By Debbonnaire Kovacs, Feb 9, 2016

On November 23, 2015, I received a press release from Loma Linda Health saying that Dr. Sheri Fink, an international speaker, best-selling author, and Pulitzer Prize winner, would be speaking at Loma Linda University Health on December 5.

I was immediately interested, and planned to write a story after the event. In preparation, I researched a little about Dr. Fink. According to that fount of all wisdom, Wikipedia, she is

“an American journalist who writes about health, medicine and science. She received the 2010 Pulitzer Prize for Investigative Reporting, ‘for a story that chronicles the urgent life-and-death decisions made by one hospital’s exhausted doctors when they were cut off by the floodwaters of Hurricane Katrina.’ She was also a member of The New York Times reporting team that received the 2015 Pulitzer Prize for International Reporting for coverage of the 2014 Ebola virus epidemic in West Africa. Team members named by The Times were Pam Belluck, Helene Cooper, Fink, Adam Nossiter, Norimitsu Onishi, Kevin Sack, and Ben C. Solomon.”

 

Her first book was War Hospital: A True Story of Surgery and Survival, published in 2004, about a few young doctors trapped with over 50,000 people in Bosnia-Herzegovina in 1992, facing “the most intense professional, ethical, and personal predicaments of their lives.” Her second, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, about the days following Hurricane Katrina, came out in 2013 and was to be the subject of her presentation at LLUH.

No one had any idea what would happen first.

On December 2, fourteen people were killed and twenty-two seriously injured when a married couple later defined as “home-grown, violent terrorists” opened fire at a San Bernardino County training event and Christmas party. Five of the injured were transported to Loma Linda Medical Center, which then received a bomb threat as well.

So when Dr. Fink arrived for the presentation she was scheduled to make three days later, critical care decisions that must be made under stressful situations were in the forefront of the minds of many of those attending.

I recently spoke with Susan Onuma, Media Relations Specialist for LLUH, and with Brett McPherson, Director of Environmental Health and Safety for Loma Linda University. He explained that this is a “shared service department” responsible for the entire environment and safety of employees, patients, faculty, staff, and students at five general acute care hospitals, one behavioral care hospital, nineteen outpatient clinics, the university, and eight schools. There are about twenty people in the department. “In everything we deal with at the hospital, we’re trained to consider these issues [of safety],” McPherson said. “They should be part of all our businesses.”

McPherson said that about 100 people attended the presentation. Most were community members, but some doctors, faculty, staff, etc. were also present.

One of those present was E. Lea Walters, MD, who wears too many hats at LLUMC to list here.

According to information sent me by Susan Onuma:

Dr. Walters was a team member, and the team leader of the Disaster Medical Assistance Team (DMAT) that was deployed to the Ford Center in Beaumont, TX in the aftermath of Hurricane Katrina.  When her team arrived at the Ford Center, the local Public Health Department had already set up a makeshift clinic, operated by medical staff. The first to arrive to the center were three busloads of evacuees from the New Orleans Superdome.  Dr. Walters’ team assessed and medically cleared each evacuee before they were sent on to other centers for additional treatment (if necessary) and aid. Dr. Walters says, “It was different from the hospital setting. There were no life or death decisions that had to be made, but it was still very stressful and very emotional.”

Of the event which is the subject of this article, Dr. Walter wrote, “Dr. Sheri Fink’s presentation was GREAT!! It was fraught with emotion. She conveyed the story of the events that occurred at Memorial Hospital after Hurricane Katrina in such a way that you could appreciate what the physicians and nurses who were there went through; it was an extremely stressful time. She told their story with great insight, and without judgment; it was a very factual account based on her numerous interviews with those who lived through these events.”

After Dr. Fink’s presentation, there was a panel interview in which Brett McPherson participated with Dr. Richard Hart, President of LLUH, and Dr. James Walters, PhD, Director of the Center for Christian Bioethics. This was followed by an open microphone where people could ask questions.

Naturally, McPherson explained, with the December 2 event on everyone’s mind, people asked more questions about that. But there were also some other ethical questions, such as questions on end-of-life decisions.

He was enthusiastic about the event, and about Dr. Fink. “Her books are really good; you won’t be able to put them down! They’re amazing, they just grab you. She is a physician…so to have a doctor’s point of view on this was great.”

He said that his greatest takeaway message was that “you really need to test and train your plans. Plans can be well-written—you don’t create the wheel; you take the best practices and incorporate them into your company—but you need to test to failure.” That, he explained, is the only way you know how well your plans will really work if you are in an actual emergency.

After Katrina, he said, watching what happened to the beleaguered hospitals in that aftermath, they did talk about where their generators are, and plan for better critical infrastructure in their basement. They are presently building two new hospitals. They have to be seismically safe by 2020, and the present main hospital is not.

But in a tragedy such as Katrina, the first hours and days are not the worst, McPherson said. “The patient care in December [after the shooting] was impeccable. We even had another bomb threat the next week. We are ready for emergencies! In fact, the following week after the shooting, we had a gang-related incident with three gunshot victims. But Dr. Fink challenges you to test how you make those long-term decisions. After the first days, when you’re running out of supplies, people are getting exhausted…then how will you determine who gets which critical supplies? Naturally, at a faith based institution, you’re praying, but those decisions are not easy. You have to put everything in place that you think isn’t going to happen.”

The Joint Commission,  which accredits and certifies health care organizations in the US requires yearly disaster relief and emergency drills. McPherson said LLUH does it quarterly. They have included the university and the healthcare center in one unified command. “Loma Linda is the level one tertiary care center for one third of the state of California, so in a disaster, we will be receiving lots of patients. We have to create alternative sites and plans. We have to find ways to provide patient care no matter what. We take that seriously. As a physician, you get trained on ethical decisions. You have life and death in your hands on a daily basis. But in a major emergency, that is more intense.”

McPherson said that because of the shooting and Dr. Fink’s presence they are realizing that they must move from thinking about such issues to doing something concrete about them. He feels they need to integrate into their testing more of local available expertise such as the people at the Bioethics Center. “I task and challenge our managers to do more integrating and looking at that. When resources are cut off, when you don’t have the Red Cross or a disaster management team, then what?”

I asked how they do the testing, and learned about something called “moulage.” They tear clothes, use makeup to create “wounds,” and so on. Although you can also do testing with paper, writing down what is “wrong” with a given “patient,” more realism makes for better training. I have learned that moulage kits are available online, and that there are even places that train people to act as if certain things are wrong with them. McPherson reiterated, “It’s critical that people understand: you don’t just test what’s written, you test to fail—otherwise your plan is going to fail when you need it most.”

His final word was, “Sheri is an amazing individual, so compassionate. If you have a chance to go hear her, go do it!”