"It Was a Cold Day in Hell When Texas Froze Over": Development of a Frostbite Treatment Interdisciplinary Decisional Capacity Protocol Following a Mass Casualty Event

On February 10th, 2021 three severe winter storms led to freezing temperatures resulting in a massive electricity grid failure in Texas. Over 4.5 million Texan households and businesses were stranded without water, food, and heat for days (1). This disproportionately impacted vulnerable Texans including those with chronic mental illnesses, severe substance use disorders, and those with limited access to social determinants of health and minorities with greater structural vulnerabilities (particularly Black and Latinx communities) (2). This led to a mass casualty event of people with frostbite presenting to an academic, tertiary care hospital in three waves.



This presentation will discuss insights from the development of a frostbite treatment interdisciplinary decisional capacity protocol following this mass casualty event. This interdisciplinary group included C-L psychiatry, surgery, burn service, ethics, social work, and chaplain services. The group created a working document operationalizing the workflow for patients with frostbite with collaborative approaches when patients without capacity have emergent, urgent, and non-emergent frostbite care needs. The medical care included intravenous antibiotics for the treatment of sepsis, debridements of necrotic tissue, amputation of limbs, and subsequent formalization of amputations. These unique cases led to the following challenging situations: capacity consultations considering the aftercare for individuals to minimize the vulnerability arising from inability to navigate homelessness, coordinating behavioral emergency response teams for patient and staff safety, and supporting staff moral distress when providing urgent medical care to incapacitated patients due to delirium, severe substance intoxication, and serious mental illness. This document was individualized for a patient centered approach for each of the patients with frostbite. This presentation will also include original data on the patients treated for frostbite including their psychiatric and medical histories, the results of their capacity evaluation(s), and their care outcomes. This presentation will detail specific ways that C-L psychiatry can be instrumental in interdisciplinary responses to mass casualty events that may become more common and more severe as global climate change continues to accelerate “global weirding” events, even in places that are not used to managing such events (3). We aim to apply a social justice perspective on challenging ethical and interdisciplinary collaborations that were successful in rapidly advancing knowledge and strengthening the medical community between C-L and our interdisciplinary colleagues.



References:

1. 
   Wright W, Robertson C. Burst Pipes and Power Outages in Battered Texas. The New York Times. 2021 Feb 17; Available from: https://www.nytimes.com/live/2021/02/17/us/winter-storm-weather-live
   
   

1. 
   Metzl JM, Hansen H. Structural Competency and Psychiatry. JAMA Psychiatry. 2018 Feb 1;75(2):115-116.
   
   

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   APA. Climate Change and Mental Health Connections. Available from:https://www.psychiatry.org/patients-families/climate-change-and-mental-health-connections