Introduction

Healthcare emergency management is one of the most important investments that a healthcare provider can make. The concept is not new as nations, agencies and organizations must be ready to deal with issues that arise in unplanned situations. Over the years, emergency management has changed, and in recent planning, there have been dedicated emergency departments that are entrusted with dealing and suppressing emergencies as soon as they happen. Most healthcare providers have gone beyond this stage and even have created the role of an emergency manager whose chief role is to coordinate emergency activities;  like disease outbreaks, catastrophes leading to loss of life or situations that could compromise the health of the community. Health care management responsibilities have since time immemorial been left to the hospitals especially in matters of fire safety, handling victims from casualty events, and back up in all these unpredictable events. The limited nature of emergency events in the communities has reduced the responsiveness and preparedness of the hospitals towards the issues. All health institutions must prepare adequately and plan for emergencies that might happen from time to time.  Acts of terrorism, hurricanes, cyclones, public health emergencies or other emergencies are the best test of an institution’s commitment to emergency management and responsiveness as all these situations require a bulwark of dedicated resources to overcome and handle. The general public and communities are also highly expectant that the hospitals and other healthcare institutions and facilities will play a significant role in helping contain the emergencies or reduce the impact of such crises. In as much as the situations might be overwhelming, healthcare institutions are expected to continually provide both emergency care, and support regardless of the magnitude and demand of services.

The ever-changing nature of communities has in recent years transformed hospitals to centers of refuge, especially when dangerous conditions or environments are felt or experienced by a group of people. The design of hospitals should be able to provide reliable communication, shelter, air, and food, water and safety at all times. In the last ten years, the level of public confidence in hospitals has proved that individuals will flock to hospitals even if they do not require medical care. The best example in this is during the terrorist attacks of 2001 and the famous Northeast Blackout in 2003. Malicious groups of people and terrorists have been seeking to take advantage of this, and this has prompted the hospitals to focus on security and less on emergency management frameworks and structures. The situation has made hospitals develop and adopt an all-comprehensive emergency management effort instead of focusing on specific threats like disease outbreaks. However regardless of all these dynamics hospitals must look beyond these emergencies and threats and work with stakeholders to design inclusive, and comprehensive emergency management approaches and preparedness that cannot be overwhelmed during emergencies.

Analysis of healthcare Setting

Our Lady of the Lake Regional Medical Center is a private hospital located in Baton Rouge, Louisiana with a bed capacity of 1020 beds. The hospital has invested in resources and equipment, and this makes it a dependable healthcare center in the region. The location and level of the hospital allow it to serve as the teaching hospital of four learning centers namely Tulane University, Southern University, Our Lady of the Lake College and Louisiana University. The facility is the largest private medical facility in Louisiana, with the hos[pital having more than 3,000 staff members and over 900 physicians. In a year, the facility serves up to 350,000 persons through their outreach networks and close to 30,000 in inpatient. The hospital is the only peripheral blood stem cell transplantation center in Baton Rouge, and this shows its commitment to scientific research. The ability to handle this has built the confidence of the local communities. The center also provides to be the only Interleukin II chemotherapy treatment center in the whole state. The hospital manages the blood donating service in the Greater Baton region and also provides access to clinical trials from other centers. The achievements of the healthcare center and the milestones achieved is proof that it can be in a position to handle medical emergencies and other emergencies that might be caused by natural calamities. The size of the hospital and the reputation it has gained over the years made the hospital a receiving center for evacuees from the areas surrounding New Orleans. The choice made to use the hospital was because of its level of preparedness before the storm struck and the collective measures it had put. The setting of the hospital allows it to deal with patients surge, transport patients in critical conditions, and coordinate communication across all agencies at the ground. The high number of physicians in the center was also a parameter that was used in the decision to choose the health center. The hospital was committed before the emergency, during the emergency and even after the crisis. Over the years the hospital has also created a disaster plan that even touches on general care during cases of emergency. The Lady of the Lake Regional Medical Center disaster plan is comprehensive as it covers both the natural and human-made disasters that can occur with and without its reach. The hospital carries out disaster drills to measure the preparedness of the teams in case disaster strikes. The medical center is organized as they have a disaster call tree throughout the different departments of the organization and a command and control structure bolsters this. The disaster management plan has been in existence for years now and to adequately overcome challenges and emergencies the program is updated on an ongoing basis (Earle, 2018).

