Taking Healthcare by Storm: Industry Insights with Robert Fisher

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Robert Fisher, AEM, CHEP, CHEC, CEDP, Regional Emergency Preparedness Specialist at UPMC. 

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-090624-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to Taking Healthcare by Storm.

I am Dr.

Jean Storm, the Medical Director of Quality Insights.

And today, we are going to be talking about a very important aspect of healthcare that I feel is often overlooked.

It is something that really was highlighted as a deficiency I think we have in the healthcare environment during the COVID pandemic, especially at the beginning of the pandemic.

I think we all became aware that we really did not do a good job at preparing for emergencies.

So emergency preparedness is now something that we all really need to focus on.

So today, I have a guest who has made it his life's work to focus on emergency preparedness, and he is certainly an expert.

So today, I am joined with Robert Fisher, and I'm going to say all these initials.

Robert, Bobby, and you can tell us maybe what they all mean.

It is AEM, CHEP, CHEC, and CEDP.

Bobby, welcome to the podcast.

Thanks for having me.

I really appreciated it.

Yes, there was a little bit of word salad at the end of my name.

Some of them are emergency management specific, so the broad scope of emergency management globally, and then two of them are health care specific.

So I definitely have a strong passion for health care emergency management.

I've been working in it and at least a part-time capacity for the last 10 years.

Absolutely love it, and very happy to come on and talk about it today.

Great.

We're happy to hear all of your guidance and expertise.

So tell us how you came to do what you do.

So I started out in the volunteer fire service here in Pennsylvania, and that really is what kickstarted my passion for emergency management.

Initially, it was focused on the mass casualty aspect of it in response to that.

Although, I have grown from that, and now we tackle everything from pandemics to power outages, to an active threat that might happen in the healthcare space.

I like to say that I got my current position through complaining because I went to our clinical leadership.

I worked technically initially, and said, what do we do in case there is an emergency?

And they said, well, we'll call this person.

I said, well, that's not really a plan.

What's the plan?

And they eventually told me to talk to my current boss, and now I am in full-time emergency management.

So that is how I kind of progressed in my career so far.

But I know we have some more questions, so I think I'll answer a bunch of stuff in there as well.

Yeah.

So I don't take it for, I want to just make sure everybody understands what we're talking about today.

So let's tell everybody, what is emergency preparedness?

So emergency preparedness is a lot of things.

So the primary thing that we focus on are the five stages of emergency preparedness.

So those are your prevention, your mitigation, your preparedness itself, the response, which everybody is very familiar with, because that is the most visible thing, and then recovery.

So how do you get past an incident and grow from it?

So what we do primarily in emergency management is look at what types of hazards are most going to affect the area in which you work, live, and we take those and we prepare for them.

So how do we do that?

Well, we look at that hazard vulnerability assessment, which is a baseline of the likelihood of a hazard happening, as it happens in the most recent future, and then how to prepare you to handle that.

So what steps do you have in place already to prepare for that?

As you're very familiar with, in ERI-PA, we have snow, very prepared for snow, kind of lower on our list.

However, there are certain things that we may not be as prepared for, say a VIP incident or a hazardous materials incident.

So we look at that globally and say, okay, this is what we can do to take care of this incident before it happens.

How can we stop it from happening, and how can we respond to it if it does happen?

The lesson that recovery period.

It's so very challenging, I feel like, because you have to prepare for the expected.

So like an eerie, it's snow.

And you also have to prepare for the unexpected, you know, like a nuclear war or something.

Absolutely.

Yeah, it's really challenging.

So I know you were in the Navy.

So I'd love to hear a little bit about your experience in the Navy.

And if you could tell us what a Chief Hospital Corpsman is.

So I am still a Navy reservist.

I've been in the Navy now for a little over 10 years.

Absolutely love it.

I am, as you said, a Chief Hospital Corpsman.

So most people don't know what that is.

The best way to put it to the lay person is a combat medic.

However, we also staff military treatment facilities, and we span all of the technical jobs that you may find in a hospital or outpatient office.

So we have folks who are cardiovascular technicians, surgical technicians, respiratory, any of those ancillary services.

What I do in the Navy, and my experience, currently, I belong to Navy Medical Forces Development Command, where I serve as the Training Chief for our Tactical Combat Casualty Care Team.

So what we do as a team is get out to our fellow Navy Reservists, as well as some Army and Air Force Medical folks on the Reserve side.

And we teach them how to take care of, at point of injury, a combat casualty, and how to get them through what we call Tactical Field Care, and then Tactical Evacuation Care, and getting them to a higher level of care for their injuries.

My experience though, I have been overseas twice.

Once I was in the Middle East in Bahrain, where I served with a small boat unit.

And then I also was in the Horn of Africa, where I served as an individual augmentee.

