Natural Disasters

Natural disasters may occur with or without warning. Earthquakes usually occur without warning, whereas hurricanes develop over a period of days, which allows for some preparation. In addition, the effect of natural disasters often seems random. Many communities must prepare when a hurricane or tornado is in the area because the exact track of the storm is difficult to predict. It is important for all employees of the medical office to be educated about immediate response to the types of natural disasters that tend to occur in their geographic area while still realizing that unusual events of great magnitude can also occur. The effect of serious natural disasters is felt far beyond the area that is affected. For example, Hurricane Katrina affected the entire United States, partly because of the shock that a disaster of such scope could even happen, partly because of the extensive relocation of people who lost their homes, and partly because of the massive relief effort, which included assistance from emergency workers and volunteers.

Man-made Disasters and Emergencies

As with natural events, the amount of threat or damage from man-made hazards can vary considerably; examples include a fire in a wastebasket that is quickly contained, a gunman threatening to injure all the employees of an office, a bomb threat, and a radiation incident that may involve an entire city or area. Man-made hazards include crime, many fires, terrorism, industrial hazards, structural collapse, power outage, radiation hazards, and chemical contamination. Municipal fire departments and police departments provide rapid assistance for fires, injury, and criminal activity, and the National Response Center of the Environmental Protection Agency responds to the release, or potential release, of oil, radioactive materials, or hazardous chemicals into the air, land, or water (Figure 49-1).

The Stress Response

Stress is the body’s response to threat or change. Hans Selye, an Austrian doctor who practiced in the middle of the twentieth century, described the body’s reaction to stress as a four-part general adaptation syndrome (GAS), also known as the fight or flight response, which is shown in Figure 49-2. The four stages of the GAS are the alarm reaction, the stage of resistance, the recovery phase, and the stage of exhaustion.

In the first stage, the alarm reaction, the body senses a stress and begins to react. Epinephrine is released from the adrenal medulla and stimulates the sympathetic nervous system. The pupils dilate, the heart beats faster, respirations become faster and deeper, and the blood pressure rises. The body prepares to fight or run away. The individual’s attention becomes narrowly focused on the perceived threat or significant task. Some people experience the alarm reaction as energizing, whereas others quickly become extremely anxious.

In the second stage, the stage of resistance, the stress remains but the body adapts. This may occur within hours or days, depending on the circumstances. Levels of adrenal hormones may remain slightly high or drop back to normal. More energy is required to maintain the stage of resistance than the normal state.

After the stress has been removed, the body enters the recovery phase, and as the parasympathetic system begins to regain control, the body returns to its normal level of function.

If stress persists or is always present, it causes an increase in blood pressure, elevated glucose (blood sugar) level, increased metabolism, and increased pressure within the eye. This is why constant stress leads to fatigue, hunger, and headaches.

Eventually, in a person subjected to chronic stress, the body is unable to maintain the response, the immune system is compromised, and the person is more prone to a variety of illnesses.

Managing Anxiety

During the alarm reaction, anxiety is a normal part of the “fight or flight response.” Anxiety is defined as a feeling of worry or uneasiness, often triggered by an event with an uncertain outcome. A person who is moderately to severely anxious is not able to notice details and think as clearly as in the normal state. Emergency procedures that have been learned and practiced help individuals to decide what to do without having to think through all possibilities. In addition, they tend to keep the anxiety level from rising because individuals feel more confident when they have a plan to respond to a threat.

Severe anxiety can be medically problematic. In an emergency situation it tends to immobilize an individual and stimulate anxiety in others. Symptoms of a full-blown anxiety attack include the following. An overly anxious person hyperventilates, has an extremely rapid heart rate, and becomes unresponsive. When there is an emergency, many people lose control of their emotions and cry or scream. The behavior can be minimized by giving the highly anxious person directions. It may be necessary to touch the person to gain his or her attention, and then directions should be given in short sentences, speaking a little more slowly than usual. Helping the person to breathe deeply will help reduce anxiety, but it is also important to direct the person exactly where to go if a dangerous area must be evacuated or if the person should take cover. Figure 49-3 shows the various stages of increasing anxiety.

