Thursday, September 21, 2006

Education Key to Emergency Response

Five years ago, it was a random Tuesday. Last week, it was a day of remembrance.

Everyone remembers where they were when the towers fell. Military rotations, however, mean staff members who were stationed at the National Naval Medical Center that day probably aren’t here any more. If today becomes the next Sept. 11, would you know what to do? Where to go? Whom to call?

Bethesda’s Command Emergency Manager LCDR Chris Gillette said education and training are so critical to disaster response that it’s impossible to have too much of either. To emphasize his point, Gillette pointed to the recent Postmaster e-mail detailing emergency plans and individual roles for the annual mass casualty exercise Dec. 7 — an event that is still 12 weeks away.

The plan poses a question many hospital staffers may ask: ‘‘What is my role if my department is staffed with non-medical personnel, or was not mentioned in the mass casualty response plan?” The plan says personnel should ‘‘remain in your work space. You [should] continue to do ‘business as usual’ — take care of patients, provide outstanding customer service and continue to support daily hospital operations. Your clinic or department will be notified and instructions will be provided regarding cancellation of further appointments, shutting down normal hospital operations, etc.”

‘‘We have a shelter-in-place policy, so don’t just make a bee-line for the gate because they will be locked down,” Gillette said. ‘‘Stay in your office and carry out the plan of the day until told otherwise.”

Emergency Management Decontamination Manager Mark Miller said wandering away from a ‘‘shelter-in-place” instruction may lead to many problems. He said employees have a responsibility to be accountable, not desert their office, and remain in safe designated areas. He said accountability is key, especially when there may be chemical or radiological agents on the scene.

Gillette said educating more than 4,000 staff members can be daunting, so his department relies on a series of internal drills, Postmaster e-mails and meetings. He said the Emergency Management staff members meet with department heads, chiefs and leading petty officers regularly to disseminate information.

‘‘There are two types of emergencies: planned and unplanned,” Gillette said, acknowledging the pseudo-contradiction of a ‘‘planned disaster.” ‘‘We can plan for hurricanes, 16 inches of snow and tornadoes, because we can see a storm system is coming from watching the news.”

He said early planning allows Bethesda leaders the ‘‘luxury” of ensuring staffing needs will be met and operations can continue as smoothly as possible.

‘‘An unplanned event has no warning,” he continued. ‘‘We will determine the nature of the event, prepare the facility for receiving incoming casualties and, when it’s safe and appropriate for our non-emergency personnel, allow visitors and outpatients to leave the installation in an organized fashion.”

Gillette said the National Naval Medical Center monitors three emergency systems for the National Capital Area. When an emergency arises, Gillette said the command has several ways — he calls it ‘‘redundant communications” — to inform staff members and patients.

The National Naval Medical Center Emergency Management Plan is available on the Intranet homepage. Miller said the plan covers the hospital’s emergency procedures and outlines staffing needs for the casualty receiving stations. The plan, for example, calls for four corpsmen — two from dermatology and two from urology — and four physical therapy technicians to report to the Emergency Room’s ambulatory entrance.

Bethesda has recently implemented a mass notification system that can call 2,000 people per hour. With more than 4,000 personnel, staff members shouldn’t worry that they’ll learn about a disaster two hours after the incident; the system calls department heads and other leaders, who will in-turn notify their managers and staff members. Personnel can also receive instructions from the public address system and the hospital’s closed circuit television.

Gillette said mass casualty exercises are based around four main ideas:

  • Protect the safety and security of patients, staff members and visitors.

  • Maximize resources internally and externally, including those shared in the Memorandum of Understanding with the National Institutes of Health and Suburban Hospital.

  • Work with Federal and Defense Department agencies, including the Army, Air Force, the National Guard and the Joint Operations Center.

  • Work through National Naval Medical Center, USNS Comfort and federal tasking orders.

    ‘‘Our goal is to provide care to the greatest number of patients in the shortest period of time,” Gillette said.

    Emergency Management officials said they pride themselves on creating challenging, yet plausible, mass casualty exercises to give first responders and other ‘‘players” true-to-life training. Gillette and Miller said they’re eager for this year’s exercise. Last year, they said, focused on a collaborative relationship between the National Naval Medical Center, the National Institutes of Health and Suburban Hospital, and communication between the three medical facilities and Montgomery County Fire and Rescue units. This year, the exercise revolves around a regional disaster response involving Defense Department and federal agencies. The exercise details are being withheld to maintain the training’s integrity.

    ‘‘We are leading the way for county and community preparedness. The county is more prepared now because of the work we’ve done,” Gillette said. ‘‘The three [medical centers] agreed to share resources — personnel, equipment, pharmaceuticals — in the event of a disaster or terrorist incident. We work with our county partners on a daily basis. We meet with them monthly and talk daily.”