So I went out there as an individual, but became part of an awesome team at the Expeditionary Medical Facility out there in Djibouti, Africa.

So I am very used to small clinics.

We had a four bed emergency department, and we did all the primary care on base.

So it was a very interesting time.

I had loved my career in the Navy, and being able to help not only our service members, but also the contractors and foreign nationals that we worked with.

It's been a super rewarding experience.

I bet.

That's really, really fascinating.

What I'm always interested in is, I was a provider taking care of patients in the nursing home and the hospital during the COVID pandemic.

Did your experience in the Navy change during the pandemic?

Absolutely.

So one thing, and I think this is very much the case across America, is that organizations really took a harder look at their employees' health and wealth.

And what do I mean when I say that?

It is, you know, a lot of folks still came to work when they weren't feeling super great because they didn't want to take time off and, you know, they weren't really supported maybe by their employer.

That's not the case anymore and that's really great.

One thing that the Navy Institute and that I really experience working in a cargo handling battalion where we had 340 some sailors, was if a sailor contracted COVID, you know, we would reach out to them, one, make sure that they were quarantining appropriately, but then making sure that they had things that they needed.

You know, were they getting their family taken care of?

How was their mental health?

How was, you know, their finances?

And how were they going to get food while they were in quarantine?

We really looked at that from the whole aspect, which was absolutely wonderful.

And something that we didn't really have initially when I joined the Navy.

So that was a big change that came about through that.

Yeah, sounds like it was a good change.

Oh, absolutely.

Yes.

So I'm really interested in organizations coming together for emergency preparedness.

So tell us what the Northern Tier Healthcare Coalition is.

Absolutely.

So I am the current serving chair for the Northern Tier Healthcare Coalition.

And what that is, is a group that brings together your acute care, long-term care, home health and hospice, EMS, a number of other...

If there is an entity within healthcare, we support it.

And we support it from an emergency management and emergency preparedness level by being able to provide grant funding that comes from the administration for preparedness and response.

And we provide that through the grant funding with training.

So we actually have a training symposium coming up where we're going to have long-term care administrators, EMS, as well as acute care providers, and getting them together and doing training such as decontamination of patients, issues that are affecting EMS, such as advances in trauma care medicine, as well as how do we evacuate a long-term care facility?

So we're going to bring all those folks together and do some training.

But one big aspect is our advocacy for our facilities.

So we take that up to what we call the Healthcare Coalition Council, which is all the chairs from across the state.

We have six healthcare coalitions here in the state of Pennsylvania, and we have the direct ear of the Director of the Bureau of Emergency Preparedness and Response at the PADOH.

So when one of our organizations is feeling the effects of an emergency incident, or, you know, specifically during COVID, when facilities were feeling the strain of not having enough staff, not being able to move patients from the acute to the long-term care for the skilled nursing side.

You know, we were able to work with the state to get state and federal assets deployed to assist those facilities.

So it's been a very rewarding part in my heart with being the chair.

But being able to assist across such a wide scope of healthcare and make sure that all of those individuals are prepared has been incredibly beneficial and empowering.

I can imagine bringing all those individuals together.

So the million-dollar question, do you think that, do you feel that healthcare, the healthcare community was prepared for the COVID pandemic?

The easy answer to that is absolutely not.

That is incredibly unfortunate.

But no, I think we are much better prepared.

However, I think there's still a lot of building that we have to do to maintain that preparedness.

The good thing is, is that we learned a lot.

We learned what to do and what not to do.

Through our after action reporting, that has been incredibly helpful.

But no, healthcare was very much lacking.

One of the big things that was noted across the healthcare continuum was supply chain management.

And us as emergency management, we really were deeply involved in that, where we were talking directly to vendors and making sure that folks had what they needed.

Or through the Healthcare Coalition, being able to engage with our members and one, not only see what they might need, but also how we could support them from another part of the organization or from the state level.

Yeah, the supply chain issue is huge.

Definitely, you know, big issue.

So do you feel that was the biggest oversight in emergency preparedness during the pandemic?

Or was there another thing that you thought was the biggest oversight during the pandemic?

I think that was the most visible oversight.

However, one of the bigger oversights that we found was the planning in terms of getting everybody vaccinating.

So that was something that absolutely everybody wanted, not just healthcare workers themselves, but getting that vaccine out to the community.

I feel like we were very ill prepared to get that vaccine deployed out to the community.

Internally, it's very simple.

We have all of our nurses and docs and pharmacy team who are readily available to get out there and vaccinate our staff.

But coordinating it through not only our system, but also across the broad scope of healthcare was very taxing and very difficult.

So I think that probably the biggest oversight was what we call points of distribution and being able to distribute that vaccine to the community.

Yeah, I can see that.

That was a challenge, I think, in getting it out to the community at large.

