Not If, But When: Disaster Preparedness
In recent years, devastating tornadoes, hurricanes and fires; explosions at manufacturing plants; and mass-casualty shootings and bombings have brought home the fact that every town and city needs to prepare an effective and efficient response to a variety of community emergencies.
“St. Louis is vulnerable to tornadoes and flooding, and according to geologists, it’s pretty certain at some point there will be a significant earthquake,” says Douglas Schuerer, MD, Washington University acute and critical care surgeon and director of trauma services at Barnes-Jewish Hospital. “In addition, some think the Gateway Arch is a possible terrorist target, Scott Air Force Base is nearby, and the Callaway nuclear plant is approximately two hours away from downtown St. Louis. About all we’re missing are locusts.”
In 2006, the National Foundation for Trauma Care (now called the Trauma Center Association of America) recognized Barnes-Jewish Hospital as one of the top five hospitals in the country highly prepared to respond to mass casualties. Since then, the hospital has continued to improve upon its disaster-preparedness program.
Planning for all contingencies
“Representatives from throughout the hospital make up our emergency preparedness committee, and there are multiple subcommittees responsible for various aspects of our planning process,” says Schuerer. “Our overall goal is to identify every aspect of managing a mass-casualty situation.” Management of such an event begins with managing public access to the hospital so that medical professionals can focus on the injured. Details like where to house the media are decided ahead of time.
“We want our attention always to be on rapidly assessing patients and making decisions about who can be treated quickly and discharged, who needs a hospital bed , who needs immediate surgery—and how many operating rooms are available and who we have to staff them,” says Schuerer. “We also need to ensure that orthopedic, vascular and neurosurgeons, anesthesiologists, nurses and all other medical professionals are ready to go.”
Part of disaster preparedness includes the concern for staff members and their families, whose own lives may be disrupted by the unfolding disaster. “At the same time we are planning for the arrival of a great number of patients, we must make sure our employees are taken care of. We have a variety of resources available for them, such as onsite daycare for their children and additional food service,” says Schuerer. “And we are prepared to provide those services using office personnel, maintenance and housekeeping staff. These are the kinds of details we revisit continually so that we remain prepared.”
The plan also includes Memorandum of Understanding (MOU) agreements with nearby institutions, including Washington University School of Medicine, St. Louis College of Pharmacy and St. Louis Community College at Forest Park, all of which can provide lodging for staff members. MOUs with vendors guarantee priority delivery of needed supplies with payment details to be determined later.
Practicing for perfection
Periodic training sessions help ensure that our emergency operations plan is ready to go before a disaster strikes. Everyone in the emergency department—physicians, nurses, techs, secretaries—is required to participate in disaster preparedness. We also maintain an emergency-response team made up of hospital staff from other areas of the hospital, including pharmacy, maintenance, environmental health and safety, clinical engineering, transport and respiratory.
And our training program evolves continuously, taking into account the needs of our community. When mass-casualty events occur in other cities, the emergency operations team at Barnes-Jewish Hospital studies them to help improve how it can prepare for similar situations in the St. Louis community.
Providing statewide expertise
Barnes-Jewish Hospital’s expertise in disaster preparedness extends far into the community and state, thanks to the regional leadership provided by Washington University’s EMS (emergency medical services) and emergency medicine physicians. David Tan, MD, EMT-T, chief of the EMS section, serves as medical team director for the St. Louis Metro Urban Search and Rescue Taskforce and medical director for both the Clayton Fire Department and St. Charles County Sheriff’s Department. The latter role includes providing medical care for the department’s SWAT team.
Other Washington University emergency medicine physicians serving in disaster preparedness leadership roles are Brian Froelke, MD, who is chief medical officer of the Missouri Disaster Response System, and Douglas Char, MD, who is chief medical officer for the federal government’s MO-1 Disaster Medical Assistance Team and for the Federal Emergency Management Agency’s Region VII. “What is vital for any of us when faced with a mass-casualty situation is to remember our individual roles and how they fit into the bigger picture,” says Tan. “Our ability to maintain the chain of command means we can focus on providing the best care possible to the patients who are brought to us for help.”