IT TAKES A VILLAGE to deal with a disaster. Ferocious winter weather and unexpected power outages brought home this theory to J. Craig Higgins, co-owner of respiratory services provider Healthspan.

"What it all comes down to is that everybody does the best they can in a disaster," says Higgins, whose company can trace its Johnson City, Tenn., roots back to the 1930s. "It takes everybody, including the patient and the caregiver, the home care company, local hospitals-all of your community services-to get through it."

Higgins ought to know. Last year, when a vicious snow and ice storm knocked out power for two weeks in the eastern Tennessee and West Virginia region Healthspan services, the company was forced to continue its operations and provide oxygen to customers while literally in the dark. Since Healthspan's liquid oxygen supplier didn't have electricity, its cylinders couldn't be refilled. Higgins got calls from a competitor's patients who were frantic because their oxygen provider couldn't get there. Nurses who worked with ventilator-dependent patients were afraid to leave their posts because the next nurse might not get there.

Each crisis had its own resolution. The oxygen supplier trucked in filled cylinders from out of state. Higgins got oxygen to his competition's panicked patients, many of whom now use Healthspan for their home care. Nurses who had signed on for a 12-hour shift moved in for the week to make sure patients would get the care they needed.

Regardless of the emergency, the objective remains the same for providers whether they are dealing with the recent twisters in Arkansas and Tennessee or hurricanes in Texas. "Our goal is not to have interruption of service for patients," Higgins says. "And if there is an interruption, we ask, 'How do we minimize it?' "

It helps to have a plan, and pretty good radar, when it comes to bracing for what weather-related disasters can do to your business. "You've got to raise your antennae," Higgins says. "You've got to have a little bigger telescope these days. We use the Internet to look at weather maps, watch television reports, read the newspaper. We try to predict what's going to happen."

EVERYONE NEEDS A PLAN BUT EVERYONE KNOWS what often happens to the best-laid plans. After dealing with an emergency situation, Higgins and company re-evaluate the emergency plan that got them through the week or month, and think about ways they can improve upon it.

The Joint Commission on Accreditation of Healthcare Organizations requires providers to have a disaster preparedness plan in place, so the concept of emergency preparedness is not a new one. But after last year's power outage, Higgins realized that making clients a partner in preparation is crucial to the planning process.

"I'm a big advocate of people whose health or well-being is compromised creating their own emergency preparedness plan," Higgins says. To raise community awareness, Healthspan puts out press releases on the subject when winter is around the corner.

People who use oxygen or are on a ventilator or who use an electric hospital bed need to think about the consequences of losing power, heat or water, Higgins says. They should be aware of the need to develop contingency plans, such as arranging for transportation to the home of a friend or relative or a shelter or hospital. Last year, at least 30 Healthspan patients were rescued from their homes by employees with four-wheel-drive vehicles and taken to shelters so their concentrators or other life-support systems could be hooked up, Higgins says.

"We just got bombarded last year with all the needs of this region," he says. "When that terrible weather system came through, the local Red Cross was overwhelmed. They said that they were not instructed on how to assist with the needs of the medical population out here in the '90s. They said they were trained to provide disaster relief for the general public. I said, 'Ma'am, the general public now includes lots of home care patients you didn't have before. This is the general public.' "

FAILING A PLAN PUNT ON A BITTERLY COLD January day, Priscilla Jackson, general manager of Star Home Health Care in suburban Detroit, talks about how hard it is to go about the business of delivering home medical equipment when the streets are piled high with snow. Keeping it together all boils down to a matter of prioritizing, she says.

"Our No. 1 concern is respiratory care," Jackson says. "We try to make sure their needs are met first. Our patients know that, if they are out of oxygen, we would weather the storm and walk it to their houses if necessary."

One employee suggestion that came out of experience is asking the family to help out when a delivery seems impossible. When a family caregiver can get to a mutually agreed upon location, the equipment is then handed off. Employees also have been known to pull over to the side of the road and walk equipment in when they can't travel any farther. Oftentimes, drivers will park on the main street, then walk three or four blocks down a side street to make the delivery, Jackson says.

