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What if hundreds of people sought help in our emergency rooms? Do we have the capacity to care for them? What if important access roads like Clifton Road and Peachtree Street closed indefinitely to everyone except emergency vehicles? How would clinicians, staff, lifesaving drugs, and supplies get to the hospital? How long could our hospitals operate? What if power were interrupted, water supplies and communications cut off? How would we communicate with families, the authorities, and the media? Some of those "what ifs?" were not so far-fetched last fall when it became clear early on that Emory Hospitals, like their counterparts across the nation, were vulnerable in this new world of terrorism. Today, the hospital's response to code blue -- the universal page for internal or external disaster -- has taken on new meaning. Since the terrorist attacks, 20 teams, representing every corner of Emory Hospitals, have explored their worst fears, brainstormed bioterrorism scenarios, and developed new roadmaps for managing a myriad of possible crises. Their task is not just revising disaster preparedness plans, but figuring out how to spread and integrate unprecedented amounts of new medical information quickly. "Before the publicized anthrax events last October, we would have treated the reality or potential of an anthrax case far differently than we would now," says James Augustine, vice chair for emergency medicine. "The only historical comparison we have is the spread and discovery of HIV, which took years to understand." The hospitals' new readiness plan includes fact sheets on diseases ranging from anthrax to smallpox to the plague. While infection control experts are well versed on the transmission, symptoms, risks, and treatment of these deadly diseases, it's harder to get the appropriate information to the appropriate people. To help manage information, the revised plan calls for a formal, military-style chain of command and communication -- similar to that refined by firefighters and adopted by public health agencies -- rather than the team approach formerly used in the heat of a crisis. Armed only with staff and materials on hand when a crisis begins, the hospitals must be prepared to sustain themselves until help from public agencies is available. "We can keep the hospitals operating at normal capacity well beyond the required 24 hours," says Lee Partridge, director of materials management. Emergency generators can keep the hospitals running for three to four days, oxygen is stocked for five to six days, and there's enough drinking water in each of the hospitals to last for three or four days. Critical medical supplies and pharmaceuticals are stockpiled on campus, and vendors have prepulled emergency medical supplies ready to be delivered on a moment's notice. And if roads are closed due to security concerns (as Clifton was on September 11), emergency supply trucks with government escorts will have access the hospital. |
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or Emory Hospitals, the September 11 terrorist attacks begged the question, "What if?..."
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To prepare staff for crisis mode, the hospitals have tested decontamination areas, rehearsed hospital lock-downs, and conducted hospital-wide bioterrorism drills. Emergency triage sites to accommodate mass casualties can now be set up in minutes at the loading dock next to Crawford Long's emergency department and in the valet area at Emory University Hospital. Wesley Woods Center will accept patient overflow, and Budd Terrace on the Wesley Woods campus can convert an entire floor into a patient overflow area or an isolation unit. As hospitals plan for the worst, they also must balance the cost of upgrading emergency response capabilities with the cost of daily operations. For example, reliance on pagers, cell phones, fax machines, and computers could cripple the disaster response team if power or cell phone service shuts off. One alternative is to buy radios for all key personnel, but that carries a hefty price tag -- $2000 each -- in a time when hospitals are already facing tight budgets. Another concern nationwide is ongoing communication with other hospitals and public health agencies -- adequately tracking diseases and symptoms and continuously sharing information. "We could have people showing up in our emergency department with the same symptoms as those at the Grady ER. That's why staff education and a decent surveillance and communication system are so important," says Betsy Hackman, director of infection control. "We're gearing up for any type of catastrophe," says Augustine. "We used to be concerned with things like chemical tank spills and school bus crashes. Now, we're thinking in terms of treating hundreds to thousands of patients at a time. It's an uncomfortable reality, but we've got to face it and be prepared."
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Web version by Jaime Henriquez.