February 2018

OPHTHALMOLOGY BUSINESS

Dealing with natural disasters


by Vanessa Caceres EyeWorld Contributing Writer


Dr. Alfonso celebrates a child’s birthday at Bascom Palmer Eye Institute during Hurricane Irma.
Source: Bascom Palmer Eye Institute

Ophthalmologists who have lived through them share stories, lessons learned

From hurricanes to flooding to earthquakes to wildfires, 2017 had no shortage of natural disasters. As residents around the U.S. and the globe rushed to escape damage, ophthalmologists also participated in the madness and sadness that occurs during natural disasters. Several ophthalmologists shared their experiences and lessons learned so others can be prepared for future natural disasters.

Helping the community

During Hurricane Irma in Florida in September 2017, Bascom Palmer Eye Institute, University of Miami, stayed open to serve patients, but it also was a shelter for 300 employees on the emergency team and their families as well as members of the Miami police and Federal Emergency Management personnel.
As part of a large university, Bascom Palmer is prepared for hurricanes with deployment plans designed well in advance by the university’s disaster planning committee, said Eduardo Alfonso, MD, professor and chairman, Bascom Palmer Eye Institute. Special teams at the university go into action at certain points before a storm and aid with recovery after, leading to a well-orchestrated event, Dr. Alfonso said.
“We learned from Andrew,” Dr. Alfonso said, referring to the 1992 hurricane in South Florida that in addition to causing more than $20 billion in overall damage, led Bascom Palmer to lose power for a week. The organization did not have storm windows at that time (they are much more common in Florida since Andrew), and the city of Miami had no running water for 3 days. When the water was running again, it was contaminated for several days and unable to be used by medical facilities, Dr. Alfonso said.
Bascom Palmer now has a triple backup power system.
Although the hurricane was not as disastrous to South Florida as planned, except for in the Florida Keys, staff on duty treated many trauma-related injuries caused by nails or wood incurred when residents boarded up their windows. There were also traumatic eye injuries that occurred during post-storm cleanup and injuries from airbags that released during car accidents around the time of the storm, said Ranya Habash, MD, assistant professor, Bascom Palmer Eye Institute, and consultant for TopLine MD, Miami.
One lesser-considered effect of the storm was the loss of reading glasses and medications; as people prepare for a storm, it’s easy for small items to get misplaced. Bascom Palmer staff helped many people replace these items, Dr. Alfonso said.
Other patients in the area who recently had eye surgery and needed follow-up were able to be seen at Bascom Palmer until other area offices reopened. Bascom Palmer communicated via social networks and the Florida Society of Ophthalmology to let doctors know about this option. Bascom Palmer also has a mobile van that can travel to communities (and did so during Irma) to help patients.
Dr. Habash praised how staff, including Dr. Alfonso, administrative staff, and first-year residents who had never experienced a hurricane in Florida stayed behind during the storm to help others. “Patients came through with blinding injuries. Our team worked around the clock to help them,” she said.

Pearls and lessons learned

• Use social media to communicate. Dr. Alfonso was pleasantly surprised by the effectiveness of social media to spread news among doctors during the storm. There were 120 ophthalmologists in the area linked to WhatsApp, a communication app, and it worked well, he said.
• Have a plan B in case your office can’t open, either short term or long term. You may not be able to see patients a few days after the storm—but you also need to consider if a storm is so devastating that patients will move away, Dr. Alfonso said.

Treating storm-related injuries

“The National Hurricane Center had predicted that Hurricane Irma would smack us right in Broward County and that we would get pummeled,” said Alan Mendelsohn, MD, Eye Surgeons & Consultants, Hollywood, Florida. As mentioned previously, Hurricane Andrew devastated South Florida in 1992, and forecasters said that Irma would be worse.
As everyone in the area hunkered down, Dr. Mendelsohn, a corneal specialist, began to treat patients with foreign bodies in the eye and cornea abrasions caused by injuries from nails and wood as homeowners used plywood to cover windows. On a typical day without a storm, Dr. Mendelsohn said he might see one or two people a day with corneal abrasions or foreign bodies; during the storm preparations, it was about 10 people a day. Some patients came to him directly, while others were referred by local ER physicians.
Dr. Mendelsohn stayed in the area during Irma. He thought it was important to be present and help the large number of patients who would have eye trauma.
Once Irma recovery began and residents cleaned up trees and removed plywood, Dr. Mendelsohn saw another surge of eye injuries with the same causes.

Pearls and lessons learned

• Preach safety goggles. It can’t be said enough, according to Dr. Mendelsohn. In Miami, Bascom Palmer used public service announcements to remind residents about the importance of safety goggles.
• Think about what needs to be moved in your office before a storm. Dr. Mendelsohn’s first floor location has floor-to-ceiling windows, but the building management prohibited plywood coverings. Although the building had hurricane-resistant windows, it was unclear how they would work in a large storm. There was also a fear of looters if windows busted open. To help protect the practice’s large optical display,
Dr. Mendelsohn hired four men who took 8 hours to move all optical products to a different area. That same manpower had to occur afterward as well. “That was a big expense,” he said. However, in the scheme of things, Dr. Mendelsohn considers that effort and expense just a headache compared to what could have happened if the storm was as strong as originally predicted.

Monumental flooding

“Almost 7 years ago, Nashville was changed forever,” said Ming Wang, MD, Wang Vision Institute, Nashville, Tennessee. “Beginning on May 1, 2011, almost 14 inches of rain fell over a 36-hour period, doubling the previously held record.” It caused nearly $2 billion in property damage and displaced more than 10,000 residents, Dr. Wang said.
Dr. Wang had staff members who were trapped in their homes by the flooding or who were displaced to stay with relatives outside of flood zones. The practice offered to pay for hotel room stays for some affected patients and staff.
Dr. Wang’s practice, located on the 11th floor, did not have damage, but business slowed significantly in the months and even years afterward. “Once the waters receded, the impact of the flood had lasting effects. Elective surgery took a hit as patients prioritized repairing their homes and lives,” he said.
The practice hosted a fundraising event to raise money to benefit patients.

Pearls and lessons learned

• Earmark savings to make up for an anticipated dip in revenue in the months following a natural disaster, Dr. Wang suggested. “Elective surgeries become a luxury that few will desire when they are focused on rebuilding their lives,” he said.
• Establish a relationship with area hotels. This could help patients and staff stay there for a lower cost if needed.
• Build in a generator that can last for at least one week in case of an electrical outage.
• Have backup staff for each key staff position, in case regular staff members are unavailable or out of town during a natural disaster.

Editors’ note: The physicians have no financial interests related to their comments.

Contact information

Alfonso
: ealfonso@miami.edu
Habash: ranya@habash.net
Mendelsohn: karensuedennis@gmail.com
Wang: drwang@wangvisioninstitute.com

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