Disaster Response: Where Does Palliative Care Fit In?

The interviews
were included in a presentation by Dr. Maggie Gibson in a symposium on disaster
response sponsored by the Canadian Red Cross and interRAI Canada at the annual
conference hosted by the Canadian Association on Gerontology (http://cagacg.ca/) in Halifax, Nova Scotia in October 2013
(see CAG2013 Program available on the website for full symposium details).

In the first interview, Dr. Lindy
Murphy – Medical Director Palliative/End of Life Care Program in the Calgary
Zone and Chris Tremblay, Manager, Hospice Operations/Hospice Access in the
Calgary Zones reflect on the experience of evacuating a hospice during the
flood:

During
the recent floods in Alberta, various health care facilities needed to be
evacuated, one of them being a residential hospice with 17 residents. The call
from the “Command Centre” advising us to evacuate came at 0700 on Friday, June
21. This call set in motion a cascade of communications and activities. I
[Lindy] immediately connected with Chris as well as the hospice leadership.
Next steps were to determine where we could place our palliative patients
considering their high care needs and their frailties. Calls went out to the
other six Calgary Zone hospices to establish their ability to help.

Everyone’s
response was phenomenal. Meanwhile, 10 ambulances arrived on the scene while we
continued organizing placement with receiving personnel:

• 12 patients were transferred to other hospices who converted family rooms and administrative spaces into patient rooms 
•  2 patients were transferred to an acute care hospital
•  2 patients were able to be cared for at home 
•  1 patient died as expected before transfer was necessary

There
were a few tense times where it was uncertain as to whether or not the
ambulances could get these patients to the new locations as river crossings
were not all accessible. However, with the help of emergency services and city
workers, routes were worked out successfully. From the time of the call to
evacuate until all patients were relocated was only a matter of hours. 
All participants in the events were resourceful, collaborative and proactive in
making sure our patients were quickly and successfully relocated to appropriate
care settings.

Apart
from the hospice evacuation we also needed to ensure service delivery continued
uninterrupted to our other palliative patients. We had to make quick changes to
physician call schedules as bridge closures and road washouts prevented us from
getting to some parts of the city. We also needed to ensure pharmacy drug
delivery to our hospices continued. For Calgary hospices, we use a community
pharmacy service and one of these pharmacies was also flooded. Health care
providers and physicians that were personally evacuated went to great lengths
to come into work.

Examples
of dedication to our patients:

• People spending hours on the road, trying different
  routes to get in to work;
• Pharmacists filling hospice weekend prescriptions
  via generator power – their feet in water;
• Families taking on extra care duties for patients;
• Administrators utilizing several phone lines,
  monitoring TV broadcasts, email threads and social media at the same time to
  get the best real-time information to keep people informed about evacuation and
  staff deployment; and
• Vacations cancelled for key staff who remained on
  call 24/7 to coordinate and manage hospice bed use.

What
struck [us] most about the events of these few days was how our health care
team worked together to come up with creative solutions in order to serve our
patients.

In the second
interview, Sarah Walker, Executive Director of Hospice Calgary, speaks from the
perspective of a receiving facility:

In June of this year
(2013), we were impacted by serious flooding. Rosedale Hospice, which we
operate, needed to take in some patients from another hospice that was being
evacuated, and through that process we learned several things which I’ll share
with you now.

The first is that we needed
a disaster plan that was updated and that staff were very familiar with, and
that was not the same thing as accessing a pandemic plan. So that was our first
piece.

Secondly, it’s helpful to
know where staff live, based on quadrants, because not everybody could get to
the north part of the city and staff needed to be able to expect the
unexpected, like we didn’t have power for four days even though we weren’t flooded.

Lastly, many of us myself
included were impacted personally by the flooding. That made it pretty tough
too. All that being said, we did a fabulous job, care was provided, and there
were no issues.

But definitely we will go
back and take a look at what worked and what we would like to improve.

Commentary

Disasters
are increasing world-wide, in response to a cascade of factors, including rapid
population growth, mass urbanizations, and climate change and its effects on
sea levels, global rainfall and storm patterns. There is a risk that the palliative care needs of those who are already
at the end stage of life can become lost when there is a sudden surge of people
requiring acute intervention or a shortage of resources.¹ Planning for the provision of palliative care as a component of
disaster management will benefit greatly if the experiential knowledge of
palliative care providers who have provided services in the throes of a
disaster is acknowledged and utilized.²   

¹ Wilkinson A, Matzo
M, Gatto M, Lynn J. Palliative care. In: Phillips SJ, Knebel A, editors. Mass Medical Care with Scarce
Resources: A Community Planning Guide. AHRQ Publication No. 07-0001 ed. Rockville,
MD: Agency for Healthcare Research and Quality; 2007. p. 101-116.

² Gibson, M. Seniors, Disaster Mortality and End of Life Care. In Charles
Cefalu (ed), Disaster Preparedness for Seniors – A Comprehensive
Guide for Healthcare Professionals. NY: Springer,
in press.