Here in Florida, it's hurricanes. In the Midwest, it's tornadoes; in the North, it's blizzards; and in California, it's earthquakes and wildfires. No matter where your facility is located, chances are you face some sort of seasonal or year-round threat from Mother Nature. Those of us who have lived and worked in regions prone to extreme weather have long understood the importance of having a preparedness plan, and in 2005, Hurricane Katrina raised awareness on a national level. Five years after that tragedy, it's important not to become complacent, but to remain vigilant by updating your facility's natural disaster preparedness plan annually and making sure each member of your staff understands her role in the event of an emergency.

What's required?
Many federal, state and local authorities require both hospitals and ASCs to have written disaster preparedness plans. It's a CMS Condition for Coverage for ASCs, and a standard required by several accrediting bodies for healthcare organizations. Consult with your regulatory and accrediting bodies to determine exactly what you're required to have in place. A sample natural disaster preparedness checklist, tailored to hurricanes, is on page 40.

While all disaster preparedness plans will share some common elements, you'll need to tailor your facility's plan to the threats that affect your geographic region. Here in Florida, it wouldn't make sense for us to have elaborate plans in case of a snowstorm. Your state and local emergency management agencies can help you conduct a vulnerability assessment to determine which types of disasters you need to prepare for, as well as provide you with a community plan that you can use as the basis for your own facility-specific plan. For example, in the case of a hurricane threat, your community plan will include:

• where the flood zones are;
• who must evacuate;
• where evacuation centers are located; and
• what role, if any, your facility will play in the community during a hurricane and its aftermath. (Freestanding ASCs with no hospital affiliations likely won't be counted as community resources during a natural disaster, since their physicians, anesthesia personnel and nursing staff are more likely to be providing emergency services at a local hospital.)

The hard decisions
When a natural disaster looms — or hits you without warning — you're going to need to make a string of important decisions quickly and with as little hesitation as possible to ensure the safety of your staff, patients and business.

First and foremost: When should you shut down? In the case of easily predictable disasters, such as hurricanes and blizzards, you usually have the luxury of some advance notice that will let you notify all the necessary parties and make physical preparations to safely close the facility before disaster strikes. In the case of a tornado or earthquake, which can happen suddenly and with little to no notice, you may be stuck making the tough calls about when and where to evacuate in the midst of the emergency. Your local emergency management agency and other healthcare facilities in the area can help you determine the best course of action relative to the risks you face.

If you're dealing with a situation that isn't necessarily dire — a tropical storm that isn't expected to progress to hurricane status — your decisions may become tougher. Depending on how many of your staff members and scheduled patients live in flood zones and would be required to evacuate, it may not be worth it to keep your facility open even if the physical structure itself isn't in the path of disaster.

Part of your disaster preparedness should include an assessment of your staff: How many live in flood zones? How many would be expected to help out at the local hospital in the case of an emergency? Who has dependents that need special care? And, of course, can patients and physicians safely access the surgery center? All those factors will play a role in your decision when to close and reopen your facility.

Finally, if the disaster has been extreme, you may need to have an engineer or someone with authority and expertise assess your facility to test the utilities and determine whether there's been any structural damage before you can reopen and reenter the premises. Consult with state and local emergency management authorities to determine what kind of assessments and forms you must complete before you can resume operations.

Stay connected
Your facility doesn't exist in a vacuum. Preparing and responding to natural disasters falls to everyone in the community. Make sure you receive updates to your community disaster plans and keep your facility's plan as up to date as possible. Review the plan annually with your staff, preferably when it's most relevant: late spring in hurricane zones and early fall in winter storm zones. And participate in community disaster drills in order to really get a feel for your staff and facility's roles during a natural disaster.