ED’s disaster plan uses incident command system
ED’s disaster plan uses incident command system
[Editor’s note: This is the first in an ongoing series profiling EDs that have updated their disaster plans in response to the Sept. 11 terrorist attacks. If you’d like to share the changes that you’ve made to your disaster plan, contact: Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: [email protected].]
Before Sept. 11, Waterbury (CT) Hospital’s disaster plan was geared toward small-scale events such as motor vehicle accidents — but that has changed dramatically, reports Betty Karas-Bartolini, RN, the facility’s emergency preparedness coordinator.
"Now we are forced to think in terms of thousands of victims instead of busloads," she says. The hospital’s completely revamped plan is based on an incident command structure, which has been used successfully for years in the military and prehospital community, says Ralph A. Miro, REMTP, the hospital’s EMS coordinator. The basic idea is to assign one individual as "CEO of the entire operation," he explains. "If you don’t use the incident command system, you have chaos," Miro adds. "That has been proven over and over again." (For more information, see Use this proven system for disaster communications in ED Management, December 2001, p. 136.)
Only the incident command system effectively can manage small and large-scale mass casualty disasters, says Miro. "This is a new paradigm for the ED," he adds. (To see chart depicting the hospital’s Incident Command System for Disaster Management, click here.)
The new plan satisfies current recommendations from the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations, says Bartolini. She points to standard EC 1.4, which requires "alternate roles and responsibilities of personnel during emergencies, including who they report to within a command structure that is consistent with that used by the local community." She says, "We chose to mirror the command structure used at every emergency by our town government municipalities simply because it works. Each member of the team of first responders knows who is in charge, and that person controls the scene."
So far, the costs of revamping the plan have been mostly staff time and minor equipment expenses totaling under $500, according to Craig Mittleman, MD, FACEP, director of emergency services. Here are key changes in the new disaster plan:
• Each individual is responsible for specific tasks. A predesignated individual is assigned as "incident commander" for each area, Miro explains. "For easy identification, these individuals wear vests clearly marked with the area of assignment, such as triage," he says.
• Clinical staff report to specific areas instead of the ED. The plan instructs all clinical staff to meet in the hospital lobby, says Miro. "During a disaster, everyone tends to inundate the ED, and you’ve got a traffic jam," he says. "Now all clinical staff meet outside of the ED, and we pull them in as needed." Individuals from the respiratory and anesthesia departments are the only clinical staff who automatically report to the ED, notes Miro.
• Nonurgent patients bypass the ED. Patents with minor injuries are brought directly to a conference room for treatment instead of the ED. "The area is very close to a bank of elevators, so patients can be quickly moved to a critical care unit if it becomes necessary," says Miro. Ambulances can transport patients directly to the conference room, since it’s easily accessed from the hospital parking lot, he adds. "The goal is to have patients with minor injuries bypass the ED, so staff can focus on those who are critically injured," he explains.
• Alternate modes of communication are available. When a disaster drill was held based on the new plan (using an explosion scenario and 20 patients) Miro discovered a glitch with the phone communication within the hospital itself. "One of the phone lines was not working properly, which was a malfunction we didn’t anticipate," he says. This underscored the need for alternate ways to communicate in case land-based or cell phone lines go down during a disaster, says Miro. "We hope to mitigate or eliminate that with the purchase of phones that function as two-way radios and cell phones, so there is dual capability," he adds. (For more information on communication during a disaster, see Here are options for communicating in ED Management, December 2001, p. 138.)
• A color-coded concept is used. Every area involved in the disaster response is assigned a color, and color-coded boxes are designated for specific tasks, such as green for triage of the "walking wounded" and white for security. A colored box is brought to each location when a disaster is called. The box contains the necessary documents, equipment, arm bands, and color-coded vests so staff can be identified easily, Mittleman explains. "Education about the color-coded plan was presented to ED staff in a [computer] presentation developed by our EMS and trauma coordinators," he says.
• Key personnel from police, fire, and ambulance services were contacted to educate staff. Community leaders, including the fire chief, were invited to participate in the facility’s disaster planning, says Mittleman. In a disaster, your ED must be able to communicate effectively with these groups, he notes. He reports that the ED is planning disaster drills that will include police and fire agencies. "The goal is to effectively coordinate all the available resources," says Mittleman.
Sources
For more information on the hospital’s revised disaster plan, contact:
• Betty Karas-Bartolini, RN, Department of Surgery, Waterbury Hospital, 64 Robbins St., Waterbury, CT 06721. Telephone: (203) 573-7577. Fax: (203) 573-6073. E-mail: [email protected].
• Ralph A. Miro, REMTP, Waterbury Hospital, 64 Robbins St., Waterbury, CT 06721. Telephone: (203) 573-7390. E-mail: [email protected].
• Craig Mittleman, MD, FACEP, Emergency Services, Waterbury Hospital, 64 Robbins St., Waterbury, CT 06721. Telephone: (203) 573-6295. Fax: (203) 573-7613. E-mail: [email protected].
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