Preparing for Potential Disaster: Hospitals on the Frontline

On September 11, 2001, the Emergency Department at Saint Barnabas Medical Center acted as the command center for Saint Barnabas Health Care System’s disaster plan, which was activated in anticipation of the arrival of victims of the World Trade Center attack.

Instead of the expected influx of injured patients, the Emergency Department experienced the same level of eerie silence that occurred at many New York and New Jersey hospital emergency departments. Most of the unfortunate victims never survived the collapse of the giant structures. Combined, the System hospitals treated 103 people; 57 people were treated at Saint Barnabas Medical Center and five of those received care in the Saint Barnabas Burn Center.

In the wake of the attack and subsequent anthrax scares, hospitals in the Saint Barnabas Health Care System re-examined and solidified their previous disaster plans, which had addressed such events as a flu epidemic, hurricane and other natural disasters, or a small scale building collapse. The current disaster plan, which has been given a $4.1 million budget for equipment and training, has been augmented to include potential biological or chemical terrorism or radiological incidents. “Under the direction of Ronald J. Del Mauro, President and Chief Executive Officer, our System’s leadership role in disaster preparedness has been recognized on a national, state and local level,” says John A. Brennan, M.D., Vice President for Emergency Services, and Co-Chair of the System’s Domestic Preparedness Committee. “Our System’s disaster plan addresses how to identify a threat, communicate it to the proper local, county and state departments and to the public, coordinate resources to address the situation and provide the necessary medical care to our patients.”

MAKING PREPAREDNESS A PRIORITY
Dr. Brennan chairs the System’s Domestic Preparedness Committee with Nancy E. Holecek, R.N., Senior Vice President for Patient Care Services, and Stuart B. Weiss, M.D., Director of Disaster Preparedness and Associate Director for Prehospital Care. There is also System participation in disaster planning at the county and state level. Mr. Del Mauro chairs the Infrastructure Advisory Committee of the New Jersey Domestic Security Preparedness Task Force for Health Care. Ms. Holecek was Co-chair of Governor Jim McGreevey’s Transition Committee for Health and Senior Services; while Drs. Brennan and Weiss serve on the McGreevey domestic preparedness committee that has been charged with creating a state plan to integrate local, state and federal health initiatives.

The System’s Domestic Preparedness Committee, which meets on a weekly basis, is comprised of specialists in such areas as pharmacy, supply, materials management, infection control, security, and information technology with eight subcommittees: Hazardous Materials/Chemical, Biologic, Radiological Incidents; Mass Casualty Incidents; System Incident Command Center; Training and Education; Pathology/Laboratory; Resource Management/Pharmacy; Security/Infrastructure Support; and Community Health Surveillance.

The Committee’s mission is to prepare for any terrorist events, natural disasters or public health emergencies; to protect employees, physicians, patients, and hospital property; and to educate the staff, the community, and government leaders on the important health care issues.

“In my experience, the more educated the population is about potential threats and the plans in place to address them, the less anxious the climate,” says Dr. Brennan, who received training on how to address biochemical or radiological incidents while serving as a physician in the military, and who also completed the Federal Emergency Management Agency’s train-the-trainer course.

“By increasing the community’s level of awareness, we can decrease the level of fear.”

THE VITAL ROLE OF HOSPITALS
In the event of a biological, chemical or radiological event, hospitals would be on the frontline of medical care for the first 8-24 hours, after which time state and federal government programs would be activated and “pushpacks” (50 tons of medical supplies for treating up to 846,000 patients for three days) would arrive.

Dr. Brennan says that, historically, more than 80 percent of victims of a hazardous materials disaster are not treated at the scene but instead selftriaged to local emergency departments. Initially, local hospitals would be the primary providers of first aid, antidotes and decontamination.

Recognizing the need for proactive planning, the System hospitals have made great progress in preparation for possible disaster:

• Each hospital will have a mobile disaster trailer equipped with inflatable decontamination units, decontamination
  showers, personal protective equipment for staff to treat the victims, and pharmaceutical, burn and
  trauma supplies.
• Comprehensive flip charts with CDC-recommended procedures and treatments for a variety of unusual
  illnesses have been distributed to all 4,600 System physicians. The charts could be especially helpful because “very few physicians have ever treated smallpox or other biological diseases,” says Dr. Brennan.
• A domestic preparedness hotline (866-739-1035) with trained health professionals was activated in mid-
  October.
• A guide for recognizing and treating anthrax was distributed to medical personnel throughout the System.
• All hospital employees are attending an educational program on the appropriate process for a biochemical
  event. Everything from procedures for security guards for containment of a biological outbreak to scripts for employees who may receive a phone call about an incident has been inacted.
• A command center will be established at Saint Barnabas Medical Center, from which the efforts of all the other System hospitals would be coordinated. Five levels of communication among the sites have been established: telephone, Internet, Intranet, cellular/satellite telephone, and fax. Health care, security and resource management decisions would flow from this central location.
• The Domestic Preparedness Committee has been working closely with state and local public health offices to further community health surveillance. “Physicians and veterinarians are the first to become aware of abnormal disease patterns in humans and animals,” says Dr. Brennan. “Our doctors are trained to recognize signs of a biochemical event, such as an outbreak of disease at an unusual time of year, in an unusual age group or occurring in a number of patients from similar
  circumstances, such as a concert.” 

Dr. Brennan relates that the efforts of the System have been combined to deliver one message to the public. “Our hospitals will provide a coordinated, unified response to any disaster.”