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The Disaster

Hurricane Katrina is grouped as a category five storm that was extensively and extremely destructive in Florida and Louisiana in 2005. The significant effects of the hurricane were felt in the city of New Orleans and the areas surrounding it. The loss of lives around New Orleans and the areas hit was significant as a result of engineering flaws in the design of levees. The hurricane is recorded to be the fourth most intense Atlantic hurricane in the history of the country. The storm is believed to have originated from the Bahamas on August 23 primarily from the combination of the tropical wave and the Tropical Depression Ten. The disaster killed caused the deaths of at least 1836 people (Raulji et al, 2018). Properties worth $125 billion were devastated with most of them being cars, and houses. 80% of the city of New Orleans was flooded and transportation and communication systems destroyed. Tens of thousands of people were left stranded with no food, shelter or even necessities. Some people had evacuated the city, but a considerable number were caught in the storm, and it required the assistance of the agencies and government to help. Most health facilities in the area were affected, and most of them could not be used as centers of refuge by the affected individuals (Hedges et al 2018). Hospital to hospital transfers was done in scenarios where the numbers exceeded the holding capacities. The Office of Emergency Preparedness ensured that there was enough staff to handle the influx as well as provide the shelters and basic needs to those who were affected.  Emergency rooms had been alerted on the number of patients who might require emergency services. The process was seen as seamless, but it was all because of adequate preparedness and coordination on the side of the institution (Raulji et al., 2018).

Assessment of Site and Location Capabilities

The evaluation of health care centers on whether they can help manage emergencies that might arise is an essential factor to consider during the planning process. In most cases, the facilities have to show beyond a reasonable doubt that they can handle the pressures emanating from the emergencies. Above all the staff has to be prepared to handle the situation and help more people avert dangers that might be associated with the crises.Healthcare delivery systems are vast and comprised of several entries points especially for primary care providers and facilities. The point of entry for most emergency in hospitals is the Emergency Department, and therefore such departments must be in a position to handle shock that arises from multiple cases of emergency (Raulji et al., 2018).  In the case of Hurricane Katrina it was of paramount importance to find a healthcentre that can be able to handle large emergencies. Emergency departments should among the many strengths be able to integrate the major components of the healthcare systems that include prehospital and definitive care. Maintaining constant and reliable communication with the emergency medical services is essential to a healthcare center the level of Our Lady of the Lake Regional Medical Center. Assessment of Our Lady of the Lake Regional Medical Center in terms of its location and site proved that the injured patients in the hurricanes could receive specialized care from the physicians.  Developing life-saving medical care mechanisms is also a feat that is readily available in the case of Our Lady of the Lake Regional Medical Center. In a broad overview, the resources at Our Lady of the Lake Regional Medical Center proved to be dependable in matters of communication, surge capacity, volunteer management, security issues, supplies, workers safety, collaboration with other centers,  trauma centers, and emergency department disaster operations. Overall, the capability of Our Lady of the Lake Regional Medical Center has been tested in these areas and has proved to be stable, uptight, reliable and dependable during cases of emergency and catastrophic events (Raulji et al., 2018).

