At my university job, I work in a clinical building called the Patient Care Center. This is a three-story building with a large dental clinic on the top floor, a medical clinic and my podiatric clinic on the second floor, and a pharmacy and optometry office on the first. This rather expensive building was opened just before I started at Western University in 2010, and is intended to provide educational opportunities for our very varied professional students.

Two weekends ago, a water pipe under the dental clinic apparently ruptured, causing a disastrous cascading of water all the way down to the first floor, flooding and destroying several of the clinics along the way - podiatry included. I came in on Monday morning ready for clinic, only to find it was cancelled and the building closed.

The management of our Patient Care Center is always watching out for the safety of the patients and caregivers, and we have protocols for several disasters. We have earthquake drills several times per year and have our codes for various problems. No one is concerned for their safety due to heavy preplanning and protocols. However, I don’t think our management planned for what happens after the disaster occurs. In fact, I think it’s a rare thing indeed to plan for what happens after the disaster strikes.

Some people plan for worldwide disasters, ready for the time when society falls apart. Most of us consider them paranoid. The chances of true disasters are pretty low, but they’re certainly not rare. For example, in 2015 the Americas (North and South America) suffered from 96 natural disasters, with 25% of them occurring in the United States, to a price tag of $25.8 billion.¹

Despite disasters being rare on a day-to-day basis, I wonder just how much pre-preparation we should have. A few weeks after I started residency in 2003, there was a major blackout in the Northeast part of the county. This occurred due to a power station issue in Canada that caused a chain reaction leading to the electrical grid going down from New York to Detroit. I believe it lasted for three days, and I recall long car lines at the one gas station that remained open. Within hours, all of the grocery stores had completely sold out of bottled water. Cell phones weren’t really much of a thing yet, but it wouldn’t have mattered. The towers were also down. I had to call my parents from a payphone to let them know we were ok. Imagine that – a payphone. Remember those things? I bet some of our podiatry students in school now have never even used one!

I recall at the time feeling pretty helpless. My wife and I were totally unprepared for the immediate loss of resources, and it’s lucky the outage didn’t last too long. Just like my wife and I, the Northeast would have been in bad shape if the outage had lasted longer. My Internet research has taught me that we were not very resilient to a disaster. This idea of resilience is an important concept. According to the Department for International Development (DFID) – the United Kingdom’s overseas disaster response service – there are four primary components of resilience to a disaster.²

Think about relatively recent disasters around the world such as the earthquake in Haiti in 2010. One of the reasons that disaster was so bad was the low level of resilience of this country. The context was a country with a poor infrastructure to start out when the disaster struck. They had a low capacity to deal with the earthquake (buildings were not made to withstand earthquakes), and they were unable to respond due to lack of resources. It was a good thing that several countries reacted with aid (including some wonderful podiatrists, I might add, that did humanitarian work on the island).

Just as I wasn’t prepared to respond to the smaller disaster of the power outage, my office was not all that well prepared to respond to the aftermath of the closure of the building. Their initial response was fine, but, like me, they didn’t seem to think about what to do when we didn’t have a building and scrambled to get our practice up and running.

Now, I’ll ask you the question: Is your practice prepared to respond to disaster? How resilient are you?

For those of you in practice, do the following thought experiment. Imagine a disaster of some type of moderate level - not enough to destroy everything – and your practice is forced to close. How would you handle this?

Consider Some of the Following Questions

This list actually goes on if you keep thinking about it. Obviously, the purpose of the thought experiment is to honestly consider just how prepared you are, and then use that information to create or modify your own disaster plan. The key here is to be prepared with resources and a protocol – AKA being resilient.

I have to give my administrators credit. Despite not having an actual post-disaster plan, they did respond reasonably fast for a cumbersome organization that doesn’t turn on a dime. We were up and running seeing our more acute patients the following day, at an alternate location with a reasonable amount of supplies available. It also turned out that technology saved the day. Cell phones allowed everyone to communicate with each other, and since our EMR is cloud-based, we were able to access patient records and communicate with them very quickly.

Days later and the damage is being assessed. I imagine the insurance payout will run into the millions of dollars for repair and replacement, but that information will come in the future. Until then, watch out for your next disaster and consider…are you prepared?.