Author Topic: When should health care providers bug out?  (Read 21863 times)

Offline Doc K

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When should health care providers bug out?
« on: January 31, 2010, 06:04:49 AM »
Here's a question I sent to Jack... since I never hear back from him (like he doesn't get any questions  ;D), I thought I'd ask it to everyone as well.

I recently watched "After Armageddon" from the History Channel - it's about a global flu pandemic.  I also recently read "One Second After" - about an EMP attack and, among other things, subsequent die-offs and diseases.

One thing that occured in both of these settings, and I think would happen in a real world SHTF scenario, were that the health care providers (docs, nurses, PA's, etc.) had to make a choice.  Should they stay and provide medical care (and put themselves and their family's life at risk by catching or transmissing the disease) or should they bug out (for a hunker down, self-quarantine)?

There is a duty as a health care provider to care for the infirmed, but when does it end and to what cost?

I've been thinking about this a lot, and I don't like either situation.

Any thoughts?

Doc K

Offline Truik

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Re: When should health care providers bug out?
« Reply #1 on: January 31, 2010, 07:11:55 AM »
If it were truly a EOTWAWKI situation (nationally or globally) I think any concept of the "business organization" will cease to function (or cease to exist) almost immediately and "health care providers" would be the individual doctors, nurses, EMT's, etc., who care enough to help others and turn it into their post-SHTF profession. They may act alone or pair or group with others over time.

Look at how fast business lock up and turn over the key now. Pizza Huts, Eckerds, Starbucks and Subways have all had shops that were shut down and the employees not even told. They showed up for work and were out of a job the night before when they left the place. Look at that trucking company that folded up shop leaving drivers stranded all over the country. Regardless of size, some major businesses have shut down the same way.

Look at the car dealerships that were told they were through, and THEIR parent companies even got big checks from the government bailout! (A lot of good THAT did to save jobs.) And these are all things I have seen in this "pre-SHTF" situation.

If the SHTF, the only record those health care providers existed will be stationary, business cards and back-lit signs on the empty shells of office buildings.

Of course, that's just my opinion.


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Re: When should health care providers bug out?
« Reply #2 on: January 31, 2010, 11:06:37 AM »
I am with you there Doc K.  A difficult quandary for sure.

My thoughts are simple, my family comes first.  Depending upon the specific circumstances, if my family's health and security is at risk during an event, then I am no longer going in to work. 

This not only applies to an "event", but also the amount of time I choose to spend working.  Over the last 12 years, I have met many providers who have neglected their family's time over their patients needs, and at one brief point I was doing the same.  Not good.  I changed jobs.  Sure, I still miss some of the kid's sports events, or I am occasionally coming home late due to something requiring attention, but my family is my priority.   

Regards,

« Last Edit: May 01, 2013, 12:32:46 AM by Archer »

Offline Doc K

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Re: When should health care providers bug out?
« Reply #3 on: January 31, 2010, 11:51:37 AM »
scrubs - I can't agree with you more about family.  I am fully planning on taking a pay cut when I am out of the military to take a job that allows me to be with my family more, and live at my homestead in the country (the one I haven't bought yet! :) ).  I also agree with you on the general premise of family coming first.  To me, that is really a no-brainer. 

I guess the heart of my question was about the events that bring you to that decision?  If there is a clear event or threat where I had to choose:
A) help others and you may die leaving your family without you   
B) bug out and be there with your family even though others may/will sufer. 

As bad as it may sound to those others, I would readily choose option B.


My dilema is considering the gray areas (for example):
- There is a growing/spreading flu (recently labeled a pandemic) with high mortality rates to those infected.  Your area is not yet hit with it hard, but there are more reports about it entering your state and maybe your county.  For the last few days, there have been more and more people calling in with sympotms.  No deaths have been reported in our county yet.  When do you stop going in to work?  What is the trigger point? 

