Emergency Preparedness in Florida Essential for All Oncology Practices

Barbara Morris, DHSc, LAT, ATC, CSCS, HDDP

Director, Corporate Safety

Florida Cancer Specialists and Research Institute

Tampa, FL

TARGETED ONCOLOGY: How has the response to hurricanes changed in recent years at FCS?

Hurricane Ian in 2022 was a wonderful teacher. We went through hurricane planning about a year ago with a much bigger storm, and we had a plan in place at that point…. But it was a very new plan. We’ve spent the course of the past year responding to the deficits we had from Hurricane Ian and trying to improve our plan.

With Hurricane Idalia [in August 2023]—I don’t want to say the plan was perfect, because I don’t know that we will ever be perfect in this, but we have worked so hard over the course of the past year to improve our plan, to communicate the plan, and to educate on the plan, that we moved over $7 million worth of drugs in 3 days to safe sites and back without having a single drug excursion [going outside of their prescribed temperature during storage or transportation]. We did well.

When it comes to storage of equipment and medicine, how do you do that and how important is that in the hierarchy when a hurricane is coming?

Financially, it might be the most important; in the scheme of things, its probably No. 3 based on the safety of our patients and our employees. Then securing the drugs would be third. But it’s planning, planning, planning—we don’t have generators at all our sites, so we have emergency sites attached to a generator site. The problem with a hurricane, Hurricane Ian is an example: It was supposed to come in at the Big Bend area, and it ended up making landfall in Fort Myers, Florida. During…the day, we had to adjust our plans to try to get everything taken care of at the last minute in Fort Myers.

Hurricane Idalia was a little different; it stayed the course. But we have sites [without generators] attached to those with generators. So, when we’re within so many hours of closing the facilities, we start packing the drugs and moving them. We have worked with our pharmacy operations teams, we have how-to videos, we have written checklists, and we have checklists on the computer; we have so many different things to show the team how to pack for the [drop-off].

When there is an emergency, what is your role when it becomes time to execute that plan?

We worked with a consulting agency to develop our plan with my boss, Sharon Lapkin, MS, RN, CPHRM, [vice president of enterprise risk management, quality/patient safety, corporate safety, licensing, and medical staff office]. We have it all laid out: Once we have a named storm and once it’s within so many miles of making landfall, then we have a specifically selected team across all different stakeholders within the company who start meeting and planning. Their job is to communicate that downline to any of their direct reports. Ken Sturtz, MBA, MHA, [chief information officer], then has one of his team members who joins to do the downline reporting. Sturtz is our conduit to the C-suite and to the physicians, but his team also plays an important role because of the information technology component. You must figure out how to continue to communicate when we start to lose power, so we’ve chosen a Teams page for a specific group, and we have all kinds of spreadsheets that are filled in real time of which clinics are closing, which ones will be open, who’s in the path, who’s not, and when are we moving drugs from particular clinics. It worked well during Hurricane Idalia, based on the things that didn’t go well during Hurricane Ian.

What goes into deciding when to close clinics?

In the past, it’s been what doctors want to close the practices at that point. But we’ve tried to make that more objective. We look at wind speeds, when they’re going to be closing bridges, and those kinds of things. I’m still doing research to try to improve that even more from an objective standpoint for the next time we have a storm. Most of the time, the bridges close when we have sustained winds of about 40 mph. When the airports close, our drugs can’t be flown in. And then for the regular car, you’re looking at anywhere, depending on what you read, 50 to 60 mph sustained winds when it becomes dangerous. We try to use all those kinds of objective measurements in areas to determine when we’re going to close a facility—also how close it is to the water, the flooding areas, and that kind of thing.

How do you get the word out to patients if you have to make the decision that they can’t come in?

Our communications team and marketing team help us keep those spreadsheets up-to-date. Every morning and every evening, I will send out an update to that small team based on what’s going on from the hurricane center: where the storm is, how fast it’s moving, and the projected paths. Then the communications team takes that update and morphs it into something that goes out to all employees across [FCS]. They get that at 10 am and at 5 pm. They’ve come to know that it’s not going to be at a whim; if they need to know, they need to look somewhere around the 10 am and the 5 pm hour to get an update about the storm and what FCS is doing.

