Last month, at roughly the same time that Haiti was attempting to recover from perhaps the worst natural disaster in that country’s history, the city of Jackson, Miss., was going through a disaster of its own.
In Jackson, more than 100 separate breaks had occurred in the city’s water mains, leaving most of the city—including several hospitals—with little or no water pressure, and boil-water restrictions, for several days. Hospital foodservices curtailed menus and shifted to disposable servingware, while hospitals turned to nearby, unaffected institutions for laundry and the sterilizing of medical equipment.
Disasters come in all types and levels of severity, and in the post-9/11 era the types of situations for which institutions and their foodservice departments have to be prepared have become even more numerous. Last April, Florida Hospital Heartland Division, in Sebring, Fla., went into a “code orange” after a suspicious white powder was brought into the hospital’s emergency room. (In a “code orange” at Florida Hospital, no one is allowed in or out of the building.)
The resulting lockdown left the hospital without a foodservice staff, except for the foodservice director, Thomas Olson, a cook, and an administrative assistant, for 16 hours. The trio managed to prepare 540 meals during that time, including three meals for each of the hospital’s 98 patients, in large measure because they had a plan in place for this type of disaster.
Virtually every school district, hospital and college or university in the U.S. has an emergency management team and a disaster plan in place. Most institutions have never had to put their disaster plans in motion, and yet teams still meet periodically to update their plans and continue to stage emergency drills two or more times a year, just in case. And still, when a disaster strikes, foodservice operators often learn that something was left out, or they discover that something could have been done better, or differently or more efficiently. Sometimes they even make their discoveries as a result of an incident that occurred in some other part of the country.
Learning from others: “The biggest change we made in our disaster plan came after Hurricane Katrina,” says Jack Henderson, associate director of food and nutrition services at the University of California at San Francisco Medical Center, who heads the foodservice department’s emergency preparedness team. “That’s when we realized that, if this happened to us, the cavalry was not coming over the hill.”
So, as a result of an event that occurred more than 1,900 miles southeast of the Bay Area, UCSF Medical Center now has enough food on hand to continue to feed patients and staff for up to nine days. That includes, Henderson notes, 13,000 MREs (meals ready-to-eat) purchased from the Department of Defense.
Another lesson learned, this time in that aftermath of the 7.1 earthquake the struck northern California in 1989, involved food distribution.
“After that quake, the foodservice director at the time said we would offer food for free to everyone working at the hospital,” Henderson recalls. “Well, they cleaned us out. We had to close the cafeteria. Now, in the event of an emergency, food will be distributed through a ticketing system. Patients will be the No. 1 priority, and everyone working will be entitled to two meals a day, which they claim by turning in a ticket they’ve been issued. If they don’t have a ticket, they don’t get a meal, no exceptions.”
The message is clear: No plan is ever truly tested until it actually has to be implemented, and none is so solid it can’t be tweaked.
Changing on the fly: Like most institutions, 150-bed Memorial Hospital in Carbondale, Ill., has a plan for dealing with power outages, including a means to generate emergency power. However, when a severe storm swept through southern Illinois last May, it exposed a few holes in the plan, according to David Gray, the hospital’s manager of food and nutrition services.
“We have handled power outages before, anything from a few hours to a day, but this storm was so powerful and took out so many trees in a widespread area that we lost power for three days,” Gray recalls. “We learned we had to do things a little differently.”
Some changes could be made on the spot, while others fell into the category, “The next time . . .”
“One of the things we realized quickly was that it would be advantageous to feed staff where they work,” says Gray. “So we sent food to various locations based on employee counts. It prevented people from all crowding into the cafeteria at one time, and it allowed us to better utilize our resources.”
This freed up the cafeteria to be used as a gathering place for nearby residents. “A lot of people flocked to our building because we were one of the few places that had any power,” he notes.
Another benefit was to allow the foodservice department to focus on one task at a time—getting patient meals delivered while the cafeteria was closed, for instance.
“Because we had no elevators, we were manually lugging food up four stories,” Gray explained. “So, we scripted things for employees; 7:30 a.m. to 8:30 a.m. was set aside for delivering patients breakfast, then at 8:30 we opened the cafeteria.
“We also found that a greeter position was very useful,” he adds. “We had someone at the entrance to the cafeteria to let people know what was going on and to spell out how things were being handled.”
Menu choices were drastically reduced, and the fee structure for menu items was simplified, which allowed foodservice to move people through the cafeteria more quickly. The patient menu also was simplified, by making it non-select and limiting patients to one hot meal per day.