So did we learn our lesson during the pandemic?

Do you think that we are well prepared now for a disaster?

So again, I would love to say yes, we did learn our lesson.

Unfortunately, we regularly see that history repeats itself.

I am really hopeful that we don't see another large scale pandemic anytime soon.

However, I think that the lessons learned, our emergency managers can look back, hopefully many years from now and see, okay, this is what worked well, this didn't.

But I do think we are more prepared.

I would hope that we have learned our lesson, but I think only time will tell on the exact answers of that.

I would agree.

Let's hope it's not something that is more significant than the pandemic was.

Absolutely.

Speaking of future threats, what are the biggest threats in emergency preparedness now in your opinion?

So I think one of the absolute biggest threats and something that we have seen across health care, especially more recently, is cyber attacks.

So it's really leveraging your information support, those IT teams within the organizations, to make sure that we have resilient organizations to respond well to these cyber attacks.

Unfortunately, we're seeing a lot of ransomware being put out through emails, and unfortunately, if somebody clicks a link, it takes down the whole network.

So I think that is the absolute biggest threat, currently, to a lot of our health care organizations.

And even though it wasn't so much an attack, the recent CrowdStrike update, Fiasco is probably the easiest way to put it, really showed that a lot of organizations need to look into who manages their IT and how they can support and respond in case one of those systems goes down.

Yes, absolutely, I would agree.

So, you were talking a little bit about nursing homes, hospitals.

So if we look at nursing homes, hospitals, physician practices, across the care continuum, are these facilities, providers, organizations, are they facing different challenges in emergency preparedness?

Absolutely.

So, hospitals typically have a little more in terms of infrastructure than, say, a nursing home or a physician practice.

And what I mean by that is at my home facility, we have a very robust power generation capability that allows us to operate even if the grid in most of our area is down.

Unfortunately, a lot of nursing facilities do not have that level of capability.

So, they may have some more struggles in cases of power outage, phone outage, especially on the infrastructure side.

Physician practices and the outpatient side of emergency preparedness is significantly different.

The only good thing about that is that a lot of the times, we can work with those offices maybe have reduced hours or flip to a telehealth model to work with their patients still in the event of an incident.

Although you do have outpatient type facilities such as dialysis that we really need to operate or have contingency plans in the regions that they are in to make sure that those folks are still able to get the care that they absolutely need in the event of a disaster.

Yeah, that is like, it's really interesting, you know, I think everybody thinks about emergency preparedness on a whole, but you know, you really have to think about each provider facility differently.

So, what advice, we talked a lot about, you know, providers and facilities, what advice would you give for a citizen, just a regular citizen, to prepare for disaster?

What can they do to beef up their own emergency preparedness?

So, that is a hard question, but it's a very good one and a very important one in today's day and age where we do have some more natural related disasters as well as man-made issues.

So making sure that, and this goes back a little bit to healthcare, if somebody is on specific medication, that they're not waiting until the last minute to get those types of medications refilled because you may not be able to get it refilled in the event of a disaster.

Having a little extra cash on hand in case, you know, a certain IT systems are down, still being able to go out to the store and get some items is very important in that aspect.

Also, it is never a bad idea to maintain some non-perishable food items as well as water in the event that you may be stuck in your house for an extended period of time due to a significant weather event.

Those are probably the easiest ones that I could put out to let folks know how they can help be prepared.

And I think those are basic easy things that anyone can do, definitely.

So if you were in charge, this is the last question I ask almost everybody that comes on the podcast.

If you were in charge of health care in the United States, what is the first thing that you would do?

All right, now this is an incredibly hard question.

But no, it's one that again, is very important.

Coming from the emergency preparedness background that I have, that is really the focus that I would likely have, just because that's my area of expertise.

But really, just making sure that organizations are more resilient, and really putting some additional funding and effort from the federal level, down through the states, to those organizations that work with health care, to be more resilient in terms of our cyber attacks or the event of a large scale pandemic.

Along with that, making sure that our wonderful strategic national stockpile is up to snuff and ready to go in the event that we have a major incident.

Because that was also something that we ran into some issues with during the pandemic.

So really focusing on the resiliency and building that resilient capability within the healthcare system is really what I would focus on if I had the ability to affect some large scale change in the United States.

Resiliency is something I think the healthcare system definitively needs.

So I appreciate that answer.

Bobby Fisher, I'm going to say, I love this conversation.

I feel safer knowing that you are out there working in emergency preparedness for our healthcare environment.

Thank you so much for what you do, and thank you so much for joining us today.

Thank you so much for having me.

I really appreciate being able to come on here and talk about this topic.

Thank you for tuning in to Taking Healthcare by Storm.

Industry Insights, with Quality Insights Medical Director Dr.

Jean Storm.

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