Disaster-Management for Private Practice, Part II

The Components of a Disaster Plan

A Small Business Administration study determined that almost 60% of small businesses impacted by a disaster would close, the majority of which would simply never re-open after the initial event¹⁰. Such numbers speak volumes to the need for a plan in the face of a disaster. The plan ought to cover four basic principles: mitigation, preparation, response, and recovery.¹¹

Mitigation is essentially the practice’s insurance and legal coverage. This can be as different as any two practices in terms of what it covers, but includes any act to reduce the severity of the hazard, which may include not having trees too close to the practice, evacuation plans, and communicating those plans to clients. A large animal practice dealing in multi-million dollar racehorses and a specialty practice dealing predominantly in pocket pets will not have the same degree of risk. However, there are some common denominators even among practices of varying types.

Any business should undergo periodic insurance reviews to make sure they carry sufficient protection. Practice owners may be surprised at how much their business has grown and/or changed in the past two years, and how a plan that initially covered every contingency is now deficient. Most veterinarians have professional liability insurance to protect against allegations of malpractice or state board investigations; however this is grossly insufficient to protect against other damages, including damage to the property, loss of revenue, or injury to pets and/or clients. Accordingly, owners should invest in business insurance, which not only protects against losses due to fire and/or theft, but against business disruption and loss of revenue due to any number of reasons.¹² Flood insurance is usually a separate policy, and practices in known flood plains should consider the added expense. One other major insurance issue is the patients themselves. Bailee insurance, or its equivalent, is recommended to protect against losses that result from the injury and/or death of a patient that is NOT a result of malpractice. And one of the major pluses to “animal bailee insurance” is that the pet is covered regardless of the circumstance. Malpractice insurance only covers the patient’s injury or death if these occur while being actively treated as a patient. If a client’s dog is tragically killed in a fire, or if the vet risks himself and frees it only to have it killed by a speeding car, or to disappear into the woods, the vet is only covered for that loss if he has bailee insurance.¹³
Copies of patient records should be made and kept securely off-site. Electronic back-up systems are an excellent investment, even if the practice never has a true “disaster.” However, make sure that the system is working properly and back-up files are actually being produced. Too often, records are thought to have been backed up only to have the owner find out that the back-up was not doing its job for the past 3 years. It would be helpful for owners to attempt a periodic restore effort to prove it is working. Also, copies should be made of inventory and practice equipment documentation, and these should also be kept off-site.

The practice’s building should be inspected by the local fire marshal for safety and structural soundness, and to make sure that local fire codes are met. Smoke alarms and basic firefighting equipment (e.g., extinguishers and fire blankets) are valuable investments. Fire codes may differ from state to state; for instance, Oklahoma does not require a written evacuation plan for animal hospitals employing fewer than 500 people.¹⁴ It does require on premise fire extinguishers, though, and the presence of a sprinkler system or smoke detectors based on building size and number of occupants. The AVMA PLIT insurance plan may potentially lower its premiums if a policy holder can verify they have a written and demonstrable evacuation plan, though by what amount is subjective and owners should speak with their individual agents.¹⁵

Preparation is probably the most overlooked part of any disaster management plan. Plans should also include how the staff is involved. For example, if the practice wants to stay open and be a community resource after a hurricane, but the staff live in outlying locations in mobile homes and have to evacuate themselves and their pets, the ability of the staff to assist would be compromised. It is not enough to type up a plan and post it on a bulletin board, although this is an important part of the process. The plan should be available in multiple copies where they are easily accessible, discussed frequently by the staff, and practiced regularly¹⁶. These basic principles ensure the plan will help save lives and protect property; otherwise it may literally go up in smoke no matter how outstanding or well written. The plan should:

Designate important responsibilities to trustworthy people (e.g., calling 911 and making sure all staff/clients have evacuated the building). The immediate concern in preparing a plan is the safety of the owner’s staff and clients. Although the patients are important and may need assistance, the first step in any plan is the axiom “people come first.” This is not only logical but reasonable, as there will be no one to care for the animals if the people are themselves trapped in the fire.
Consider the fate of the animals only AFTER people have been safely evacuated. Whenever possible, animals should be rescued from dangerous situations. However, people cannot be allowed to re-enter a potentially deadly situation to rescue animals. This need must be filled by trained emergency personnel.
Name a common meeting place away from the immediate area if evacuation is needed, even if only across the street. The meeting place may be a vacant lot, or a private business or municipal area. Ideally, the place should be able to accommodate animals at least temporarily. The meeting place should also be within easy walking distance of the practice.

Develop a mutual-assist agreement with another local veterinarian or animal welfare group, or the nearest specialty hospital or university for emergencies. If patients are evacuated, they may require further veterinary attention or at least temporary boarding. In a larger, more far-reaching tragedy, local vets are encouraged to be able to be self-sufficient for up to 72 hours. In this instance, a generator would make a sound investment and is suggested for vets in tornado-warning areas and along hurricane coasts. Generators need to be tested, fuel needs to be fresh or stabilized, as well as properly sized. Some generators may require an electrician to install appropriate switch panel. Also be sure to take into account the amount of fuel that will be needed.
Designate someone trustworthy to call the clients/owners and inform them of the situation. This important step highlights the need for current and complete information about clients. Contact information on clients should be verified regularly, ideally during each appointment. It would be helpful to periodically remind your clients what the policy for the practice is.
Practice, practice, practice . When a plan has been implemented, discuss it with all staff and associates. And then practice the plan, even if it’s only a fire drill. It’s important that you not only practice evacuating the building, but also that the back-up files are checked, client contact information verified, and your meeting place tested for its size and suitability to your needs.

