Hospitals in Seattle, Chicago and Vancouver learned they could come up with some innovative on-the-spot solutions but also faced some communications challenges during large-scale, albeit simulated, bioterror disasters last week.
Advocate Illinois Masonic Medical Center's lobby was converted into a triage room as 75 patients flooded the Chicago hospital within hours last week, more than 40 dead on arrival and the remainder exhibiting severe flulike symptoms.
A staff of transporters, security personnel, emergency and specialty physicians and triage nurses awaited them. Outside traffic was redirected and the hospital was put on high alert.
Fortunately the coughing and wheezing "patients" weren't really ill, but volunteers easily identified by the bright gold shirts they wore reading "role player." In a scene echoed at more than 150 hospitals in British Columbia, Washington and Illinois, nearly 1,600 patients tested the response capabilities and emergency preparedness of two of the nations' health systems to handle terrorist attacks.
The five-day simulation, which included staged helicopter crashes and explosions of a radiological device, or "dirty bomb," in Seattle, as well the release of biological agents in Chicago and Vancouver, was the largest disaster training exercise since the Sept. 11, 2001, terrorist attacks in New York and Washington.
Nearly 8,500 people from state, federal, provincial and local agencies; hospitals; and the Red Cross participated in the drill, which took place in the metropolitan areas of Chicago, Seattle and Vancouver, and was monitored and directed by federal authorities in Virginia and Washington. Hospitals played a key role in the events, which were enacted from a 200-page script developed by the Department of Homeland Security. The agency spent an estimated $16 million to defray the costs of the drills, which were clearly identified by the media and within the hospitals as simulations.
In the metropolitan Chicago area alone, 63 hospitals in Cook, DuPage, Kane and Lake counties treated 1,600 victims of a mock biological terror attack. The hospitals learned May 13 that the "patients" had been exposed to pneumonic plague, a deadly disease.
Because the drill events continued through the week, beyond Modern Healthcare's deadline, the Illinois Masonic disaster planning team had not yet completed its final assessment. In addition to treating patients, Masonic is the hospital designated to monitor available bed status for Chicago's hospitals in the event of a real regional emergency.
Sharon Ward, Illinois Masonic's director of emergency room, emergency medical services and trauma and the coordinator of its disaster response team, said her nightmare isn't that something would go wrong.
"The worst thing that could happen is if everyone said everything went just fine," said Ward, a nurse. "Then that means they're not thinking hard enough and I'm not doing my job. Complacency is the enemy. I believe you can always improve something." Ward said Illinois Masonic's staff responded very well to the challenges. But because of the media coverage, there was very little that was unannounced.
"Our response was great, partly because we had the playbook and the drill occurred during the daytime business hours when we have plenty of administrators and physicians on the scene. Because of the vast amount of resources expended, I know it has to be that way," she said. "But I wonder what our response would have been at 3 a.m. with a skeleton crew."
Ward said the hospital's staff had to get creative and resourceful in answering challenges relating to bed capacity, isolation rooms and where to store dead bodies.
"We asked to go on bypass but were refused because there were too many patients, so our engineer suggested he could transform a building into an isolation center with duct tape and by reversing ventilation flow," she said. "That was news to us that we could flex our capacity like that. This exercise has been very useful to us."
She said preparing for the unforeseen is a challenge for hospitals. "Two years ago who would have thought we'd have to prepare for smallpox? Ten years ago we didn't have a plan for weapons of mass destruction. Threats change. When this is all behind us we hope to come out with a list of things that haven't been discussed or addressed and develop a reference manual for how to face them."
In Seattle, hospitals confronted a different, though equally frightening disaster scenario. Harborview Medical Center received nearly 200 "patients" who had been exposed to radiation from the explosion of a radiological device.
"When we first got the first call from the fire department, we went into disaster mode and began triaging patients to 15 area hospitals," said Johnese Spisso, chief operating officer for the 388-bed county-owned hospital. "We treated about 30 of the most critical patients and transferred about 130 to other hospitals between 12: 40 p.m. and 4 p.m. The remainder died. We were actually very pleased at how successfully the drill went."
Spisso said Harborview staff erected tents early on and began decontaminating patients exposed to the imaginary radiation.
One of the difficulties was identifying the kind of radiological agent used in the mock attack, she said.
"Until you find out what it is there's always a lot of anxiety," she said.