We also added an emergency texting service this year like you would see at a university in an active shooter situation or something similar. We can text all our employees or we can pick specific areas to communicate with and keep the others out if it’s not relevant to that area. Then we have different kinds of hotlines for our patients, so the closure list and that kind of thing will be put in a messaging system as patients call the hotline to determine what clinics are open or closed. We also try to communicate as much as we can with the local news agencies. When they start to run the list of closures, then our communications team speaks with them as well, so our patients could see on TV or on the radio where the closures are.

How do you decide when to get patients back in?

After a facility is closed, typically another small team of us, including our facilities group, will visit any site that was in the path and then we will report back any damages to that Teams page. We do this by a placard system. For instance, if we determine it’s OK, then there’ll be a green placard placed in the front window of the facility in case anybody goes by there. Then we place it on the Teams page that that facility is cleared to open. If there’s minimal structural damage, that might be a yellow placard, or if there’s something major from a structural standpoint, it would be a red placard and we wouldn’t open. Keep in mind we try to plan and communicate in our meetings to determine when the facilities are going to open based on any damage, and how soon we can get that drug back there. Because we can’t treat our patients until we can get that drug safely back.

When it comes to a lot of the planning, who is tracking these storms?

That’s me; the week [of Hurricane Idalia], I probably worked 70 hours. I was sending emails at 2 am, just before landfall, not that anyone else was up yet. I want to make sure when they get up that they know whether this storm has changed overnight, then I need them to know exactly what we’re looking at when we start early the next morning. For that storm, I started tracking it almost a week before it made landfall, so then they are starting to get communications. We had our first small team meeting on Sunday at 9:30 am, and then we had a hurricane team meeting at 1 pm Sunday…. By that point, we had a name, and it was within 1000 miles of making landfall. Then we started meeting with the hurricane team at 8 am and 3 pm every day, until we made the decision to close or we’re ready, and until we are finished afterward.

Depending on the amount of damage that we have, we may roll that into the crisis management team, which is a different group. We continue to meet until we’ve handled everything as far as repairing the building and making it safe for the patients to come back or that could be moving patients; that’s one of the beauties of a company like FCS—if we have to close one site down for a week or two, we can move those patients to another one of our own sites to continue treatment, but we’d have to move the drug around. One thing that I [have not] mentioned yet is communicating with the couriers and the drug companies to stop our drug shipment at a certain time and then start it back up. Procurement plays a major role in this as well, as we’re making these determinations.

How far in advance are you thinking about what you’re going to do during the storm?

One of the things we did prior to Ian, and then I think we made it better after Ian, is every department has a checklist that starts at 96 hours before landfall. Several days before landfall, they’re already looking at their checklist—what should I be doing, what supply should I have—every few hours prior to the storm. Then there’s a small checklist for during the storm, and we don’t ask [individuals] to do much on that. The one thing we do ask, if possible, is that those who have access to monitor the temperature of the stored drugs. We need to keep an eye on that. Then there’s a checklist post storm, prior to opening the clinic. We try to have everything documented and listed for them. All they need to do is read and check yes or no, and then contact whatever the appropriate entity is if there’s something that’s a negative on the checklist.

What is one of the biggest lessons that you’ve taken to heart in this process and would want another practice to know regardless of where they are?

For me, it’s having a plan, activating the plan, making sure everybody’s been educated on the plan, and following the plan as best you can. But we might be in the middle of it, and we must change, especially with hurricanes. If it’s a fire or other kinds of emergencies we deal with, it’s a little different. But with a hurricane, we’re making changes during…the hurricane.

We planned for Hurricane Ian in the Big Bend, and then it was going to hit Tampa and so we got everybody ready in Tampa, not that they weren’t already working on it. And then it ends up coming in, one of the largest storms that’s ever come in on United States soil, in Fort Myers, so 5 hours south of where it was originated. That’s our main hub, so that was a big hit for us down there, with all the clinics and the corporate offices we have. We didn’t do poorly, but if it were to hit tomorrow, I think we would do much better.

When you’re coordinating, how do you get information from different parts of the state?

That’s part of what I do. I have a law enforcement background, so I look at those things…. We’re in [almost all 67] counties in the state of Florida, which means we have to please all those different inspectors, but we try to stay a part of those groups and attend some meetings. So, I get updates from different counties all the time, which makes it nice, because you see from a county perspective what’s happening.

The other thing that we must stay abreast of is evacuation plans. We don’t have any of our clinics in evacuation zones, but many of our employees live in evacuation zones. We talk about planning for the company, but we also must make sure that our employees are taking care of their home things as well so they can work for us as long as they can safely and then get home and be there to be safe with their families.