Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients

Hiram A. Gay, Roberto Santiago, Betty Gil, Carlos Remedios, Pedro J. Montes, Javier López-Araujo, Carlos M. Chévere, Winston S. Imbert, Julia White, Douglas W. Arthur, Janet K. Horton, Reshma Jagsi, Rachel Rabinovich, Sushil Beriwal, Akila Viswanathan, Beth A. Erickson, Ramesh Rengan, David Palma, Billy W. Loo, James A. KavanaughJeff Bradley, Sue S. Yom, Paul M. Harari, Omer Lee Burnett

Research output: Contribution to journalArticle

Abstract

Purpose: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. Methods and materials: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. Results: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of “Prepare, Communicate, Operate, Compensate.” Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. Conclusions: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.

Original languageEnglish (US)
JournalPractical Radiation Oncology
DOIs
StatePublished - Jan 1 2019

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Cyclonic Storms
Puerto Rico
Radiation Oncology
Disasters
Radiotherapy
Communication
Emergencies
Guidelines
Dose Fractionation
Uterine Neoplasms
Rain
Islands
Cervix Uteri
Uterine Cervical Neoplasms
Prostatic Neoplasms
Neck
Head
Breast Neoplasms
Lung
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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Lessons Learned From Hurricane Maria in Puerto Rico : Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients. / Gay, Hiram A.; Santiago, Roberto; Gil, Betty; Remedios, Carlos; Montes, Pedro J.; López-Araujo, Javier; Chévere, Carlos M.; Imbert, Winston S.; White, Julia; Arthur, Douglas W.; Horton, Janet K.; Jagsi, Reshma; Rabinovich, Rachel; Beriwal, Sushil; Viswanathan, Akila; Erickson, Beth A.; Rengan, Ramesh; Palma, David; Loo, Billy W.; Kavanaugh, James A.; Bradley, Jeff; Yom, Sue S.; Harari, Paul M.; Lee Burnett, Omer.

In: Practical Radiation Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Gay, HA, Santiago, R, Gil, B, Remedios, C, Montes, PJ, López-Araujo, J, Chévere, CM, Imbert, WS, White, J, Arthur, DW, Horton, JK, Jagsi, R, Rabinovich, R, Beriwal, S, Viswanathan, A, Erickson, BA, Rengan, R, Palma, D, Loo, BW, Kavanaugh, JA, Bradley, J, Yom, SS, Harari, PM & Lee Burnett, O 2019, 'Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients', Practical Radiation Oncology. https://doi.org/10.1016/j.prro.2019.03.007
Gay, Hiram A. ; Santiago, Roberto ; Gil, Betty ; Remedios, Carlos ; Montes, Pedro J. ; López-Araujo, Javier ; Chévere, Carlos M. ; Imbert, Winston S. ; White, Julia ; Arthur, Douglas W. ; Horton, Janet K. ; Jagsi, Reshma ; Rabinovich, Rachel ; Beriwal, Sushil ; Viswanathan, Akila ; Erickson, Beth A. ; Rengan, Ramesh ; Palma, David ; Loo, Billy W. ; Kavanaugh, James A. ; Bradley, Jeff ; Yom, Sue S. ; Harari, Paul M. ; Lee Burnett, Omer. / Lessons Learned From Hurricane Maria in Puerto Rico : Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients. In: Practical Radiation Oncology. 2019.
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abstract = "Purpose: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. Methods and materials: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. Results: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of “Prepare, Communicate, Operate, Compensate.” Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. Conclusions: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.",
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AU - Santiago, Roberto

AU - Gil, Betty

AU - Remedios, Carlos

AU - Montes, Pedro J.

AU - López-Araujo, Javier

AU - Chévere, Carlos M.

AU - Imbert, Winston S.

AU - White, Julia

AU - Arthur, Douglas W.

AU - Horton, Janet K.

AU - Jagsi, Reshma

AU - Rabinovich, Rachel

AU - Beriwal, Sushil

AU - Viswanathan, Akila

AU - Erickson, Beth A.

AU - Rengan, Ramesh

AU - Palma, David

AU - Loo, Billy W.

AU - Kavanaugh, James A.

AU - Bradley, Jeff

AU - Yom, Sue S.

AU - Harari, Paul M.

AU - Lee Burnett, Omer

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