- There was an EMP 28 days ago.  Already those with high levels of care have died due to lack of electricity (ventilators, dialysis, etc.).  People have already started to run out of their meds, and a few have died from that also.  You are just starting to see some illness break out in the general public: vomiting, diarrhea, fevers.  Not really sure what it is.  It could be poor sanitation, but it could be something contagious.  When do you abandon those you have already been helping for the last 4 weeks?  When do you isolate yourself and your family from them?  What is the trigger point?

- A massive natural disaster has hit (tsunami, earthquake, hurricane - depending on where you live).  Your family is doing well.  You've prepped well and are actually doing pretty good at home.  The others in the area are doing very bad.  This was much bigger than Katrina and the gov't is way behind in their relief efforts.  They need help at the make-shift clinics and the docs from the community are there and wondering where you are.  There are some reports of violence breaking out, and you know of someone who was shot in a "random" incident, but it was not that close to where you are.  Do you go in to help?  Do you stay put?  This one is even more bothersome, because you know that "order" will be restored in a few weeks. 

These are the scenarios I am wondering about.
« Last Edit: May 01, 2013, 01:01:10 AM by Archer »

Offline DrBob

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Re: When should health care providers bug out?
« Reply #4 on: January 31, 2010, 01:18:34 PM »
Hey Doc K!!,

DrBob back at you again. You and I agree that scrubs has hit a very good point about making the family priority. You ask about when to quit going in, when is the trigger point. Let me ask you this: When would you stop letting your spouse or your teenager go to work? What level of risk would be too much for you to tolerate for them?

We might have a natural tendency to place ourselves at more risk because we are health-care providers. Is that the right approach, when we consider the level of risk we would consider unacceptable for our family? They (our family) would also consider it unacceptable for us to subject ourselves to that same level of risk. If you or I got shot trying to make our way to the makeshift clinic, who would take care of our family?? I'm not going to risk making my wife a widow, and my boys fatherless, because I'm worried about what the other docs who already made it to the clinic are saying about me.

For me, it comes down to this simple question: "Would my contribution to my family and my community be more significant spending the next fourteen days saving as many people as I can, before I die, or surviving to spend the next fourteen years saving as many people as I can?"
DrBob
« Last Edit: May 01, 2013, 01:01:22 AM by Archer »

Offline phargolf

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Re: When should health care providers bug out?
« Reply #5 on: January 31, 2010, 01:33:42 PM »
hey Doc K, these moral dilemnas are more troubling to me than the average citizen would understand. I am torn between doing my job and helping people(even though most of them wouldn't return the favor) and taking care of my family. We all will just have to answer this individually when the time comes and live with the consequences (some choice, huh). Since my home is my retreat, i imagine we (my partner and his wife,who is a physician) will work until we deem it no longer feasible, load up whatever is left at my pharmacy and just head home, leaving the rest to the looters and druggies. Not a very pleasant scenario but hopefully a realistic one. Hopefully after some period of time our post-SHTF profession will still be healthcare but on our own terms. Just 1 old coots .02 ;)

Offline Roknrandy

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Re: When should health care providers bug out?
« Reply #6 on: January 31, 2010, 01:40:07 PM »
All of you that are Doctors, nurses and other types of care givers have my utmost respect in that you have taken an oath to help your fellow man through thick and thin. That being said each of you will have to do some soul searching to see what your limit (if any) is. I don't there is a generic answer. In the After Armageddon show the paramedic did what he could for as long as he could then tossed in the towel to stay with his family. This is a very deep subject, Look at what the staff at mercy hospital did to help patients after Katrina. Most checked on their family then stayed the rest of the time helping patients.

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Re: When should health care providers bug out?
« Reply #7 on: January 31, 2010, 01:57:41 PM »
1.  There is a growing/spreading flu (recently labeled a pandemic) with high mortality rates to those infected.  When do you stop going in to work? 
A: I would stop going to work if I determined the ability of PPE was unable to protect me, or if PPE ran out.

2. There was an EMP 28 days ago.  You are just starting to see some illness break out in the general public: vomiting, diarrhea, fevers.  Not really sure what it is.  It could be poor sanitation, but it could be something contagious.  When do you abandon those you have already been helping for the last 4 weeks?  When do you isolate yourself and your family from them?
A: Same, I would stop going to work if the ability of PPE was unable to reasonably protect me, or if PPE ran out.
 