In the Louisiana area, only a few out of the many hospitals have taken the initiative to hire full-time emergency preparedness coordinators and therefore choosing Our Lady of the Lake Regional Medical Center was the right course of action. The magnitude by which the hurricane affected the community required a committed emergency preparedness coordinator. The most probable reasons as to why there is a shortage of health centers with disaster and emergency preparedness are because the process is capital intensive, and it does not bring any direct return on investment, and thus many for-profit health centers avoid it. Our Lady of the Lake Regional Medical Center is a Catholic-sponsored medical center had it easy committing resources to the emergency department, and this has always made it be a preferred center to help in cases when disasters and emergencies strike (Hedges et al. 2018).

The lack of qualified individuals who can comfortably fill the positions of emergency coordinators makes it challenging for all health centers to have the potential to step up in times of emergencies and disasters. The lack of separate emergency departments in most hospitals means that disaster and emergencies are matters that are only dealt with once they arise and not on a continual basis like the case of Our Lady of the Lake Regional Medical Center. Regardless of the factors that were taken into consideration in selecting Our Lady of the Lake Regional Medical Center as a prime center during the emergency that was brought by Hurricane Katrina, it is essential to understand that all systems and parameters were weighed. Disaster management systems have been evolving over the years, and Our Lady of the Lake Regional Medical Center has proved to be moving into the right direction in matters of helping avert disaster or reduce the effects of tragedy to the community. The last bits of assessment have to involve the location of the response centre which in this case must be secure from the potential risk, while at the same time have communication stand by as well as critical departments like operating suites, acute care areas, information systems, families waiting for areas, and an environment that is not fragile. Assessing the factors that came into play during the hurricane Katrina, it is right to say that Our Lady of the Lake Regional Medical Center was best suited and could also be the preferred center if such a disaster struck again.

Evaluation of Response Challenges and Outcomes

Hurricane Katrina greatly devastated the Louisiana region especially the networks and structures that were put into place. One of the significant challenges that the hospital faced in the process of responding to the Hurricane Katrina emergency is the breakdown of communication between the health institutions and within Our Lady of the Lake Regional Medical Center. The lines of communication were overwhelmed and destroyed, and this is a significant way affected the evacuation process and the response towards the emergency. In responding to this situation, the mayor of New Orleans and other officials called upon the government to provide alternative communication options until the main lines were restored (Raulji et al., 2018).  Our Lady of the Lake Regional Medical Center had ample resources and had tried to manage the issue of communication strategically. Throughout the occurrence, the health center had abilities to coordinate both internal and external communication. The high levels of poverty in New Orleans are also believed to have slowed the process of evacuation and response to the problem. The mayor of the city had hinted that the high levels of poverty in the city could be attributed to the many lives that were lost. The government was also reluctant in making efforts to help the affected families, and this worsened the situation.

The government was highly criticized during Hurricane Katrina because of the mismanagement and lack of preparation in the relieving of individuals during the Hurricane and its aftermath. The chief executive officer of Our Lady of the Lake Regional Medical Center hinted that there were delayed responses to the flooding in the city of New Orleans. In a significant way, the failure of the New Orleans mayor to implement his flood plans are also attributed to the high number of casualties that were reported during the Hurricane (Hedges et al. 2018). The high numbers of victims were overwhelming to the health center because the nearing hospitals were not able to handle any patients or members of the community became they were devastated as well. The hospital was committed to helping the individuals who were affected by the hurricane, but the supplies were getting depleted at a particular time. The response to this challenge was the health center reaching out to the government agencies to have them replenish the supplies. The preparedness of the health center significantly improved the overall situation and in a significant way reduced the number of deaths and desperate situations that were experienced (Raulji et al., 2018).  

Proposed Solutions

Developing solutions to the challenges that came up from the emergency of the Hurricane will require a multi-sectoral approach. Most of these challenges in regards to the crisis could have been overcome if enough goodwill by the government agencies and coordination was seen. The first important step will be in reviewing the planning processes since there is a growing awareness of preparedness of health centers to emergencies (Moynihan, 2015). The elements to be considered in the planning process include mitigation, preparedness, response, and recovery. The government both at the Federal levels and the local levels must ensure that plans are there at all times. Planning for the sake of emergencies will entail facility risk assessment and a follow-up and hazard vulnerability analysis. The analysis for hazard vulnerability requires hospitals and health centers to complete an annual hazard vulnerability analysis(HVA). Hazard vulnerability analysis means that community resources that are likely to be affected are also put into account (Moynihan, 2015).

