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January 17, 2020

4 lessons a Kaiser medical center learned from battling wildfires (twice)

Daily Briefing

    A Kaiser Permanente facility in California successfully evacuated patients during the Tubbs wildfire in 2017 then again during the Kincade wildfire in 2019. Writing in Harvard Business Review, Tom Hanenburg, COO for Kaiser Permanente Northern California Region, and colleagues share the "resilient" emergency response they've developed based on their firsthand experience.

    From fires to hurricanes: How can hospitals prepare for disasters?

    Hanenburg's co-authors are Shakiara Kitchen, regional emergency management - practice specialist for the Kaiser Permanente Northern California Region, and Suzy Fitzgerald, regional emergency management training director for Kaiser Permanente Northern California Region.

    The fires

    When the Tubbs Fire flames threatened Kaiser's Santa Rosa Medical Center in 2017, doctors, nurses, and support staff came together to evacuate the facility. "It was a job that many, if not most, of them never imagined doing in their careers," Hanenburg and colleagues write. But again in 2019, another wildfire, the Kincade Fire, threatened the facility. "Both times we safely evacuated more than 120 patients and ensured care continuity under extreme duress," according to Hanenburg and colleagues.

    The authors describe what their team learned from the experiences and how they used lessons from the first evacuation to improve the response the second time around.

    1. Launch a turnkey command center

    In the past, Kaiser employed regional ad-hoc command centers to respond to emergencies, the authors explain. But Hanenburg and colleagues learned that summoning emergency personal to a new location, re-connecting the communications center, and establishing a physical command center for support staff wasted "critical time" during emergencies.

    As such, in 2018, Kaiser established a turnkey command center at its headquarters in Oakland, complete with proper communications and IT equipment and trained personnel. Through the new center, the system can coordinate emergency responses across multiple sites for various disaster scenarios, allowing Kaiser to "provide constant visibility into the operational performance of each of our hospitals during an emergency, enabling us to provide the necessary resources and support in real-time," Hanenburg and his colleagues write.

    2. Don't wait to set up a local command center

    When the Tubbs fire hit in 2017, the flames reached the grounds of one of Kaiser's hospitals in the middle of the night, the authors write. "The decision to evacuate and manage the associated logistics was made swiftly at the ground level and was ultimately carried out safely," the authors explain. But when the team debriefed on the incident, they felt they needed to devise ways to buy time in a similar situation, the officials recall.

    "Now we open a command center at the first sign of a potential threat," the authors write.

    After analyzing what happened during the Tubbs fire, Kaiser in October 2019 opened a command center "long before" the Kincade Fire became an emergency, the authors note. Kaiser started transferring patients out of the Santa Rosa Medical Center hours before an official evacuation notice. "[T]he decision to not wait until we felt seriously threatened helped us improve our response by putting critical steps in motion sooner," the authors write.

    3. Make use of all resources

    When Kaiser faced the Tubbs fire in 2017, hospital staff's main concern was safely evacuating all 122 patients from the facility. But, because their neighbor hospital started evacuating earlier, "ambulance resources were scarce," the authors write. As a result, most patients were transported to the next hospital by buses and private cars.

    By contrast, during the Kincade Fire, Kaiser made a point to ask their other facilities to assess their patient capacity and command centers in advance in preparation for the evacuation of the Santa Rosa hospital. As part of emergency preparation, the regional transportation hub at the command center lined up dozens of emergency vehicles to transport the first patients. "This allowed our unaffected hospitals to be ready and able to receive Kaiser Permanente Santa Rosa Medical Center's patients safely and expeditiously," the health officials write.

    4. Complete pre-work to speed up evacuations

    Before a full evacuation is ordered, Kaiser takes certain incremental actions to speed up the process. For instance, in the case of an emergency, Kaiser might transfer non-critical patients in advance. This "can help avoid overwhelming the receiving facility and reduce the at-risk patient population in case of emergency," they write.

    As part of its "comprehensive evacuation plan" the hospital also spends time gathering equipment, completing paperwork, and doing other "pre-work" to speed up the evacuation process, the authors write. "Educating and training for employees and physicians on these processes in advance of an emergency will help achieve optimal performance and the best possible outcomes for patients in a real event," the authors explain.

    The importance of a pre-emergency response

    The authors note that while some of Kaiser's solutions might be best for an integrated system like Kaiser, they note, "[W]e also believe that hospitals and health systems of any size can learn from our experiences and changes we made between the two fires." And while the health system hopes to never have to use the emergency system again, planning for an emergency is critical to keeping patients safe, the authors write. "The reality is that the risks our facilities face today are different than what we imagined a decade ago—and that a rapidly changing climate poses yet unforeseeable hazards for the future," they conclude (Hanenburg, et al., Harvard Business Review, 12/26/19).

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