| Chlorine gas leaks after a train-car derailment. | | | | doctors stripped the victims of their clothes. A |
| Radiation contaminates the community when an | | | | physician collapsed as the critically ill patients were |
| industrial accident occurs. A levy breaks, washing | | | | hustled onto gurneys. Many emergency rooms |
| through every refinery and industrial plant and | | | | have equally easy access, so the ER and every |
| polluting all the water. Terrorists attack. Pandemic | | | | person in it can easily be contaminated. If the |
| flu strikes. | | | | decontamination and first responder teams are in |
| When large numbers of people in your community | | | | the ER at the time a contaminated individual or |
| are very sick, the last thing you want is for your | | | | group wanders in, in effect the whole hospital is |
| hospital to be incapacitated as well. In America, | | | | rendered useless and no longer has any ability to |
| any hospital or emergency room is considered a | | | | respond. |
| "first receiver." That is, in the event of any kind | | | | Question #4: Who is being trained? |
| of a healthcare disaster or mass casualty event, | | | | Many hospitals make the mistake of training only |
| they would be the first to receive patients. | | | | those in the emergency room for disaster |
| Therefore, hospitals must be able to work as | | | | response. And if their ER becomes contaminated, |
| health care providers and, to some degree, as | | | | a disaster quickly turns into a catastrophe. What's |
| hazardous materials (hazmat) operators. But | | | | the difference? In a disaster, needs exceed |
| setting up hazmat operations can cost up to $2 | | | | resources. Trained providers have the people and |
| million, training decontamination teams can cost up | | | | the ability to respond, but run out of needed |
| to $250,000 in the first year, and running the | | | | resources. In a catastrophe, needs exceed the |
| required disaster drills twice a year, every year, | | | | ability to respond, and if you run out of trained |
| can run anywhere from $125,000 - $250,000. | | | | responders, it doesn't matter how much "stuff" |
| Federal funding for these efforts has been scarce. | | | | you have. So trained people must be spread |
| So most private institutions have been left with | | | | throughout the hospital: front desk, custodial staff, |
| two choices: Paying for equipment and training out | | | | administration, and every other department. In |
| of pocket, or not doing anything. | | | | the event that one team is lost, another team |
| For small and rural hospitals, spending this kind of | | | | can quickly fill in. |
| money for disaster preparedness has been | | | | Question #5: What decontamination facilities are |
| difficult. But poor hospital response to Hurricane | | | | available? |
| Katrina and other disasters, and the specter of | | | | In studies of every disaster, 80% of the victims |
| pandemic flu on the horizon in the next 3-6 years, | | | | arrive at the hospital by some means other than |
| lead the Joint Commission on Accreditation of | | | | an ambulance, which means they show up |
| Health Care Organizations (JACHO) and the | | | | contaminated or potentially contaminated. Is your |
| federal government to begin enforcing | | | | local hospital set up with the equipment to offer |
| longstanding rules about disaster preparedness for | | | | decontamination? The days of a single small |
| hospital accreditation. These rules include twice | | | | shower inside the ER are gone forever. Some |
| yearly disaster drills and the ability to be a first | | | | hospitals have put in permanent showers while |
| receiver. | | | | others store equipment that can be set up in 15 |
| Additionally, communities have been receiving | | | | minutes in trailers. Many hospitals have moved to |
| Homeland Security funds to use for training, drills | | | | collapsible shower tents with a middle aisle for |
| and equipment purchase since 2002. And yet | | | | gurneys, for those people who cannot move |
| 2005 data shows that almost every community in | | | | themselves. These offer a modicum of privacy |
| the United States is no better prepared in 2005 | | | | for those who enter the shower on one side in |
| than they were in 2000. Many don't spend what | | | | their contaminated clothes, and exit the other side |
| they receive, or they purchase equipment that | | | | in scrubs. And the majority still use a garden hose |
| they aren't trained to use properly. How do you | | | | and nozzle. Or they may rely on their local fire |
| know if your local hospital is up to snuff as a | | | | department and hazmat team; this can be |
| first-receiver facility? Every individual citizen needs | | | | problematic, though, since those first responders |
| to ask the following five questions of their | | | | will head to the site of the disaster, not to the |
| community's healthcare institutions: | | | | hospital to spray down patients. |
| Question #1: What has been done to prepare? | | | | What can you do? |
