Public health emergencies: clinical guidance and resources
Steps to protect your practice and the community before, during and after a disaster or outbreak.
Overview
What are public health emergencies?
Public health emergencies are events which pose a substantial danger to the health of the community. Examples include disease outbreaks (like COVID-19), natural disasters (such as earthquakes, hurricanes, floods or wildfires), hazardous materials (hazmat) incidents involving the accidental or intentional release of chemical or biological agents or an ongoing situation, like the opioid crisis.
Why preparedness matters for family physicians
Public health emergencies can unfold at a moment’s notice and carry the potential to quickly overwhelm local resources. Family physicians play a vital role in their communities. Having an emergency plan in place is crucial to protect staff and patients on site, keep lines of communication open and provide care for the duration of the event.
Disaster relief and preparedness
Key steps for disaster planning
Just as your patients require periodic checkups and adjustments to their treatment plans, the disaster preparedness checklist for your practice needs annual attention to make sure you’re ready in case of emergency. Is your insurance coverage up to date? Emergency contacts list updated? Building prepared in case staff and patients need to shelter in place?
Here are key areas to cover in a disaster preparedness plan:
Insurance: Review coverage with your provider, especially what happens if the building is damaged or destroyed. Document and take photos of all equipment.
Assign roles: Make sure everyone on staff has a designated responsibility, from contacting local hospitals and securing patient records to unplugging equipment.
Communication plan: Determine who will alert staff and patients of the situation, especially if the practice needs to close and/or patients must be moved.
Support: Keep handy a list of neighboring businesses, as well as your utilities, vendors and suppliers. Include email addresses in case cell and/or landline service is down.
Assess supplies: Make a list of medical and nonmedical supplies you'll need for an extended emergency. Take note of items that may expire, such as batteries.
Resources for emergency response
You can find much more on disaster preparedness for your practice, including insurance checklists and contact information forms, in the AAFP’s Practice Preparedness Guide for Disasters and Emergencies.
Supporting community resilience
As a family physician, you're part of the health care fabric of the community. You can play a valuable role before, during and after a disaster or emergency situation by helping educate the public on how to stay safe and coordinating with local authorities to monitor public health, especially in older people and those with disabilities or chronic conditions.
Other ways you can help:
The AAFP offers the Advanced Life Support in Obstetrics (ALSO®) course in a variety of locations throughout the year. Learn more.
The National Incident Management System Training Program offers courses that take a comprehensive approach to emergency management. Learn more.
The National Disaster Life Support Foundation offers training programs focused on disaster life support, mass casualty triage and emergency medicine. Learn more.
Get more information on how to help prepare your community, including yourself and your family, in the AAFP Personal and Community Preparedness Guide for Disasters and Emergencies.
Treating patients in disaster-affected areas
Clinical considerations post-hurricane
Family physicians are an essential part of the emergency medicine safety net. Following a disaster, you should educate your patients and community about conditions that could lead to an infectious disease outbreak. These include compromised drinking water and food, lack of medication and temporary lack of shelter and/or exposure to unsafe conditions.
The AAFP recommends these steps as you see patients:
Health care providers should:
- Look for community and health care-associated infectious diseases.
- Ask patients in the continental United States about recent travel to hurricane-affected areas.
- Consider screening less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection or other febrile illness. Particularly important infectious diseases include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis and influenza.
Health care providers should contact:
- Their territorial or state health department if they need assistance with ordering specific diagnostic tests
- Their territorial or state health department or the CDC for consultation for certain conditions, such as leptospirosis. Empiric therapy should be considered pending results of diagnostic tests—treatment for leptospirosis is most effective when initiated early in the disease process.
Health care providers should report:
- Patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid and vibriosis to their local health authorities while awaiting laboratory confirmation
- Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever and vibriosis immediately to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.
Managing chronic conditions during disasters
The disruption caused by a disaster can take a particular toll on your patients who are living with chronic conditions like cancer, diabetes, heart disease and Alzheimer’s disease. Patients with weakened immune systems are at elevated risk of infection and power outages can cause refrigerated medications to spoil. The stress of even a temporary emergency situation is potentially deadly for people with hypertension. For patients with dementia, disasters can cause confusion due to breaks in daily routines and unfamiliar faces and places.
Urge your patients with chronic conditions and their caregivers to prepare for emergencies by having extra medication and supplies on hand, and a plan for where they’ll go in case of an evacuation.
The following resources can help guide your conversations.
Mental health support for patients
Disasters and emergencies can be especially traumatic for your patients living with mental health issues. The stress from a sudden emergency can trigger existing anxiety, depression and post traumatic stress disorder. Trauma or loss from a disaster can compound these feelings.
Make sure your patients know help is available, even in a disaster:
The toll-free federal Disaster Distress Helpline will connect you with crisis counseling.
(800) 985-5990If you are having suicidal thoughts, call or text 988 to reach the Suicide and Crisis Lifeline for free, confidential support.
The CDC’s How Right Now website can connect you right away with people who can help.
How Right Now
When seeing patients after a disaster, family physicians should use screening measures, including questionnaires, to identify adults who may be experiencing mental health problems. Focus on vulnerable populations, like people with a history of mental health issues.
Read more from American Family Physician.