“One of the things we discovered was that emergency power was lacking in the foodservice area,” Gray added, noting that there wasn’t enough power to operate refrigerators and freezers. “I had brought this up in the past, but it hadn’t been deemed a priority. We got lucky, because there was a contractor working in the area who came in and rewired our emergency power to our walk-ins and freezers. That saved us probably $20,000 worth of food.”
In the ensuing months, the hospital renovated the emergency power system to prevent foodservice from facing this dilemma again. “The cost of the fix was just about equal to what we might have lost in food spoilage,” Gray says.
Eat, Drink and Be Prepared: The next “best” thing to a real emergency is a self-created one, and a day-long exercise at 21,400-student California State Polytechnic University in Pomona, Calif., has revealed several problems in foodservice that have since been corrected.
The emergency drill was called Eat, Drink and Be Prepared. During the day, each meal served to students simulated a different type of emergency.
“In the morning, foodservice prepared breakfast for the residents without power,” says Debbi McFall, the university’s director of emergency management. “In the afternoon, they prepared lunch without water. In the evening they prepared dinner without a building, simulating an earthquake. Some really great things came out of each meal.”
For example, the no-power portion of the drill uncovered the fact that, even with emergency lighting, there were areas of food preparation where there wasn’t enough light to allow employees to work safely. As a result, lighting in those areas has been enhanced with glow sticks, hard-wired and battery-operated lighting.
“We also learned that in all the operations we need to install more emergency lighting,” says Brett Roth, director of dining services. “We need more portables, battery back-ups for all the cash registers and portable calculators. We also developed procedures for employees working cash registers so they would know what to do if a piece of equipment lost power.”
Another discovery, this one made during the drill’s no-water portion, was the need for a portable hand-washing station. “You can’t imagine how many times that has come in handy when the water has been off,” notes McFall.
Aspects of Eat, Drink and Be Prepared take place several times a year; however, there is no substitute for practicing under actual conditions, McFall says.
“We do one every 12 weeks,” she explains. “We don’t have to do the three meals at the same time; we might do only one meal. Once a year in Housing we do one emergency plan that dining participates in.”
Communication and cooperation are keys to disaster planning success, McFall and Roth agree.
“There are lots of pieces to this stuff,” Roth adds. “Debbi comes to our managers’ meetings so we keep this fresh in everyone’s minds. We talk through the different situations that could come up.”
Regarding the drill, McFall notes, “We learned all kinds of things. Without the partnership it wouldn’t have been possible,” she says. “I could have told them we were going to have a drill, but without their wholehearted participation we wouldn’t have learned a tenth of what we did.”
What if?: Drills are valuable tests of emergency plans, but it can be equally helpful to talk out various scenarios. Several institutions, such as 29,000-student Virginia Tech University in Blacksburg, Va., use what are called “tabletop exercises” as part of their planning.
Ron Angert, emergency preparedness planner for the university, calls the multi-disciplinary discussions a low-cost method of bringing people together to solve real-world problems.
“We can do this for about $200, which is the cost of catering,” he explains.
Recently, Angert enhanced this procedure using video interviews during a discussion of a weather-related disaster.
“In the past we’ve used Power Point presentations with bullet points,” says Angert. “This time we added video interviews with organizations like the local weather bureau to set the stage.”
The exercise in question was a late-season snowstorm hitting southwestern Virginia at about the time commencement was to begin. Angert laid out the scenario, using the videos to add realism, and then it gets the group talking about how they would handle the situation, from preparing and serving food to providing security.
“It is a continuous improvement process,” he notes. “How are you going to pull this off?”
Then, as the discussion wanes, Angert throws in what he calls “interjects,” defined as “other conditions you never thought of, but could realistically happen.” In this case, interjects included a second weather system that brought mixed precipitation to the area, and an unauthorized “kegger” by campus fraternities that added a security issue.
“It is all about the mentality of preparedness,” Angert says of the interjects. “You think it out before it happens so you aren’t surprised.
“The most valuable part of the tabletop exercises,” he adds, “is not what comes out of the scenarios we set, but all the ‘what-ifs’ that the people around the table come up with.”
Foodservice directors in schools and hospitals confront restrictions.
By Becky Schilling
As fears about the spread of H1N1 in hospitals heated up last fall, several hospitals across the country put restrictions in place for both visitors and staff. These restrictions have affected foodservice departments by decreasing sales and leaving staffs shorthanded.
In some hospitals, visitors are being restricted from the grounds, including the cafeteria. Last fall at 211-bed BroMenn Medical Center in Normal, Ill., the community was told not to come to the hospital unless necessary. “There were cases of H1N1 and it was huge,” says Karen Mellon, hospitality manager. “I think the cases have diminished as has the excitement, but in the spring the flu season hits.”
