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3 2 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U N E 2 0 1 6 and author of the bestselling book "Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital," the culmination of 6 years of reporting into what hap- pened in those desperate days at Memorial. In her OR Excellence presentation, Dr. Fink will take you inside a hospital fighting for its life and into a conversation about the most terrifying form of healthcare rationing. Dr. Fink will also challenge you to make ethical patient care decisions in high-stress situations, to make tough choices under circumstances you hope you'll never experience but for which you need to be prepared. • Disaster preparedness. The doctors and staff at Memorial had drilled for disas- ters, but for scenarios like a sarin gas attack, where multiple pretend patients arrived at the hospital at once. Never had they drilled for the simultaneous ravages of a hur- ricane and flooding. Memorial was situated on one of the low points in the bowl that is New Orleans, 3 feet below sea level, but amazingly nowhere in its hundreds of pages of emergency preparedness plans was there a plan for evacuating over water. • Disaster-plan around your vulnerability. Yes, it's hard to grapple with worst-case scenarios, but my argument is we need to think about those and plan realistically. For example, Memorial's main emergency power transfer switches were located only a few feet above ground level, leaving the electrical system vulnerable to flood waters. This was a big infrastructure vulnerability. A major flood would certainly result in the hospital losing all power, yet they failed to fix that vulnerability or plan for the reality of it. • What's your vulnerability? What's the vulnerability in your area: hurricanes, earthquakes, tornados, terrorist attacks or pandemic influenza? Plan around what are the likeliest of the unlikely scenarios that can hit you. You need to know what is the problem in the place where you work. Memorial was not prepared when Hurricane Katrina hit. • Healthcare Ethics 101. I'm going to ask tough questions to help prepare attendees for ethical decision-making during high-stress situations. Should lifesaving interventions, including evacuation, go to the sickest first? Doctors at Memorial decided that the sick- est individuals in the hospital — including all patients with Do Not Resuscitate orders — were to be evacuated last, an idea that was nowhere in the hospital's disaster plans.