3.   A massive natural disaster has hit.  This one is even more bothersome, because you know that "order" will be restored in a few weeks. 
A:  If I felt security was lacking at home, I would try to correct that with help from others, and if unable to do this then I would be at home.  If security at work is the issue, (we already have this problem at my a few locations where I work), then I go armed.  If the problem became greater that what I feel I could reasonably manage, and if no effort was made to mitigate the security risk, then I stay home.  If I showed up to work with gangs of armed thugs throwing bullets around, how much use am I to the community if I am dead? 

Sure, it sounds selfish.  No different on the battle-field, self protection comes first.  When a medic dies, he/she dies with all the soldiers they could have saved with their skills.  The effort to "save your own skin" is not unethical or immoral, in fact, it is the right thing to do for your future patients.  Think of how many years, and the resources it takes, to train a single Physician.  If times became really bad, we better protect the ones we have.

Respectfully,
« Last Edit: May 01, 2013, 12:32:37 AM by Archer »

Offline DrBob

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Re: When should health care providers bug out?
« Reply #8 on: February 01, 2010, 05:32:33 PM »
scrubs,

Stated very well!! Thank you.
DrBob
« Last Edit: May 01, 2013, 01:01:32 AM by Archer »

Offline Heavy G

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Re: When should health care providers bug out?
« Reply #9 on: February 01, 2010, 05:54:54 PM »
Great thread.  Great posts, all of them.

What about the health care worker who insists on "doing my job" who then risks bringing a disease back to his or her family?

Would the non-health care spouse be right to say, "Don't bring that crap home to us.  You're not welcome back home until this pandemic runs its course." 

You wouldn't let someone or something bring death into your family's house if you could avoid it.

In a pandemic, I bet health care workers would quarantine or self-locate at their clinics. 

Offline joeinwv

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Re: When should health care providers bug out?
« Reply #10 on: February 01, 2010, 06:11:50 PM »
Do a google search of "Dark Winter CDC" - this is a .gov scenario based on a weaponized smallpox attack on US soil. In answer to your question, under this scenario - the answer was 3-4 weeks. Which is when the hospitals are overrun. This scenario results in 1,000,000 casualties in about 6 weeks.

If you stick around long enough, you get to practice medicine under marital law. Treating the sick with minimal resources while the national guard tries to maintain a border around the hospital so you can do triage. Fun stuff, tough choices.

From my observation, most who are in medicine for the right reasons will stay far longer than anyone would expect.

Offline Asclepius

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Re: When should health care providers bug out?
« Reply #11 on: February 03, 2010, 01:32:25 AM »
History shows that in big disasters, about 50% of emergency services workers are either out of town, dead, injured or AWOL, and cannot operate.

Much of your initial action is focused around making sure your family and friends are safe. It is difficult to operate when you don't know if your loved ones are safe.

I tried to answer your questions but there are so many what-if's. If on duty on my ambulance I would make sure my partner and I are safe and armed, and I would make ourselves available to help where we could. All the while I would be hyper-aware of personal safety, and I would have no ethical issues with bugging out of the operation if I did not think I could be safe. If off duty I would report to help wherever I could.

All of this depends so much on what kind of disaster, what extent, the expected danger, my educated risk vs. benefit assessment, etc..

Our county currently has a disaster plan for us to locate our unit in the middle of the evacuation areas. I would NOT do this. I like being in the shit and helping people but I'm not stupid. And I'm not in the military: I get to say no.

Offline Asclepius

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Re: When should health care providers bug out?
« Reply #12 on: February 03, 2010, 01:44:12 AM »
By the way that show on the History Channel was a freaking joke. I'm embarrassed at that actor's portrayal of a paramedic. I don't know many people who are that dumb and unable to function; EMS providers are usually a little more street than the average asshole. I guess they were from Kalifornia, though, so maybe the acting was believable.

