Are you prepared?

For all intents and purposes, Haley Perry, O.D., was trapped. 

Isolated from the outside world inside a two-mile radius of Arden, North Carolina, a suburb of south Asheville, Dr. Perry and family found themselves hemmed in by downed power lines and trees, flooding and mudslides—simply cut off. 

“Hurricane Helene had a profound impact on our community and our practice, bringing significant challenges,” Dr. Perry said, nearly two months later. But even then, she was still living the fallout of the “once-in-a-thousand-years rainfall event.” 

It took two weeks for the power to return and three before the internet came back online, conservative estimates to be sure. It was seven weeks before Asheville’s water was safe to drink again, and months before crews would reopen a vital stretch of Interstate 40, which had collapsed into the Pigeon River Gorge. 

Dr. Perry’s Elite Eye Care sat closed that first week, hindered by the lack of internet and communications. They couldn’t process payments. So, her team offered a free clinic for patients who lost glasses. They partnered with a local competitor, Tunnel Vision, to share office space for a glasses and winter coat drive. But some businesses couldn’t reopen—think local restaurants lacking clean water. A “vibrant food scene” and tourism draw just vanished, especially heartbreaking, Dr. Perry says. 

“The recovery process has been challenging but it’s strengthened our community’s resilience,” she adds. 

Extreme weather events, such as Helene’s deluge in September 2024 that affected eight states across the southeastern U.S., show a worryingly increasing trend in recent years. Such events are difficult to forecast and still harder to plan for, especially when trying to keep a business solvent. So, how can optometry practices plan for the unthinkable? 

The state of play

“Extreme weather,” by definition, is a weather phenomenon occurring at the far outliers of historical weather data distribution. In other words: weather that rarely occurs at a particular place and/or time, with unusual intensity and scope or probability of occurrence. The term “100-year events” is often tossed around, a phrase coming about from the 1960s’ National Flood Insurance Program as a standard for flood modeling, e.g., the “100-year flood.” Then there are “1% events” or “1% storms,” which describe events with infinitesimally small chances of occurring in any given year. 

But if that were the case, why do we keep hearing about 1% storms? Because frankly, the 1% storm may no longer be the 1%. Extreme weather events are increasing, whether you view it by meteorological data or their financial toll.  

Consider this: The prevalence of extreme, single-day rainfalls was steady between 1910 and the 1980s, but rose substantially into the 2020s. In fact, nine of the top 10 years for extreme, single-day rainfalls have occurred since 1995, notes the U.S. Environmental Protection Agency (EPA). Or consider that heat wave frequency, duration and intensity have measurably increased since the 1960s. Record-setting daily high temperatures have become more common than record lows, the EPA says. And while the number of tropical cyclones in the North Atlantic has fluctuated considerably since the 1950s, cyclone intensity has grown measurably, with eight of the 10 most active hurricane seasons occurring since the mid-1990s. 

When coupled with human factors, such as outdated forest management plans creating tinderbox situations in the U.S. West, widespread coastal development in areas prone to sea-level rise, and dams and flood risk-management structures counterintuitively contributing to greater flooding, those extreme weather events have a magnified human toll. 

While organizations from the National Oceanic and Atmospheric Administration to the EPA, the American Public Health Association to the World Health Organization, have devoted significant time and effort to increasing public awareness of the human health consequences of extreme weather, state and federal health and human services agencies have developed emergency preparedness guides for the health practitioners themselves. 

“Sound, timely planning provides the foundation for effective emergency management,” the Centers for Medicare & Medicaid Services notes in their Health Care Provider Guidance for emergency preparedness. “A coordinated response is essential.” 

Applying lessons learned 

But how do you prepare for the monster you never expect? No one could know at the time that Helene would become the worst tropical storm in North Carolina’s history—some 300 miles from the nearest coastline. It simply caught many off guard, including Ryan Corte, O.D. Away from his Asheville practice, presenting in Michigan, Dr. Corte didn’t have Helene on his radar until the day before landfall. By Thursday, Sept. 26, it became clear that there would be a significant impact back home, so the practice opted to close. By Friday, flights were getting canceled, including Dr. Corte’s connector midflight.  

“In western North Carolina, we’re accustomed to heavy rainfall due to our location in a temperate rainforest, but this storm was on an entirely different scale—unlike anything we’d ever seen before,” Dr. Corte explains. “Closing early was the right decision to ensure the safety of our patients and team, but the aftermath was far greater than what anyone could have anticipated,” he says. 

For seven hours that Friday, Dr. Corte tried navigating a rental car around downed trees and flooded roads between Charlotte and Asheville before returning to the former. It wasn’t until Saturday that Dr. Corte made it through. 

And when he did, the atmosphere was simply surreal: people in a state of shock, wandering aimlessly or assisting wherever they could. Local authorities and volunteers worked with chainsaws to clear roads or assist stranded travelers. Dr. Corte says it was equal parts devastating and inspiring to witness communities coming together amid catastrophe. 

“The experience taught me that mountains and hurricanes are an unpredictable and dangerous combination,” he says. “I never imagined a hurricane would strike the mountains of WNC with such force.” 