Mellon says since the administration put the word out to stay away except under certain circumstances, people have listened. “For a few weeks the extra traffic through the hospital was kept to a minimum,” Mellon says. “I think that people did heed the warning. If you had a husband, wife or child in the hospital you were here, but if you were coming to visit an aunt or uncle I think it restricted those people. I think that at that point people hadn’t had the H1N1 vaccination and I think they were all scared of that.”
Cafeteria sales dropped during the weeks when the restrictions were in place. “There wasn’t much that we could do,” Mellon says. “We had to understand that there was a reason for the restrictions and hope that they were temporary. The flu thing could have gone both ways. It could have gotten worse, but it’s leveled off, at least for right now.”
At 550-bed University of California San Francisco Medical Center, visitors under the age of 16 were not allowed on patient floors, but the children were permitted in the cafeteria. Dan Henroid, director of nutrition and food services, says he is offering gift cards to the hospital’s cafeteria for those who cannot visit patient floors. “We get a lot of people who have traveled from significant distances to visit patients and they are forced to hang out in the café. One parent will stay with the child while the other parent goes up to the patient floor.”
Henroid says he wanted to be able to give visitors affected by the restrictions a break, so he started offering the gift cards. He has given out 150 since the beginning of November.
For Walter Thurnhofer, assistant administrator of support services at the 450-bed University of Washington Medical Center in Seattle, H1N1 restrictions have hit closer to home. Any employee who exhibits flu-like symptoms cannot come to work.
“We had a meeting with all staff in the hospital and told them every day you need to self-screen and if you have any of the following symptoms—fever, cough, sore throat, runny nose or nasal congestion—you need to stay home,” Thurnhofer says. Employees are not allowed to return to work until 24 hours after their symptoms have resolved. “That’s probably good practice any time, but with H1N1 it’s made everybody more aware of what’s going on. We have trained our supervisors to essentially check employees as they come to work every day to look for these symptoms.”
Thurnhofer says the department has been affected. “Out of about 200 employees, we’ve probably had about 20 to 25 who have shown some kind of these symptoms and been restricted from work—either self-restricted or we have sent them home. This is definitely above average. You are always going to have one or two people who call in sick, but we have made people so aware and we are checking so closely that that number is probably well more than double the usual amount.”
A hospital-wide system is in place to cover sick employees. If a department is short on staff, employees from other departments will help out. Thurnhofer says he can’t have non-foodservice employees help cook, but he says other hospital employees can help with tasks such as tray delivery if the need should arise.
Another byproduct of H1N1 is fear of spreading the virus. “We have customers who have been concerned with self-service and the spread of pathogens and we’ve had concerns ourselves,” Thurnhofer says. “These buffet, self-service, all-day operations are problematic. We can screen people at the door and put out hand sanitizer, but the fact is that some people are going to come through who didn’t wash their hands in the bathrooms or have flu or cold issues and have been touching their nose or eyes and then handle utensils. Then the next person comes along and it’s transmitted.”
In response to these fears, Thurnhofer says the department is moving away from all self-service aspects. The make-your-own sandwich bar has been removed. He has requested money to replace the self-serve salad bar. “We are going to expand our made-to-order sandwich operation and put in a display cooking station. People like to make their own stuff, but many people understand the risk you incur that is just inherent in these open food bars. We want to give customers something back so they feel like they haven’t lost anything.”
Thurhofer is also hoping to change the way utensils are distributed. Right now customers take utensils from a self-serve area. Soon, flatware will be distributed from single-serve dispensers.
Hospital foodservice directors aren’t the only ones facing complications from H1N1. School operators are also feeling the pressure, especially following last year’s massive school closings, which could have left students without a place to receive a nutritious meal.
Beth Palien, child nutrition director for the 3,900-student Asheville City Schools in North Carolina, decided she didn’t want to be caught unprepared should an H1N1 outbreak hit. She worked with the city’s housing authority to set up meal distribution at eight of the city’s housing developments if H1N1 closes schools.
“Our county health department is monitoring for a spike in absentees,” Palien says. “If there is one, we can order food that is easy to transport.”
If the schools close, employees will deliver a lunch and snack to every student under the age of 18 at the eight sites. The H1N1 program is set up like a modified summer feeding program so the department can receive federal reimbursements. Palien says shelf-ready foods will be used for the first couple of days.
“We have the program ready, but we hope we never have to use it,” Palien says.