Terrorism is an unfortunate reality throughout the world, but one for which the U.S. healthcare system prepares on a continuing basis. To effectively treat the masses in case of a tragic event, medical settings must consistently strive for high leadership standards, communication mastery and offer comprehensive care.
Following the Nov. 13 attacks in Paris, which left 129 people dead, 352 injured and 99 in critical condition, cities throughout the world are left wondering if they will be the next target of the Islamic State of Iraq and Syria (ISIS). In preparation for such a strike, many major U.S. hospitals are preparing themselves for the worst by practicing and refining disaster operation strategies.
Practice Equips Response
Just hours before the attack in Paris, the city’s hospitals had practiced for a live shooter situation, a safety measure prompted by the shooting deaths of 16 journalists at Charlie Hebdo in January. Using a centralized dispatch system, personnel readied ambulances and staff to treat arriving victims during the simulation.
Emergency physicians in Paris work 24-hour shifts. Mathieu Raux, emergency room chief at the Piti‚-SalpetriŠre hospital in Paris, explained to Bloomberg Business that almost every emergency room physician who had participated in the drill was on duty at the time of the ISIS attack. As a result, the hospital had 10 operating rooms and staff in position just 20 minutes after the first bomb went off outside the Stade de France. Most of the victims transported to Piti‚-SalpetriŠre survived.
SEE ALSO: Ready if Disaster Strikes
In the United States, the Department of Homeland Security has published a U.S. Active Shooter Plan that outlines how healthcare facilities should train in preparation to respond to a mass casualty event such as what occurred in Paris.
Ensuring Preparedness
The U.S. Federal Emergency Management Agency (FEMA) recommends an “all hazards” approach to hospital emergency planning. By simultaneously preparing for both acts of terrorism and unintentional or natural public health emergencies, economic and organizational efficiency can be optimized by medical facilities.
The premise behind this notion is that while causation may vary, the potential effects of mass public health emergencies remain congruent. Regardless of type of disaster, if numerous victims are rushed to emergency facilities to be evaluated, the necessary treatments and staffing can range dramatically. While some victims may be in critical condition, other incoming patients may have only minor injuries but require evaluation.
“The Johns Hopkins Hospital has developed a process or ‘all hazards’ approach to respond in the event of a crisis or disaster,” explained Howard Gwon, senior director of the Office of Emergency Management at Johns Hopkins Medicine in Baltimore. “Our staff members actively prepare for such instances through drills and exercises on an ongoing basis. In addition, we have plans in place to respond to mass casualty or surge capacity incidents.”
With this more centralized approach to the medical consequences of disasters, hospitals should design detailed emergency response policies and procedures, expert recommend. This plan should include communication and operation protocols triggered in case of disaster.
In an article published in 2005 issue of Archives of Diseases in Childhood, authors Sarita Chung, MD, and Michael Shannon, MD, state that an efficient plan should focus on specific emergency functions and hazard-specific operations-and that a standard operating procedure checklist be implemented. This checklist should include and assign responsibilities and step-by-step instructions to those in the emergency operations center. These suggestions are intended to offer insight into hospital planning for acts of terrorism and other public health emergencies involving children
“We also have specific response procedures for trauma, chemical, radiation, active shooter and other disasters,” Gwon said of Johns Hopkins. “If an incident occurs on our campus, we are able to address the impact from that incident and prepare to receive casualties until mutual aid is provided to triage casualties away from the hospital.”
Challenges in Boston
The last fatal disaster on U.S. soil was the Boston Marathon bombing on April 15, 2013. Two explosive devices were set off near the race finish line. Three people died and 243 were injured, but all patients who were transported to area hospitals survived.
Although emergency medical response was executed effectively, facilities received both criticism and praise for their efforts. Hospital teams were able to save dozen of lives, but they experienced challenges and failures in the midst of the day’s chaos.
With family members and friends separated in the aftermath of the explosions, they were rushed to different hospitals and patient identification was challenging. Many patients arrived for medical care without purses, wallets or any other personal items, impeding the ability to correctly identify them, according to The Boston Globe.
In response to this confusion, staff at Brigham and Women’s Hospital assigned each unidentified victim a six-digit number; however, this presented further miscommunication errors during treatments. The Boston Globe reported that doctors and nurses had to continually double-check that imaging test results and medications were going to the correct patient.
The Boston Marathon bombing also demonstrated that hospitals must utilize social media much more effectively as an early warning system. This would allow the facilities more time to prepare trauma teams and operating rooms, as well as to organize and deploy hundreds of additional employees for assistance. To ensure preparedness through social media, hospitals should follow reputable local and worldwide news sources, checking public updates regularly rather than relying solely on information from authorities.
Although it is impossible to predict a large-scale attack, emergency medical facilities should develop rational approaches for unforeseen circumstances in general. These preplanned objectives should incorporate lessons learned from prior attacks in combination with new patient management protocols.
Predicting the Unpredictable
On April 15, 2013, the Boston Athletic Association (BAA) was preparing for the possibility of a much different event than the one which transpired. Twenty-six medical tents had been placed throughout the race course, including Alpha and Beta Medical tents at the finish line to treat expected physical results of a heat wave. The BAA didn’t want to overburden hospitals with an influx of heat-related injuries, as had occurred the year before. In the end, those medical tents and stationed ambulances ended up making a big difference in the immediate triaging of victims after the bombs went off, explained Maureen McMahon, RN, BSN, MS, the director of emergency management at Boston Medical Center.
“The plans that we had put in place and had practiced quite frequently worked beautifully the day of the marathon,” said McMahon, who credits that day’s success to monthly emergency drills. Since then the hospital has assessed what tools staff members need in emergency situations and made minor enhancements to ensure both a coordination and mobilization of their team. They’ve also continued to work with other area hospitals.
“We can work toward goals as a region rather than an individual institution, because none of us stand alone in an emergency,” McMahon said.
Those sentiments of oneness have been reverberated in the news and throughout social media since the Paris attacks. Just as people’s hearts go out to the victims, hospitals are thinking about the healthcare workers who are responding to these mass casualty events and how they themselves will mobilize and respond in a similar situation.
Lindsey Nolen and Chelsea Lacey-Mabe are staff writers. Contact: [email protected] or [email protected].