When he grabbed the gun out of the van and said "this guy thinks he's a cowboy," it actually took everything I had not to break the TV. He should have used it to cull his retarded wife and kid and then remove himself from the breeding population. I wished they had drank more radiator fluid so the show would have ended sooner. What a dumbass.

Offline DeltaEchoVictor

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Re: When should health care providers bug out?
« Reply #13 on: February 04, 2010, 10:39:27 PM »
Health care providers should bug out when you realize that the very first thing in EMT school has clicked...The Scene Isn't Safe.

If it's not safe for me, then it's no longer safe for my family.  As selfish as it sounds, I can't help them if I have to be quarantined away from them.  I'll put them first...always.

Offline student

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Re: When should health care providers bug out?
« Reply #14 on: February 12, 2010, 04:36:10 AM »
This topic has been discussed in a number of medical journals.

The duty to treat in the face of perceived harm was first encountered during the HIV epidemic. It was (rightly) determined that people with HIV had a right to be treated without discrimination by healthcare workers.

The latest epidemics by SARS and influenza are not adequately addressed by the discussions or legislation borne from the HIV question. Influenza and SARS are more readily communicable and less treatable. 20% of all people infected with SARS during the epidemic were healthcare workers.

There is a nice collection of articles at Google Scholar.
http://scholar.google.com/scholar?hl=en&q=doctor+obligation+treat+epidemic
(you can narrow this down to articles published in the last 2-4 years, which prioritises the airborne viruses)

Here are some select articles:

Obviously, replace physician above with whatever healthcare related occupation applies to you.

edit: The CDC have also weighed in with a policy review (surprisingly written by a UK author).
CDC - Virulent Epidemics and Scope of Healthcare Workers' Duty of Care
« Last Edit: February 12, 2010, 04:38:31 AM by student »

Offline Heavy G

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Re: When should health care providers bug out?
« Reply #15 on: February 12, 2010, 08:52:45 AM »
+1 student.  You have the highest karma:post ratio on the forum, I think.

Offline rangergear

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Re: When should health care providers bug out?
« Reply #16 on: February 12, 2010, 09:32:57 AM »
Although I am not a health care provider my wife is. She is a Nurse at a local small hospital in our town. I have asked her what her plan was if there was a dirty bomb or some other disaster and she instinctively said she would stay and help.
I think most grasshoppers/ sheep  would do the same thing.   Instinctively say they would stay.  But after talking to her we war gamed the situation so that if something were to happen then she would have a idea when it was no longer safe to stay there.
I also think it’s important to know what your facilities plans are in the event of a disaster.  If your location doesn’t have equipment to triage or deal with chemical situations then that shows you that in the event of a disaster you will probably be more exposed to threats.
Another situation that my family faces is I’m in the National guard and would be expected to show up to the armory in the event of a disaster. I also have a son. If my wife is off helping the sick and I’m protecting vital infrastructure. Then who will take care of my son.
For my wife and I, I feel we have come up with a decent plan of attack in the event of a disaster. But as we all know no plan survives first contact. 
Here are the planning steps that my wife and I went through that helped us.
1. What disasters are we panning for? Flood, dirty bomb, flu
2. What are your facilities plans?
3.  What are your family’s requirements?
4. What supplies should you have at your location? I.E Gas mask, Tyvek suit, extra PPE, Food, Water, cloths, personal protection.
5. What are your triggers for leaving? If the facility can no longer protect you, if the possibility of contamination is likely ect..
Another option is do you want to set up your own treatment facility that off site that you can control and manage.  (for those hard core do gooders)  This option would probably be the most rewarding and hardest thing to do, logistically speaking.

Offline Heavy G

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Re: When should health care providers bug out?
« Reply #17 on: February 15, 2010, 09:17:21 AM »
+1 rangergear.  Great to have a plan laid out with numbering.  This will help lots of people on the forum, which is why the forum exists.


I have asked her what her plan was if there was a dirty bomb or some other disaster and she instinctively said she would stay and help.
I think most grasshoppers/ sheep  would do the same thing.   Instinctively say they would stay. 