Providing ample training to the health centers is also a significant step towards creating a solution to reduce the impact when emergencies like hurricanes hit a region. In the case of Our Lady of the Lake Regional Medical Center, adequate training was availed to the public health professionals, but this was not done to other health centers. Setting up clear lines of command and coordination is also essential in reducing damage in case emergencies hit the region. During the occurrences of most crises, chaos and confusion have been attributed to lack of a dedicated command and coordination process (Moynihan, 2015). Adverse effects can be minimized if the management of such health centers can respond quickly. Building resilient command and coordination for health care centers can easily be achieved through the installation of the Hospital Emergency Incident Command System (HEICS)  and linking it with the relevant government agencies. Streamlining the process of evacuation is an area that requires to be improved. Improving this means creating a robust safety and continuity care program that is not overwhelmed by the high number of evacuees in an emergency. Enhancing evacuation means securing the facilities while at the same time strengthening the communication (Moynihan, 2015).  Emergency experts believe that the most workable way to improve evacuation is by enhancing security and how communication is being made. The last process in improving responsiveness and readiness in matters of emergencies requires updating the preparedness of all the teams and stakeholders. Re-examining coordination with local planning emergencies will ensure that chances of having solutions that cannot work are reduced. The management of Our Lady of the Lake Regional Medical Center, however, must ensure that the solutions set are workable (Moynihan, 2015).

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Conclusion

Disaster preparedness and readiness is an important function that cannot be ignored especially in the 21^st century. The complexities of situations and the challenges that accompany these situations and emergencies call for a multisectoral approach that looks deeply into creating solutions. Since no single entity can be able to manage crises all by themselves, it is essential to ensure that resources mobilization and allocation is done in the most viable way. Our Lady of the Lake Regional Medical Center has proved to be a strong healthcare center over them, and they are an example of what it means to be ready and set in the wake of emergencies both from natural calamities and disease outbreaks. Creating a culture of disaster management improves the confidence of the general public and shows the level of commitment by the government to take care of its citizens.  I believe that strong nations and communities will only be established when we overcome the pressures that come with emergencies.

References

Raulji, C., Velez, M. C., Prasad, P., Rousseau, C., & Gardner, R. V. (2018). Impact of Hurricane Katrina on healthcare delivery for New Orleans patients, 2005–2014. Pediatric blood & cancer, 65(12), e27406.

Hedges, J., Soliman, K., D’Amour, G., Liang, D., Rodríguez-Díaz, C., Thompson, K., … & Yanagihara, R. (2018). Academic Response to Storm-Related Natural Disasters—Lessons Learned. International journal of environmental research and public health, 15(8), 1768.

Moynihan, D. P. (2015). Collaboration amid Crisis: The Department of Defense during Hurricane Katrina.

Earle, C. R. (2018). C2 Agility for Emergency Management: Examining the Katrina and Sandy Responses. Journal of Homeland Security and Emergency Management, 15(4).

Healthcare Emergency Outline

Thesis Statement: The situation has made hospitals develop and adopt an all-comprehensive emergency management effort instead of focusing on specific threats like disease outbreaks. However. Regardless of all these dynamics hospitals must look beyond these emergencies and threats and work with stakeholders to design inclusive, and comprehensive emergency management approaches and preparedness that cannot be overwhelmed during emergencies.

1. Introduction
2. Analysis of the Healthcare Setting

• The Disaster

1. Assessment of Site and Location Capabilities
2. Evaluation of Response Challenges and Outcomes
3. Proposed Solutions

• Conclusion

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