Emergency preparedness was among the many topics discussed during the first annual U.S. News Hospital of Tomorrow Forum, held in Washington, D.C., in November. In a keynote panel moderated by U.S. News & World Report Executive Editor Margaret Mannix, health industry executives described how their hospitals coped with crises like the Boston Marathon bombing and Superstorm Sandy and shared the lessons they learned from dealing with those disasters.
Anthony E. Shorris, senior vice president, vice dean, and chief of staff at NYU Langone Medical Center in New York, described what happened at his hospital as Sandy made landfall in 2012.
"Within about an hour, 15 million gallons of contaminated water came into the basement of the hospital," he recalled. "The water was of such force that it bent metal doors and toppled bricks and other things that had been put in place, and crashed from building to the next -- the basements are all interconnected. It began to knock out infrastructure for the hospital, eventually leaving the hospital without power or light."
Other area hospitals ended up taking on patients as the storm overwhelmed the city.
"Our response was more about patient surge, and how we were going deal with and handle taking in many of these evacuees," explained Jeffrey Bokser, vice president for safety, security and emergency services at New York-Presbyterian Hospital. "Hurricane Sandy tested all aspects of our emergency response plan... situations and scenarios that we had only discussed at tabletop exercises became a reality."
Shorris, who said he has been through other disasters in other settings, pointed out that there are really two types of crises hospitals need to consider.
"There are disasters and crisis that you have notice of, and disasters and crisis that you have no notice of," he said.
Terrorist attacks are one example of the former. Dr. Eric Goralnick, medical director of emergency preparedness at Brigham and Women's Hospital, recounted the situation in Boston during the Boston Marathon Bombings.
"The morning of April 15th, 2013, we rounded in our emergency department in our hospital to prepare our staff for what we typically would expect from marathon injuries -- dehydration, blisters, etc," he said. Instead, the ER ended up going "Code Amber," building capacity in all departments to accommodate survivors of a terrorist attack. "The first patient went into surgery 26 minutes after they arrived at Brigham and Women's Hospital," he said, describing how his team created primary and secondary triage areas and readied operating rooms in record time.
Hospitals face unique challenges when it comes to dealing with both types of disasters.
"When hospitals prep for disasters, they tend to not focus on dealing with multiple problems simultaneously," Shorris said. "Too often our planning is about one really bad thing happening. In our case, we would have been OK if there'd been a blackout. We might have been OK if there had been a flood. But when there's a blackout and a flood it adds a different setting of complexity."
"Because crises are by nature activities that exceed the capacity of an organization to handle -- because if actually an organization could handle them then they really wouldn't be a crisis -- that means that the sinews of an organization, which is it's communication ability, are the most important things," he added. "Because you can't possibly plan for all the things that are going to happen."
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