Yep.  It's called the "normalacy bias."  It's basically where people, when faced with a disaster, assume everything will be like normal.  They underestimate the threat and think preparations for a thread are an overreaction because the normal pre-disaster world is all they can conceive of.  Here's a brief explanation of it: http://en.wikipedia.org/wiki/Normalcy_bias

It is no exaggeration to say that normalacy bias is the number one thing that will kill people.  Flood water, radiation, pandemic, effects of an electrical grid failure, civil unrest--all those will be a distant second.  People going to work because that's what they've always done will get people drowned, irradiated, sick, shot, etc.  

We preppers don't suffer from normalacy bias, but the 99% of others around us do in varying degrees (like maybe your wife; my wife for sure).  We have to be ready at a moment's notice to lead our loved ones out of their normalacy bias.  I mean a moment's notice.  Fast.  Decisively.  Confidently.  Our quick leadership on this topic will make or break our lives and our loved ones'.  It will be the biggest thing we do in our whole lives.  You'll look back on your life and say "bugging out on day one was what saved us."

Offline monkeybird

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Re: When should health care providers bug out?
« Reply #18 on: February 15, 2010, 09:50:00 AM »
I'm a retired Registered Nurse.  I worked 20 + years in the ER and another 7 as an Infection Control Nurse. 

When I worked in the ER, the hospital had a major problem with staff during hurricanes.  Most nurses are mothers, mothers have a instinct to be with their children when there is a perceived threat.  Just ask any mother.

The hospital developed a method of allowing working professionals to bring their families to the hospital to keep the workers from leaving.  It works if the event is known before hand and it it time limited, however it will not work in sudden or infectious events.

As my child is now a grown man, I would probably stay.  But in all honesty, when he was small, hell itself could not have kept me away from him in a time of emergency!

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Re: When should health care providers bug out?
« Reply #19 on: February 15, 2010, 04:57:42 PM »
Love this topic. As others have said, I'd bug out when the facility could no longer provide me with adequate protective gear and or something was so virulent that I would be endangering myself or my family.

As an ICU nurse in a big city, I have seen many cases of threatening or violent family members when they perceived that their family member was not getting the care that they thought their family member should receive.  Examples of this would include- a family member pushing one of our physicians into a wall when he told them a patient was not eligable for a transplant, a family member who screamed at me when I told her that although we had around the clock interpreter coverage an interpreter could not be stationed at her mothers bedside around the clock, multiple cases of families being aggressive with other families in waiting rooms, a family member pointing a gun at a lab tech in the parking lot, etc. etc. etc.

And this is in good times. I can only imagine what the response will be when people are turned away or told there are no more antibiotics.  You won't find me at the hospital when TSHTF.

Offline Orionblade

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Re: When should health care providers bug out?
« Reply #20 on: February 15, 2010, 08:33:58 PM »
Whether I wind up as a tried and true medical professional or not, even with my current skill set being of benefit during SHTF/TEOTWAWKI, I'm GTFO asap. Or bugging in.

Either way, there's enough folks in my bugout/in group that can run into survivors/etc. and direct them my way at my leisure without me feeling too broken up about not being exposed to the general populace and all the risks associated with the Zombie Apocalypse + murder/death/kill + pillage/rape/burn.

That said, if you're bugging out, there's no reason not to aid those that have fallen before you or around you. If it's that bad, folks are going to die, and they're just as likely to kick the bucket as they walk out of your clinic as they were before they were carried in.

If it's pretty localized, though, like a hurricane with flooding/building collapse, etc. - as long as me and mine are safe, then I'll move out from there in offering aid.

I think it's a pretty sound plan - you can only be of help as long as you're still sucking wind.

Offline ColdHaven

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Re: When should health care providers bug out?
« Reply #21 on: February 15, 2010, 09:21:26 PM »
Health care providers should bug out when you realize that the very first thing in EMT school has clicked...The Scene Isn't Safe.

If it's not safe for me, then it's no longer safe for my family.  As selfish as it sounds, I can't help them if I have to be quarantined away from them.  I'll put them first...always.