But what if you're out, say, in the proverbial middle of nowhere and need to get to a patient? You might try slapping on a pair of skis to get to the snowed-in home of a patient. That's what a nurse did last year near Yellowstone Park, says Richard Saravelli, development director for West Mont, Montana's largest not-for-profit home health care agency.

That's not an uncommon attitude for a Montanan to adopt, or for people who populate and do business in the more rural areas of the country, he says. "We're a very independent lot, and being king of our domain is pretty important. Home care just fits into the value of the rancher," Saravelli says. "What started our state out here in the early years-the trappers, the ranchers-were people who took care of themselves. Home care falls right into that tradition."

Doing business when home care is on the range does have financial drawbacks, Saravelli admits. It's hard to try to keep costs down even in the best of weather when doing business automatically means having to journey long distances and travel to hard-to-reach places.

HAVE A LITTLE FAITH "WE JUST GET THE TRUCKS out on the road, keep them there and pray," says Patrick Egan, president of Mercy Medical Equipment in Buffalo, N.Y, half-jokingly. "But really, you just do whatever you can. It's a struggle, and there is no way to plan for it."

During a treacherous snowstorm this winter, 70 percent of his employees could not make it to work. Regular operations were shut down, and the only deliveries made were those considered emergencies, such as liquid oxygen or the replacement of a concentrator or ventilator. The small staff worked the phones to identify which deliveries absolutely had to be made that day. The disaster-preparedness plan that JCAHO requires them to have in place helps because it specifies that providers must have detailed information available regarding the status of patients, Egan says.

When the going gets tough weather-wise, Egan doubles up drivers so someone can always stay with the truck and help keep it from getting stuck somewhere. Three of Mercy Medical's 10 trucks made it out on the road that day. "Thankfully, that only lasted one day," Egan says. "It costs us a lot of money to put off most of our deliveries from one day to the next. We had to run overtime for the rest of the week."

WHEN ALL ELSE FAILS, TRY PLAN 'B' AT WALLA WALLA HOME MEDICAL, the emergency plan is informal, says Mars Alderson, office manager of the Washington state HME company. Common-sense tasks are attended to before the cold weather months hit, such as winterizing delivery vehicles and putting on snow tires. Any time someone is on call, another employee is designated as a backup, in case there's trouble with phone lines or roads.

The most important policy is one that literally gives oxygen-dependent patients room to breathe. "Every single one of our concentrator patients has a gaseous backup, a portable for power outages," Alderson says. "Everyone has at least five hours of oxygen. That's been our policy from day one."

In the past, many providers might have said "that they weren't a rescue squad," Higgins says. "But there are so many more people in home care situations now, that when an emergency or disaster presents itself, you've got to be compelled to help them."

And find a way to do it no matter what. With the complex health care now administered via home care, Higgins says providers need to operate their businesses like an emergency room that's open 'round the clock 365 days a year. HC

TO MAKE THE BEST a potentially bad situation, make sure patients know how to do their part in an emergency, says J. Craig Higgins, co-owner of Healthspan, Johnson City, Tenn. Explain to them what could specifically go wrong.

Patients should ask themselves:

* What am I going to do if I lose gas or electric power or water? "They need to understand that all the questions aren't medical," Higgins says.

Explain that their home health nurse or other aide may not be able to get there, or that the oil company may not be able to get oil to their furnace.

OTHER TIPS INCLUDE:

* Make provisions to contact outside relatives.

* Make a plan in case your home care company can't get in touch with you or make the delivery.

* Know where the nearest shelter is.

* Make family members aware of emergency needs, and, further, create a plan to provide assistance.

"DOES YOUR STAFF KNOW what to do after an earthquake or blizzard? Which of your patients would be most endangered in the event of a power outage? Whom should local authorities call in the event of an after-hours disaster at your facility?"

These startling questions are in the introduction to the Emergency Preparedness in Home Care Handbook published by the National Association for Medical Equipment Services and available for purchase with a video of the same name. The handbook is filled with helpful tips, such as predicting what obstacles the weather might bring, how to assign risk levels to patients, questions to ask yourself to set up your own emergency preparedness plan, and how to communicate during an emergency.

For NAMES members, the video and study guide are $145 for the set, or $125 for the video and $30 for the handbook. For nonmembers, the video is $190 and the handbook $70. For more information, call NAMES, 703/836-6263.