfort during advanced or end-stage disease. In a disaster, symptom management of disease is more important than ever, not only for dying patients, but for trauma.  Broken bones hurt! But what about symptoms without disease? Americans love this. We visit the doctor for headache, backache, neck pain, colds, and heartburn. We expect symptoms relieved, even when the underlying problem is benign. We are an uncomfortable society, based on dollars spent for symptomatic medical care. When medical care is limited after a disaster, this might be the first to go. Spending resources on pain without illness is probably not the best choice. Complementary medicines such as acupuncture or massage may pick up some slack, but in general,  plan to cope with discomfort more on your own.

Elective Medical Care

We often use medical care for distressing problems that are not actually health threatening –  things like skin problems (acne, cosmetic lesions), eye problems (nearsightedness, cataracts), and low-grade injuries (repair of my meniscus tear!). We don’t stop to consider that it is elective. If we have insurance, we generally want it done, and in a timely manner. Try this question: Does it still seem essential if you had to pay for it out of pocket? If not, it’s probably elective, and shouldn’t be needed during disaster recovery.

Radiology in Disaster

Chest X-ray (for the physicians out there – any guesses on the diagnosis?)

 

Medical Bells And Whistles

Finally, consider medical care without the labs, X-rays, and scans we know and expect. They seem routine for most problems, to the point of questioning doctor competency if not ordered. Even worse, if a diagnosis is missed because something wasn’t ordered, we sue! Many American doctors are developing dependence on tests, and losing old-fashioned skills of physical examination and diagnosis. After disaster, technology will simply not be available for most patients. Will both you and your doctor be comfortable reverting to the basics of clinical medicine?

 

 

Recommendations:

No matter what, medical care will be drastically different after a disaster, so start planning now. Consider these steps:

  • Talk to your doctor about the type and frequency of care you really need if resources are limited.
  • Stockpile necessary medications. If your insurance won’t allow an extra refill, try to refill even one or two days early each month, and put aside extras.
  • Ask your doctor about office emergency and business continuity plans – are they prepared to stay open?
  • Talk to Public Health, Medical Reserve Corps, Red Cross, and churches to see how you can help healthcare preparedness.
  • Be ready to take greater charge of your own health in a disaster setting (more on this in future posts!)

Stay safe,

Sheila Sund, M.D.

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Comments
  1. Heck I gotta broken wrist…..the er charged me $400+ and gave me tylenol…told me i had severe arthritis…i already know this…try to give a ace bandage….who’s kidding who?…..we’re on our own already…

    • disasterdoc says:

      I’m not always a fan of current American health care. I think we (patients and doctors) have become too dependent on technology. In the process, some doctors are losing the ability to communicate with patients and to think about what is going on before (or instead of) ordering tests. I am sorry about your broken wrist. The same happened to me this year, and I also was frustrated. In reality, unless the bone has broken through the skin, the wrist is significantly deformed, or your circulation is affected, all anyone can do for the first few days is tell you it’s broken, ace or splint it, and maybe give you a pain med. That’s because the swelling has to go down before they cast it (or do routine surgery). So why are we all told to go to the ER for this? Why not see our primary care doctors? In truth, you probably don’t even need an Xray for the first few days unless there is a deformity, but I guarantee patients become very upset if you suggest it is fractured but don’t Xray it. It is important to see an orthopedic surgeon a few days after the fracture, as they are the ones that can tell whether surgery will help prevent long term complications and when casting is needed. By the way, in a disaster situation, broken wrists definitely fall in the walking wounded category (green for those who know triage colors). Other than basic first aid, they would be very low priority for treatment.

      • Awww thank you….thumb first finger middle finger are useless when iput weight or god forbid something pulls on them i about jump outta my skin from the pain. I feel like i got a flipper instead of a hand. How did yers take to heal?

        • disasterdoc says:

          I’m in my 9th month and wrist is still slowly healing. it is better now than a month ago, and loads better than 3 months ago. Most of the time I don’t notice it, but I still wear a brace when doing heavy lifting, otherwise it gets very sore. I still can’t bear equal weight on that hand when I do yoga, and I can’t work the gear shift on my bike. My plan is to see the orthopedist again if my recovery stalls without full function. Good luck on your recovery!

          • No brace no orthopedist. No money. A year. Wow was hoping for alot quicker heal time…guess just keep hoping it heals all the way back to normal…full use. Mine feels like theres some bone or something stuck cant open hand all the way. Well good luck on your healing too. Thanx for taking time to talk to me.

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