I have thought about this long, hard, and often. If the time ever comes I would feel awful, but my duty is to protect my family. I have spoke with Joy about this and I am not sure if she has come to a personal decision about it. I would respect her either way, but I would have to leave. I would hope she would leave with me. I have a sense of duty to the patients and the ill, but my primary duty comes to my family foremost. If I die, I cannot protect them.

I think it depends on the situation as well. If it were localized to one place with no threat of expanding danger to the hospital then I would stay. If it was something involving one or more cities around the hospital I would be bugging out and just consider myself unemployeed. It sounds harsh, and words on a screen cannot display the amount of grief I would feel to make that decision, but in my heart I know it is the right one.  :-\

I just pray I never have to make that decision.

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Re: When should health care providers bug out?
« Reply #22 on: March 05, 2010, 11:24:12 PM »

And this is in good times. I can only imagine what the response will be when people are turned away or told there are no more antibiotics.  You won't find me at the hospital when TSHTF.

I am an ICU nurse who's now taking care of the baby at home, but I pretty much came to that same conclusion a few years back.  It's heartbreaking to think of the what if's, that you're abandoning your co-workers and friends as well as your patients, but the line has to be drawn somewhere.  If things are bad enough on the outside, then it'll be hell on the inside.

I can always find another job.  I can always rationalize away my actions.  But if I am killed or can't protect my family, then what's the point.



Read up on the doctors and nurses that stayed during Katrina--and that was mild compared to what could happen and they had support arrive fairly quickly.



The whole problem, as stated, is that there are varying degrees of emergency.
Novel new bacteria is dropping people like flies?  Earthquake levels most of the city?  War breaks out and your city is in the cross-hairs?  Zombies lumbering towards the center of town?


My thought is that everyone is going to find their own breaking point and it will be a highly personal and very difficult decision.   
« Last Edit: March 05, 2010, 11:29:18 PM by BrotherWolf »

Offline sledgehammer

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Re: When should health care providers bug out?
« Reply #23 on: March 06, 2010, 08:16:10 AM »
I'm not in a medical field. But I am in the Guard and that leads to a similar situation. It's hard to preemptively decide when I would turn my back on an oath. (Call me old fashioned.) But one of my considerations has eased the moral burden a bit.

The question isn't just "should I stay and help people or leave and help my family?"
The question is "should I stay and help people or leave and help my family and survive to help other survivors?"

I don't know if it helps any. It helped me a bit.

Offline rangergear

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Re: When should health care providers bug out?
« Reply #24 on: March 06, 2010, 12:28:10 PM »
I have taken a impromptu serve of my company about what they would do in a emergency. The results were about 50% would come to the armoire if something happen. I think that number would change due to severity of the disaster and the individual’s current financial situation. Of course most of the guys that didn’t have a family or a job said they would be willing to come in and help.

Offline Koldsteel

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Re: When should health care providers bug out?
« Reply #25 on: March 08, 2010, 06:58:31 PM »
    This is also a question I have asked and would have answered it differently years ago. I always felt that I had a moral obligation to place myself at risk to maximize my impact in a disaster. Each nurse/physician could exponentially affect the outcome of those in need.

   I now feel that is the case still unless I have reason to believe that the infrastructure that protects us is overtaxed or broken down. In that case, it is my sole duty to protect my family.

   In a true, Schumer-hits-the-fan scenario, our families look to us to provide them with protection that will not otherwise be given. I would leave my hospital and go home without remorse or doubt.

Kold

Offline quiet-man

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Re: When should health care providers bug out?
« Reply #26 on: March 11, 2010, 07:01:04 PM »
I think the main factors on that decision depend on whether you're single, or have a family to think about. Back in the day, when I was a paramedic(LAFD,70's) I was inclined to do more, as I didn't have a family yet. After a career change as a LEO, my family was central to all my decisions. When you lose someone on the job, it sucks seeing their family trying to cope. If it's something "big" like those 2 programs showed, my family's safety & well being comes first. Some guys on the job were very up-front about whether they would come to work, or wait to be relieved if their families weren't "secure".
A bit of a double standard exists if you're single though, everyone expects you
to be there.

