|A newsletter for research & medical education||August 2014|
Tornados and Hurricanes and Explosions, Oh My!
Federal Grant Helps Baystate Plan For Disasters
In March of this year, the NICU was scrambling to evacuate patients and staff. Windows had been blown out and power lost after a helicopter swerved into the Wesson Women’s building and crashed into the ED parking lot spilling jet fuel across the pavement. Fifteen fragile NICU babies, their life-saving equipment, and medical records had to be moved to the PACU, two buildings away and down a flight of stairs.
In this carefully planned drill, staff grabbed pre-stocked backpacks and flashlights, loaded the patients into newborn/neonatal evacuation baskets, and following the directions of wayfinders along the route, arrived to find the PACU ready to receive them, having been set up by a neonatologist and a discharge planner.
Mastering Disaster: Planning For the Worst
Tom Lynch, Director of Security, directs such drills and other preparedness actions through a Hospital Preparedness Program (HPP) grant. HPP provides resources—$228.5 million in total grant awards in 2014—to ensure that communities can respond effectively to disasters, whether a hurricane, chemical spill, or pandemic.
Lynch, who is also chair of Baystate's Emergency Management Committee, has been the principal investigator of HPP grants totaling $1.2+ million since 2001. The Office of the Assistant Secretary for Preparedness and Response (ASPR) administers the grants.
Each year the Committee does a hazard vulnerability analysis. They also play out potential disaster scenarios, sometimes based on actual events.
Lynch gives an example. In 2008, a tanker flipped over on the Chicopee curve spilling 5,000 gallons of diesel. But what if it was 5,000 gallons of gasoline? And it had spilled into N lot? Now a plan is needed for managing patients and staff all along the north Main Street corridor.
The Committee identifies gaps in preparedness, sets priorities, and develops plans. "We figure out the best allocation of our funding in such a way that we can build on it in the next grant cycle," says Lynch. "We are very aware of our responsibility to use taxpayer money wisely.”
Trusting That You Know What to Do
The NICU drill stemmed from a gas leak scare shortly after a gas explosion in downtown Springfield. Staff felt unsure about what to do if they had to move the babies. “The drill wasn’t perfect, but they proved to themselves they could move 15 babies just like that, and they could do 55 if they needed to,” says Lynch.
According to Lynch, there have been 12 Plan Ds in the past year. "There's no doubt that drills help in real life situations. Drills build on familiarity and show people that if you know how to get out of the building for a fire drill, you know how to get out of the building for a helicopter crash.”
Lessons Learned in the Doing
Lynch relates that staff were resistant to wearing vests with their roles printed on them because they "are goofy looking." But during a 4-day evacuation exercise built into the Hospital of the Future move, "Light bulbs went off!" Lynch says.
"They saw how useful they were. It is the same configuration used by the city, the state, federal agencies...So you can pick up the phone and talk to your counterpart doing the same thing you’re doing but at a different level."
Becoming Believers in the Process
After every exercise there is an action briefing with lessons learned and a work plan to correct any issues, Lynch explains. They then become objectives for the next exercise.
For example, the 8 month planning process for the NICU drill involved a multi-disciplinary committee, input from police and fire departments, a NICU-specific evacuation plan, trainings, and a mini-drill. Still, doing the actual drill revealed a communication issue.
"One big thing was that when you deal with a specialty unit, you need someone in the Operations Center who can translate," Lynch says. "NICU has very specific needs and someone who understands those needs has to be there."
It Takes a Coalition: Hospitals Working Together
One HPP goal is to strengthen health care community coalitions that can collaborate on emergency planning and share resources in a disaster. Since 2001, Baystate has participated in monthly meetings with the nine other acute care hospitals in the four counties of western Massachusetts. Led by the regional coordinator from the Department of Public Health, it also includes city emergency managers, and representatives from public health and EMS.
Hospitals also benefit from feedback provided by staff of other hospitals in their region and members of other organizations who act as observers during drills. During the NICU drill, two people from Mercy Medical Center were observers.
The coalition has also created caches of equipment, stored at Baystate Franklin Medical Center, Berkshire Medical Center, and Holyoke Medical Center, that can be accessed by any member in an emergency.
Grant Provides Needed Flexibility
According to Lynch, HPP grant money has been used for a variety of needs, from the purchase of portable flood lights for outside triage to laminated Emergency Care Guides located in all patient care areas.
The majority of the funds have gone into training exercises, such as a series of evacuation drills—hospital level, emergency department and NICU—with drills planned for the remainder of the ICUs and other speciality areas.
"This put us ahead of the curve in terms of what the Joint Commission and DPH expects."
Lynch has an upcoming publication in the Journal of Healthcare Protection Management, coauthored by NICU staff Janine Niedziela RN and Elizabeth Kugler CRT, detailing some of Baystate's best practices.
"People took ownership," concludes Lynch. "And that’s where you need to be."