Disaster Planning for the Medical Office, Part 2

Mariana S-B Lamb, MS
Executive Director
Medical Oncology Association of Southern California

Every medical practice is at risk for a natural or man-made disaster. Those who have worked through a disaster will share their relief at having had a plan in place to get through it, or they may share, unfortunately, how much they wish they had developed a plan ahead of time. Crises such as a fire or weather event have the potential to be a major disruption to your business, and, should disaster strike, many will turn to the practice manager for a plan.

Since you never know when a crisis may strike, the best time to prepare is now. We hope this series of articles will guide you in your ongoing preparations, or perhaps will inspire you to start developing a plan. The first article in this series (“Bringing the Future into the Present: Disaster Planning for the Oncology Office,” Urology Practice Management, Volume 3, Number 5) addressed how to get started with your disaster planning as well as steps to take before a disaster strikes. This second article provides insights on how to involve patients in emergency planning, and what to do when a disaster is imminent, as well as before and after it strikes.

Involving Patients in Emergency Planning

Recognizing that disasters are prone to occur—earthquakes in California, hurricanes along the ­East Coast, and floods in the Midwest—the Medical Oncology Association of Southern California (MOASC) launched the Oncolo­gy Patient Emergency Network (OPEN) in 2007. Key to that plan is the creation of wallet-sized cards that patients carry with them; these cards contain critical and updated information such as their diagnosis, treatment, medications, and insurance carrier’s contact information. Staff members update the patient’s card after each treatment. If there is ever a need, the patient will then be able to access continuity of care with alternate health providers. Even in an emergency, most people will grab their wallet or purse as they run out the door, and their OPEN card is in their wallet. Further, as a backup, patients are encouraged to mail a copy of their card to a friend or family member who lives in a different area. Then, even if patients do not have their card, they will be able to retrieve their record of treatment from their backup contact person.

Aside from emergency planning, the OPEN card has helped patients even in day-to-day settings. One doctor shared that recently one of his oncology patients received treatment one morning, then found himself in the emergency department that very afternoon. He was unable to communicate the names of the drugs he had been given that day. Fortunately, he was able to provide the OPEN card that had been updated by staff at his oncology visit.

When a Disaster Is Imminent

If you are fortunate enough to receive 24 hours or more advanced warning of a pending disaster, you will have a chance to attend to some specific tasks to protect your practice. It is important, however, to be practical. Do what you can without jeopardizing your life or the lives of others. Stay in touch with authorities to know when to evacuate.

Here are some tips to secure the building and equipment when a disaster is on its way: (1) close window blinds and coverings, and remove flammable candles and lamps from the building; (2) move all furniture and medical equipment (if feasible) away from windows, and place them on counters or cabinets (off of the floor), covered in plastic sheeting tied or taped in place, if possible; (3) unplug all electrical equipment; (4) close and secure all doors and windows, evaluate the risk of vandalism, and barricade windows and doors with sandbags if possible or required; (5) clean out the breakroom refrigerator, remove all personal items, and remove all trash from premises.

To protect the business, you should secure business documents, equipment, and inventory. This includes securing both perishable and nonperishable inventory and removing and storing medication inventory offsite at a generator-serviced site or a site with secure power. Inventory should be reported to the office manager. Finally, to coordinate patient continuity of care, contact patients and alternative physicians or hospitals to arrange referrals for potential future care of patients if needed, print out 2 weeks of patient schedules, maintain compliance with the Health Insurance Portability and Accountability Act, and provide patients with a copy of salient medical records. These should also be forwarded to previously identified alternative providers. Include treatment plans, a treatment summary, and follow-up plan documents, as well as a current medication list.

It is also important to get up-to-date information and maintain contact with local and county medical societies, your state medical society, and state professional societies during an emergency. Keep a list of these in your disaster plan. Table 1 features some important contacts to get your list started.

When a Disaster Strikes

When a disaster does hit, stay calm. Now is when you will appreciate the time you put into advanced planning. In addition to the items addressed in our first article, be ready to perform the following steps:

  • Contact media on closing and opening of office
  • Evaluate the disaster site for any personnel injuries or deaths; confirm evacuation of the office by all individuals
  • Evaluate the need for containment and disposal of biohazard waste, as well as decontamination and radioactive fallout potential
  • Determine mobility (car, bus, train, airplane, fuel availability), and determine availability of water, food, electricity, communication, and shelters
  • Maintain contact with public service communication sources (weather stations, news stations, and security such as the police department, fire department, or highway patrol), as well as the American Cancer Society and the American Red Cross.

Conducting Research

If you are involved in ongoing research, you will want to ensure that you are also prepared to maintain the integrity of that research in the event of a disaster. Refer to the Belmont Report1 for guidance on implications related to basic ethical principles of respect for persons (individual auto­nomy, protection of individuals with reduced autonomy), beneficence (maximize benefits and minimize harms), and justice (equitable distribution of research risks and benefits).

In the midst of emergency situations, your goals remain the same, and are perhaps even more intensely highlighted: (1) to protect continuity in FDA-regulated studies; (2) to protect communication with regulatory authorities; (3) to keep patients informed about what to do; and (4) to ensure that the principal investigator maintains compliant with 45 CFR 46, the Department of Health & Human Services regulatory code regarding the protection of human subjects in research, specifically relating to unanticipated problems involving risk to patients or others, suspension of trials, and termination of trials.

After a Disaster

The Disaster Plan Coordinator will maintain communication with area emergency teams and notify staff when it is safe to reopen the office. Staff will initiate responsibilities to reestablish the practice. The list in Table 2 should serve as a guide to facilitate an organized, well-planned reopening of the practice.


We hope this 2-part series has helped you consider preparations to make for a potential disaster. While we cannot predict when or if a disaster will strike, we can put steps and processes in place now to help plan for one and ensure continuity of care. As practice managers, our staff members and the patients we serve will turn to us for answers in the event of a disaster. With proper planning, we can offer our team members and patients the answers, guidance, and reassurance they need in a time of turmoil.


  1. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. www.hhs.gov/ohrp/humansubjects/guidance/belmont.html. Published April 18, 1979. Accessed October 10, 2014.

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