Offline odimodus

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Re: When should health care providers bug out?
« Reply #27 on: April 24, 2010, 08:22:43 AM »
I've often thought on this topic. My wife and I are both critical care nurses with a young one at home. We've pretty much decided that one of us would quit and stay home, the other (me) would continue to work as able and self isolate in the home.

 I think the idea of leaving when its no longer safe is important and appropriate. If there is no PPE I wont be able to safely help. I think a large number of people who come to hospitals will no longer show up in a critical disaster because they know there is no help to be had, but the ones who do show up will swamp the system.

 My greatest fear is an H5N1 outbreak. It currently has a greater than 50% mortality, if that becomes suddenly person to person transmissible and people start dropping like flies in Asia on the news sites, that will be the point my wife stops working even if she has to quit. I'll probably avoid all possible routes of infection and I wont even eat at work. I may just have to quit as well. It pains me to consider it, but what good am I to my family if I'm dead.

 I read a great book on the 1918 spanish flu, I want to say the title was The great influenza but I'm not certain and the book isnt conveniently accessible. Anyways, it illustrated how hospitals were reduced to having only a few nurses and bodies were piling up quickly. Nurses were being kidnapped and kept in other peoples homes. I dont think things were Hollywood drama level bad, but 10 bodies in most hospitals is certainly a 'Piling up' situation.

Offline 91B30V

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Re: When should health care providers bug out?
« Reply #28 on: May 18, 2010, 01:50:15 AM »
There are a lot of factors involved in such decisions.  Working in an inner city ED safety is always a concern.  Its bad enough now with the almost nonexistence of common respect for people.  I can say that I have been verbally attacked and threatened if people don't get what they want i.e. drugs of abuse or you catch them stealing supplies.  I just had a woman arrested after she kicked me in the abdomen when I told her I was not comfortable giving her a month supply of percocet! The point I am making is that based on my own experiences of 15yrs in the ED is that my personal safety is first.  The "safe world" we live in is truly a fragile thing.  There are only so many cops and security personnel.  They can't be every where.  When you throw in a situation where people are getting frantic and desperate it gets ugly fast.

There is also the question of tools for the trade.  Hospitals go thru an insane amount of supplies to do what they do.  They also unfortunately are  "supplied by just in time inventory".  If you doubt that look in the supply bins after a long holiday weekend.  Without our gear most places would be brought to a halt quickly.  You seem to see the Pharmacists restocking meds from the main pharmacy in small amounts a lot more often during these long weekends and when there are large unexpected surges in volume.  How often do we get memos that there is a shortage on this med or that med?

I apologize if this sounds like a rant, but this has been my experiences and at more than 1 facility.  I for one will have to make my decision for my safety and live with my decision.  But personally I ultimately am responsible for my family and their safety.  Altruism should not be confused with extreme naivety.

And the statement of "How many I help over years is more important over the number of days" is so very true.


Offline GreyWolf

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Re: When should health care providers bug out?
« Reply #29 on: February 11, 2011, 11:04:38 PM »
27 years working EMS has taught me many things, one of which is you cant help others if you are hurt or dead.The bugging out decision is a situational decision.What is the emergency? Is it short term or is it permanent? How far are you from your family? Are they set up and prepared to ride out the emergency without you or until you can leave and join them? Is it safer to remain where you are and treat others until the situation becomes calmer and it is safe for you to travel? CAN you leave? In other words do you have the means to travel or are you trapped at your location and have no other choice than to remain where you are and treat the sick and injured.? Are you sick or injured and unable to travel? Can your loved ones travel to your location safely?The decision whether to bug out or when to bug out is different for each individual.Each person has their own limits to which they will place themselves in danger. There is no ever encompassing answer to this question as the answer is a different one for each of us. I pray each and every one of us using our years of experience in this field and recognizing when our gut instinct kicks in makes the right decision at the right time.