If an emergency occurs while the medical assistant is at work, he or she should immediately focus on responding to the immediate situation, implementing established procedures, and helping others. Deep breaths will help to control anxiety, which should be seen as a normal response. Even in disasters that have caused enormous amounts of physical damage, lives have been saved and injury has been minimized when people have been able to stay reasonably calm and follow procedures to stay as safe as possible.

Putting It All into Practice

My name is Beth Ann Wilson, and I am a certified medical assistant. I have been assisting the office manager to update the equipment in our office that might be used in case of fire or natural disaster. We recently purchased an additional fire extinguisher for the staff break room, where we have a microwave and coffee maker. In addition, we have purchased an office disaster kit which has emergency supplies for 10 people for a few days including food, water, a flashlight, a radio, batteries, a first aid kit, and other supplies that might be useful in a building collapse. Of course we hope that we will never have to use these things. I was also one of the staff members from our office who participated recently as a “victim” in a mock disaster drill that was held for emergency personnel in our town. I pretended to be a victim with fractures of my arm and leg. I had never been in a situation where there were many people injured or been transported in an ambulance. The experience increased my understanding of the problems that emergency personnel face, and now I have a more personal understanding of how important it is to be prepared with training and equipment. 

Posttraumatic Stress Disorder

After the initial phase of a disaster or serious emergency, in addition to a possible injury caused by the event, an individual may be in a state of shock as he or she adjusts to a changed situation. Depending on the individual and the damage to his or her health, property, and personal relationships, it is common to experience irritability, loss of appetite, self-blame, mood swings, physical symptoms such as headaches and stomach pain, nightmares and difficulty sleeping, fatigue, sadness, and depression. It is recommended to return to normal activities as soon as possible. Educational materials and/or grief crisis counseling are helpful as the person gradually adjusts and returns to a more normal state. In some cases, however, weeks or months after the catastrophic event, the individual begins to experience stronger symptoms of stress including flashbacks, memory disturbances, nightmares, severe irritability, severe depression, and impaired functioning. Posttraumatic stress disorder (PTSD) is the name given to the emotional disturbance that develops after a traumatic, catastrophic life disturbance when the disturbance lasts for at least a month. Individuals with possible PTSD should be referred for counseling, because this is one of the most effective treatments for this disorder.

Fire Protection and Fire Safety Plan

Fire protection for an office building is the responsibility of the landlord or office condominium association (if the units are condominiums), but fire protection for the contents of the office is the responsibility of office staff.

Many states require sprinklers in commercial and office buildings. Some states that require sprinklers for larger office buildings do not require them for smaller offices, such as a physician’s office that has been converted from a house.

In addition to the health hazards smoking presents, there are also potential fire hazards related to smoking. Smoking should not be permitted in a physician’s office, and signs advising patients and visitors that the office is a smoke-free environment should be clearly posted in the waiting area.

Exits should be clearly marked, and an emergency evacuation map should be posted near the door to the waiting room. Lighted exit signs should be tested by shutting off the lights in the room; bulbs should be replaced if necessary.

In a large office or freestanding clinic, there may be fire doors at certain points in corridors. These doors are designed to contain any fire on one side of the door from going into another area of the building. Fire doors should never be propped open but should be allowed to shut to their naturally closed position. Fire alarm pull stations are frequently located in the building corridors. These alarms alert the entire building and also notify the fire department directly (Figure 49-4).

A fire extinguisher (a portable device that discharges foam or another material to extinguish a fire) should be positioned in each room near the exit, and they may also be located in the corridors of a large building. These fire extinguishers are important both for putting out small fires and for giving a person the ability to clear an exit path from a room that is on fire. There are many types of fire extinguishers, and many have a numeric rating that indicates how much fire they can handle. For the medical office, the extinguisher should be multipurpose and usually contains a dry chemical. Extinguishers are placed near the door so that the fire does not get between the person and the exit (Figure 49-5). There should always be a fire extinguisher within a 50-foot travel distance of flammable liquids that are stored in containers. Staff should be trained to use the fire extinguishers properly (Procedure 49-1).

Procedure 49-1   Demonstrating Proper Use of a Fire Extinguisher

Outcome

Demonstrate proper use of a fire extinguisher.

Equipment/Supplies

• Portable office-size multipurpose (ABC) fire extinguisher

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