The best statement about the “response” portion of disaster preparedness is “Respond as you train, and train as you intend to respond.”¹⁷ In a single sentence this summarizes and hammers home the point of all disaster response training. Train your personnel in the manner you would have them respond to a given disaster, and expect them to respond to a true disaster in exactly the same way in which they trained.

Recovery from a disaster can take months, even years. The length of time depends on many elements and what remains after the immediate danger of the disaster is past. Even after the damage has been assessed, it is up to the practice owner to decide if there is a possibility to re-build. In many cases, the feasibility of coming back from a disaster will hinge on mitigation and preparation of the individual vet. For instance, Dr. Smith and his predicament:

The Dr. Smith Individual Disaster Management Plan

Evacuate the building of all human personnel. Have all or most of the files on that day’s patients on hand so they can be brought out too.
Call 911.
Meet at a designated place, ensuring that all people are safely out of the building.
If the situation is stable and the risk very low, evacuate the animal patients or as many of them as can be safely brought outside.
If there are patients in need of immediate veterinary assistance, designate a driver to take them to the nearest veterinary hospital, shelter, or similar location where help can be acquired. NAME Phone Number:
Using the files from the day’s patient case load, begin calling owners to collect their animals. If owners cannot come immediately, take them to the nearest veterinary hospital, shelter, or similar location that will allow them to be boarded and inform the owner of the name, address, and phone number.

NAME Phone Number

ADDRESS

When the local 911 responders have the situation under control, check on the status of any controlled drugs that may have been spared by the fire. Do NOT leave on-site even if the safe or locked cabinet where they are normally stored is intact. Fill out a DEA Form 106 (Theft and Losses) and report the incident to your state DEA office.¹⁸ Controlled substances must be kept in a secure location, such as another vet hospital or even the local police station.
Contact the vet hospital, shelter or other locations where your patients were taken for the day and make sure they arrived safely and/or were picked up by their owners. If there are no doctors at this site (e.g., humane shelter volunteers), send an associate to check on them. If there is no associate, check on them yourself at the end of the day.
Contact the insurance company and file a claim. (This step may fall wherever the owner has time.)

Phone Number

Helpful Resources

The AVMA website www.avma.org contains numerous disaster preparedness resources, including state-specific emergency plans. It is highly recommended that veterinarians review these resources and download the state emergency plan that applies to them. Unfortunately, the vast majority of these plans deals with state-wide issues solely and do not address individual emergencies such as a hospital fire.

Practices along hurricane coasts and in areas where major natural disasters such as floods, tornadoes and/or earthquakes are likely to occur may consider educating their clients about pet evacuation. The website http://www.chelandem.org/flyers offers information on pet evacuation kits and general information for pet owners about caring for their animals during a disaster. Veterinarians could suggest the site to their clients, or create a link to it or a similar site on their own homepage.

ASPCA also provides animal welfare disaster funding including for organizations that take in animals from a disaster area. This funding can cover qualified veterinary expenses and medical care for animals. More information can be found at http://www.aspcapro.org/emergency-and-disaster-response-grants.php.

Post-Katrina

Although Hurricane Katrina was a true disaster, resulting in significant numbers of human and animal death and injury, good came from the tragedy, thanks to the attention given to the pet component of disaster management planning. The strides that were made helped agencies, many formed post-Katrina, to prepare for evacuations and to help alleviate pet and pet owner suffering during the Category 3 hurricane named Sandy in October 2012. This is not to suggest that Hurricane Sandy was not the cause of numerous pet-related crises, only that the groundwork laid post-Katrina appears to have somewhat of a positive impact on large scale disasters.

Conclusion

Veterinarians need to adopt individual disaster management strategies not only to protect the safety of their staff and patients, but to reduce their risk of being driven out of business by a sudden crisis. In the end, explaining all of the possible caveats and provisos of Dr. Smith’s situation is a gesture in rhetoric. The point is not in the fine print, but rather in the headline. Disasters are often categorized as such because they are unexpected, but preparations can be made even without a specific danger in mind. Dr. Smith could just have easily arrived at work to find a flood, or a tornado ripping through town.

Dr. Kevin Dennison¹⁹ formerly of the Colorado State Animal Response Team classified disaster management not as a myriad of plans covering the minutia of every possible problem, but rather as a contingency to face “the elephant in the road.” Where did the elephant come from? What is it doing here? Who cares, for as long as there is a plan for unexpected emergencies, an elephant in the road is nothing more than an unusual spin on a common theme. Ultimately it is within the power of the private practitioner to decide how disruptive it will be.

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