Vol. 11 •Issue 2 • Page 24
Home Pathways
Home Care Companies Stand at the Ready
By Christopher Cella, RRT, RCP
Home care companies are perfectly positioned to serve as responders to natural and man-made disasters. More than 8,000 home care offices located throughout the United States have access to thousands of heated warehouses stockpiled with millions of dollars of medical supplies. Some companies even offer first-dose pharmacies, enteral services and infusion services.
These organizations operate massive fleets of delivery trucks and vans capable of transporting oxygen and miscellaneous medical supplies to any place at any time of the day or night. Most people who work for these companies, including respiratory therapists, nurses, nutritionists, pharmacists and trained service technicians, know every inch of the city and are able to get to their destination despite roadblocks, detours or traffic jams. These vehicles could be used to augment oxygen and durable medical equipment delivery to the scene of disasters and triage treatment areas.
The events of Sept. 11 proved that more preparation needs to be coordinated between local police and fire departments, hospitals and medical centers, home care providers and the federal government. New York City home care companies quickly assessed how they potentially could continue to serve their customers under restricted circumstances. In addition, they provided help to local emergency providers. They delivered hospital beds, oxygen and compressor nebulizers to assist individuals who were acutely short of breath as a result of the enormous quantity of particulate matter that dispersed from Ground Zero.
Although a barrage of patients never occurred, hospitals now realize that the number of casualties likely would have overwhelmed their resources. They would have needed to rely on home care companies to deliver medical supplies “on location,” allowing many more patients to have access to oxygen and assistive therapy.
DILEMMAS OF LIQUID OXYGEN
Should a catastrophic event occur while a hospital happens to have a heavy census of oxygen users, the facility quickly would go through its supply of liquid oxygen, shift to its backup system of oxygen cylinders, and then be totally out of oxygen. The hospital would need to call on oxygen supply companies and home care companies as reinforcements.
Such an event occurred in 1984, according to Getty Phippen, director of respiratory care at Affiliated Health Services in Skagit, Wash. A cargo tanker truck was transferring liquid oxygen to a hospital’s storage tank when a fire started that ultimately destroyed the tank, the truck and 20 vehicles in an adjacent parking lot. Luckily, no one was injured. The hospital’s secondary source of oxygen was a bank of H-cylinders. Hospital administrators had to contact the company delivering the liquid oxygen and regional home care providers in the area to request cylinders and additional oxygen sources.
If a hospital’s access to oxygen is totally depleted, facilities might have no choice but to follow procedures commonplace in remote, Third World locations where liquid oxygen frequently is scarce. They use petroleum-powered industrial-grade oxygen concentrators. No hospital in the United States has probably ever tried this, as all oxygen gas outlets would need to be labeled that gas may be less than 100 percent pure.
PLANNING AHEAD
A representative of the U.S. Office of Emergency Preparedness visited our operation two years ago so he could learn the potential contributions home care companies can make during disasters of any type. He was impressed with the resources available, such as a disposable pneumatic ventilator that could be used to inexpensively provide life support to large numbers of patients. To this date, I continue to provide the office with information on advances in therapeutic modalities and devices that could be used both for and against the American public.
The only way that the current system will improve is by clinicians sharing knowledge, networking and being prepared. It requires thinking beyond a single scope or type of practice and stepping across the spectrum of private and public health care. It also requires reading and research to build a foundation of knowledge on an individual level.
No place in the world is safe from natural or man-made disasters. Because we now have a heightened national awareness, it’s far easier for those who once said, “It can’t happen here,” to understand why planning for emergencies is vital.
Cella is the lead respiratory care practitioner at APRIA Healthcare in the Seattle area.
