should disaster strike

Monday, August 15, 2011

The middle of August marks the start of back to school shopping, cooler nights and the start of the NFL pre-season. The exhibitions allow teams to evaluate player performance, coaching strategy and game planning when the results don’t really matter. New careers are started and veterans see their opportunities wane. The attention to detail and attempts to predict future performance also occur in medicine. Hospitals and communities spend significant time and effort disaster planning, evaluating personnel, equipment and game plans.

Disaster planning and readiness is a key component in hospital accreditation. It is not done in isolation because community involvement is necessary to deal with issues that are often beyond the bounds of the hospital walls. Police, fire and emergency medical services need to know how to respond to any number of disaster situations and be prepared to cordon off the disaster area, assess victims in the field and decide who goes where for treatment. Training exercises are expensive and time consuming to plan and execute but are important to get people ready to perform and to learn what holes exist in the system. Since there are many agencies involved that can cross all levels of government, job descriptions and responsibilities need to be assigned well in advance. The heat of battle is not the time to bicker about who does what.

Hospital disaster drills are often a disaster in themselves. Think of playing an NFL exhibition game on the same field, at the same time as a regular season game. That is the difficulty of arranging for a disaster drill in a busy hospital. On a normal day, the ER, operating rooms and ICU are busy caring for real patients, and when dozens of “fake” disaster victims show up at the door, chaos can ensue. The ability to care for both groups is an important consideration since in real disaster situations, the regular patients don’t go away.

Planning involves both personnel and facility. Since hospitals are at work 24 hours a day, disaster mobilization needs people to run toward the disaster instead of away from it. Aside from the frontline doctors and nurses, workers behind the scene are just as important. There will be an increased need for clean sheets, sterile equipment and medications. Workers need to be fed and housed. Where patients are put is another significant strategy when space is at a premium. Maintenance and engineering are also important players.

Communication is key. Incident command centers at the disaster scene need to know which hospital can accept what patient and how that patient is going to get there. Command centers at hospitals update their status to ambulances and to scene commanders. This ballet needs a traffic cop and disaster planners are often assigned roles regardless of ego or title.

Occasionally, multiple agencies get together for a mass disaster drill. An example scenario might involve a train derailment with injuries and a toxic chemical spill. Imagine the number of organizations that might be involved, from first responders, police and fire departments, to ambulance services and hospitals, to HazMat teams and the DNR. If a waterway is involved, the Coast Guard might show up. National guard troops could be mobilized as could terrorist response team. Learning how to get along and work as a team is a major part of disaster planning and management.

Disasters come in all sizes and shapes from weather and earthquake to mass casualty accidents and terrorist threats. Just like in football, there is a playbook to be learned. Hospitals have to evaluate, revise and go through disaster preparedness every year to maintain their accreditation. There are plenty of study sessions with individual groups working on their part of the plan and tabletop walk throughs occur where managers devise strategy. Sometimes, though, you have to put on the pads and actually coordinate a disaster drill and hope that the real one never happens.

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