| If your community is in an area where a natural | | | | These five questions are tough ones that a lot of |
| disaster or an industrial accident could occur, is | | | | hospital administrators don't want to answer |
| your hospital conducting live disaster drills? | | | | because they know they will get failing marks. But |
| Tabletop drills, with toy cars and shoeboxes | | | | when people in their own community ask, "Where |
| painted like houses are, obviously, insufficient. | | | | do we stand?" they can be compelled to answer |
| Shuffling chess pieces around the board and | | | | and to fill in the gaps in their disaster |
| pretending that's equivalent to human lives in the | | | | preparedness. Therefore:o Every time you go to |
| parking lot just doesn't make sense. Nothing | | | | the hospital for something as simple as a blood |
| substitutes for what is called in disaster parlance, | | | | test, you'll get a satisfaction survey. At the |
| "getting cold and wet." Full-scale scenarios with | | | | bottom is a space to make a comment, so ask |
| wet, "contaminated" patients, and front-line first | | | | these questions every time you get such a |
| receivers in bio-hazard gear will show hospital | | | | survey.o If your community's media haven't |
| staff if they can properly cope with an influx of | | | | asked these questions of local healthcare |
| extra patients who need to be decontaminated. | | | | administrators, then the public should be telling |
| And a real disaster is not the time to discover | | | | them to. Make phone calls to reporters at local |
| that someone cannot function in the equipment | | | | papers and radio and television stations.o Attend |
| provided. The best way to learn is by combining | | | | county commission and city government meetings |
| the familiar (the environment of the facility) with | | | | on disaster planning and ask these questions. |
| the unfamiliar (a disaster scenario of some type). | | | | Almost every community now has at least one a |
| Question #2: Who's grading the drills? If your local | | | | year, if only to keep the Homeland Security |
| hospital is holding drills, who's grading them? | | | | dollars flowing.o Every city, county, and state level |
| A hospital grading its own performance is like | | | | of government has a website where you can ask |
| asking a 10-year-old to grade his own final exam. | | | | these questions, as does every hospital. When |
| Of course they'll give themselves good marks, | | | | you find the space where you're asked what |
| because they aren't qualified to assess their own | | | | they can do to make things better for the |
| performance. In many cases, they might not | | | | community, this is the answer. |
| even feel they're "cheating" by giving themselves | | | | Ready or Not...Here We Come |
| unmerited high marks, but most hospital | | | | Fortunately, Hurricane Katrina-sized disasters and |
| administrators and CEOs don't understand the | | | | pandemic flus don't happen every year. But the |
| standards or the evaluative procedure so they | | | | sad truth is that, sooner rather than later, there |
| can't objectively measure outcomes. Determining | | | | will be another New Orleans, another Charity |
| who grades drills is critically important. Even | | | | Hospital, and another total system failure if local |
| though they'll be paid by the hospital, independent | | | | communities don't take care of themselves. |
| experts will offer a realistic, less biased | | | | Most hospitals now are private businesses, |
| assessment and will be capable of comparing the | | | | completely driven by public perception, and the |
| hospital to other similar facilities. An independent | | | | opinion of the loudest voices wins. So one person |
| evaluator will be able to offer real | | | | speaking out can make a difference, and a group |
| recommendations to improve. | | | | of people calling out can make a huge difference. |
| Question #3: Does the ER door lock? And can | | | | If a hospital consultant makes a recommendation, |
| people get past it without any difficulty? | | | | a CEO is likely to say, "Sure, but you're not the |
| An episode of the television show ER pointed out | | | | one paying for it." But if 50 or 100 or 1,000 |
| this danger in the show's first minute and a half. | | | | hospital customers make the statement, that |
| Following a very realistic disaster scenario--a | | | | CEO will listen or will risk not being CEO anymore. |
| ruptured tank at a chemical plant--three victims | | | | When informed citizens in every county, every |
| arrived in the ER completely soaked and | | | | parish, and every city ask "Are we ready?" first |
| non-decontaminated. And because the ER doors | | | | receivers will be compelled to do what it takes to |
| didn't lock, they were able to walk straight in | | | | get the equipment, the people, and the training to |
| from the street, covered in a chemical so toxic | | | | keep everyone safe in the event of a disaster. |
| that it ate through the floor laminate after the | | | | |