Further, the whole experience taught Dr. Corte lessons in preparing his practice. Like the COVID-19 pandemic, Helene brutally reinforced the importance of maintaining a financial surplus. While neither of his practice locations sustained physical damage, the surrounding communities were devastated. It would be months before a semblance of  normalcy returned to the shattered area, including the practice’s routine business. 

“Ensuring the safety of our team and patients was our top priority,” Dr. Corte says.  

“Moving forward, we’ll continue to prioritize proactive communication and financial resilience, ensuring that we’re prepared to support our team and community in the face of future unforeseen challenges.” 

Developing your plan 

And that preparation is key. Having the fallback of a thoughtful, comprehensive plan is critical in times of crisis.  

So, consider creating a business continuity plan (BCP). This document outlines the critical procedures and processes that must be accomplished to keep the practice or clinic operating in the event of a significant disruption of business. When the worst happens, a well-thought-out BCP is something a practice can lean on when the situation devolves. 

Begin by identifying potential threats and their likely impact on business function, e.g., loss of utilities for an indeterminate amount of time due to severe weather and how that may affect electronic patient information or practice file retrieval, patient and vendor communications, and refrigeration loss for clinical products. What’s the plan for communicating with staff if there’s a cellular outage? What happens if an emergency happens in the middle of providing patient care? The more work put into the comprehensiveness of the BCP upfront means the greater efficiencies and leverage it creates when it’s called upon. 

Use staff meetings as opportunities to brainstorm emergency situations and their likely consequences, and make sure someone takes notes. Compile these scenarios into your BCP and develop any additional policies or procedures specific to employees’ roles. In addition to regularly reviewing and updating your BCP, pressure test it through periodic drills and reinforce through staff education or training opportunities. 

Many doctors need only rely upon recent experience with the COVID-19 pandemic for one important lesson that both Drs. Corte and Perry mentioned for disaster recovery: financial resilience. Things such as deferring payments, opening lines of credit for emergencies, and securing Small Business Administration loans—remember those Emergency Injury Disaster Loans—to maintain stability, Dr. Perry says, were critical steps. 

“This knowledge was invaluable when navigating the disruptions from Helene, as we leveraged these same COVID-19 strategies to support our recovery,” she says. 

So, too, Dr. Perry reiterated the importance of having cash on hand for when internet connectivity fails and electronic payments are impossible. Lastly, she has now equipped her office—and home—with back-up generators and Starlink internet, so they are prepared for whatever lies ahead. 

Looking toward recovery 

But even best-laid plans go awry. All the planning and preparation still won’t stop a force of nature. As G. Timothy Petito, O.D., knows, you can only do so much. 

“At some point we have to be at peace that we’ve done all we can do,” Dr. Petito said as he actively evacuated his St. Petersburg, Florida, practice ahead of Hurricane Milton in October. Only two weeks removed from Helene, western Florida took the brunt of another category 3 storm that was forecast to be a worst-case scenario for Dr. Petito’s practice. Adjacent neighborhoods still had Helene debris heaped on curbs from the storm surge when Milton took an ill-fated turn toward Pinellas County.  

“As small-business owners, we worry about the financial toll of disasters,” Dr. Petito says. “We plan for as much as we can by building or renting sustainable buildings, insure against foreseeable risks and react when we can to the maximum extent possible. But at some point, we have to be at peace that we’ve done all that we could do. The most important thing is to protect your staff and yourself.” 

As it were, Milton made landfall farther south of Tampa Bay, sparing the community of the 12-to-15-foot storm surge that had been forecasted. But still, 18 inches of rainfall and hurricane-force winds had their way. Many patients were displaced, Dr. Petito says, some likely to never return. While the practice sustained relatively light damage, the economic toll has been significant—Dr. Petito estimates a slowdown of at least six months. 

“Overall, we fared better than many of our neighbors and were blessed,” he says.  

Even with a month remaining in the 2024 hurricane season, early reports estimated U.S. economic losses from just five hurricanes to be between $127 billion to $129 billion. That would make this last season one of the more costly in modern record, behind those of standouts in 2022 and 2017.

The critical situation playing out across the U.S. Southeast prompted The AOA Foundation to issue an emergency appeal for donations to Optometry’s Fund for Disaster Relief (OFDR) to which the profession rapidly responded: some $231,000 in donations—$100,000 from EssilorLuxottica, $50,000 each from the Healthcare Alliance for Patient Safety and AOAExcel®, and over $31,000 in individual donations. 

The AOA Foundation awarded OFDR grants to 28 doctors across four states after quickly processing and reviewing applicants. Applications abounded with notes of catastrophic damage, lack of utilities and cellular service, transportation difficulties and water damage. 

“We are proud to provide critical resources to help ensure optometrists can continue to serve their communities during these challenging times,” noted AOA Foundation President Belinda R. Starkey, O.D. “We appreciate the gifts that have been donated, including those from members and our corporate supporters. Given the forecasts, the need will be great.” 

Dr. Starkey’s words are a poignant reminder: The climate data does suggest extreme weather is all but certain. It’s up to doctors and their practices to prepare as best they can. And when the unthinkable happens, OFDR stands ready to help weather any storm.