In May 2011, as a massive tornado barreled toward Joplin, Mo., St. John's Regional Medical Center braced for impact. Staffers closed curtains, moved objects away from windows and transported patients to chairs in the hallways. After the tornado dealt a direct blow, destroying generators, shutting down communications, peeling off the roof, blowing out windows and turning IV poles into projectiles, they shifted into disaster mode, moving out patients who could walk and using evacuation sleds and even doors ripped from their hinges to take those who couldn't walk down as many as nine floors. Critical patients were quickly sent to another hospital; the emergency department set up operations on a safe area of the street. Afterward, people told me they "knew exactly what [they] should be doing," says Dennis Manley, then director of quality and risk management for the hospital and now vice president of quality for Mercy Hospital Joplin. "All that drilling and education really does pay off," he says.
And there has been a lot of it. Hospitals have significantly boosted their readiness for disaster since Sept. 11, 2001, and the anthrax attacks that began just a week later. Those two events served as a vivid reminder that the country's overtaxed emergency departments needed to somehow get ready to cope at a moment's notice with "an influx of patients with any number and any type of injury," says Craig DeAtley, director of the Institute for Public Health Emergency Readiness at the MedStar Washington Hospital Center in Washington, D.C. Hurricane Katrina and the fear of a pandemic sparked by SARS and bird flu only added to the sense of urgency. The Institute of Medicine and the Centers for Disease Control and Prevention have increasingly urged hospitals to prioritize preparedness. And emergency management standards from the Joint Commission, which accredits hospitals, now require them to perform two practice exercises per year.
Hospital executives who have watched the hits keep coming – Superstorm Sandy, mass shootings, the Boston Marathon bombings – are convinced "that they need to invest in this," says Eric Toner, senior associate at the University of Pittsburgh Medical Center's Center for Health Security, located in Baltimore, Md. "My own hospital has conducted more than 150 different training exercises in the last five years alone," says Paul Biddinger, medical director for emergency preparedness at Massachusetts General Hospital. Most are short training sessions to teach staff how to wear protective equipment or to use evacuation sleds. But a few are full-fledged simulations using actors and mannequins to play the role of patients.
That kind of exercise, which can cost $20,000 and include most hospital departments, served Mass General well in the aftermath of the Boston Marathon bombings, Biddinger says. The hospital, which treated 39 victims all told, took in 18 seriously injured people between nine minutes and two hours after the explosions, at a time when the emergency department was already dealing with twice as many patients as there were beds. Thanks to its readiness plan, an automatic call system immediately summoned transport staff to the ED so beds could be freed up within five to 10 minutes. The plan also brought needed specialists, such as trauma surgeons, to the ED, implemented a system of 15- to 30-second triage and rapidly made X-ray and CT machines available.
In the first couple of years after 9/11, readiness efforts focused mostly on purchasing equipment and shoring up communications capabilities. St. John's in Joplin, for example, bought its evacuation sleds; St. Elizabeth Healthcare, a system of hospitals serving greater Cincinnati and northern Kentucky, bought 120 15-channel radios so that area hospitals could easily communicate with each other.
Since then, the preparedness movement has also influenced renovation and new construction. New York-Presbyterian Hospital expanded its emergency unit with the anthrax scare in mind, making sure every room had isolation capabilities. When Rush University Medical Center in Chicago planned its new building, which opened in January 2012, the emergency department was designed to become part of the first-line response to a bioterrorism event or a pandemic. The ED rooms, usually singles, are equipped to accommodate two patients; the adjacent hospital lobby can also be used to house patients if necessary. That capability is baked into the architecture, with oxygen lines tucked into the lobby's support columns.
The emergency department itself is divided into three "pods" that can quickly be isolated from one another using negative airflow via the HVAC system, says Dino Rumoro, Rush's chairman of emergency medicine. Outside the ambulance bay, fire hydrants can be repurposed to hose down patients and begin the decontamination process.