The term "disaster preparedness" is something of an oxymoron, especially in light of Hurrican Katrina. But there are ways we facility managers can brace for natural disasters. Hurricane Season 2004 produced an unprecedented number of catastrophic hurricanes, four of which barreled toward my facility in Cape Coral, Fla. The worst of them, Hurricane Charley, wasn't even supposed to hit us; but within 30 minutes, it had intensified from a Category 2 to a Category 4 storm and made a radical course change.

Brace yourself
If you have the luxury of advance warning, take advantage of it. In the case of hurricanes, the National Weather Service issues predictions up to a week in advance. If your area falls within the cone of probability, it's best to get ready, whether you're on the periphery or in the middle of the storm's trajectory. When we know a hurricane is on its way, we take five steps.

• Cancel all scheduled elective procedures far enough in advance to let staff members prepare their own homes and property, and to evacuate if necessary. (See "Considerations When Canceling Cases.")
• Get electronic equipment, such as computers, up off the floor.
• Cover expensive equipment such as microscopes, phaco machines, lasers and monitors with plastic sheeting - large trash bags work well. Wind-driven water will enter your facility in the most unexpected places.
• Secure medical records. If you don't keep your records in contained cabinets, cover them with plastic sheeting.
• Have an up-to-date emergency phone tree. Make sure employees have these at home, not in their desks at work. Eventually, phone service will be restored and you have to know whom to call.

Advance warning is a blessing and a curse. It lets you prepare as best you can, but it also weighs on everyone's minds and increases anxiety.

We were blindsided
Our disaster preparedness plan didn't account for three aspects of Charley:

• An absolute communication blackout. We expected the land phone lines to be lost, and relied on cellular service. But the storms knocked out towers, and all communication abilities were lost for several days. The storm hit on a Friday (the 13th, of course) we had closed at noon Thursday. We opened on Monday for anyone who could get in, for recovery efforts, not surgery. Without power, we weren't really open for business again till Wednesday, but even then communication was haphazard. As a result, we've shifted our surgical days from Monday and Tuesday to Tuesday and Wednesday. That way, if we have a prediction of a hurricane before the weekend, we're not forced to decide whether to close so far ahead of time that we turn out to be wrong.
• Torrential rains caused leaking roofs. The result was water damage in unexpected places. We expected storm surge. We didn't expect water to pour down the walls. After the storm, you're going to have to perform a thorough inspection of your facility. Check sterile supplies in cupboards for moisture or mold contamination.
• Loss of power beyond the emergency generator's fuel capacity. High building temperatures subsequently caused humidity damage to sterile supplies. We had enough portable water on hand to support 12 people for three days, but we wouldn't have been ready with extra fuel. Loss of all power makes it important that you check your drug supply. You may need to replace all refrigerated pharmaceuticals. You should also test all electrical equipment before it's used again in surgery. The force of the electrical surges may have caused electrical damage that's not readily apparent.

Back to normal
With each successive storm, it became increasingly important to make staff feel our concern for them. The first time through, there was a sense of community; the second time, people were fighting over water in stores. But by the fourth, people were like zombies, walking around in a state of utter disbelief. We let staff know they could go home without pay and that there would be no ramifications. You also have to let staff and patients feel free to talk about their experiences - just getting it out was often the cure for the so-called hurricane fatigue the area was experiencing.

Finally - and this is most important - as a manager, you have to remind yourself that, in disaster situations, things are out of your hands. Once you can understand that, you'll be able to be patient and to persevere with a cool head.