No Hospital Left Behind

South Dakota - America's frontier. A vast expanse of small towns, farmland and big blue sky. When I left New York City and headed here, every comment my friends and coworkers made was about the dramatic transition. I'd been manager of emergency services for a large metropolitan hospital system in an environment target-rich for terrorists. Now I would manage emergency preparedness for an even larger, but prospectively "safer," system in the American heartland.

What I found on my arrival was an organization that had already established a solid foundation of preparedness. The team at Sioux Valley Health System was working in an atmosphere of great cooperation to realize a comprehensive preparedness goal that worked not only on paper, but in reality as well. This team effort epitomized the unified concepts of incident management.

Sioux Falls and Its Healthcare System

Sioux Falls is one of America's small big cities. It is growing rapidly: Its population, 124,000 in the 2000 census, is now estimated at around 150,000. Large corporations that have roots here are growing in size, and other corporations are moving in, creating jobs and expanding commerce. It is a multicultural city with an active population: There were at least 55 various public events planned for summer 2005. Some larger events, like the Sioux Empire Fair and a Christian music festival, bring an additional 200,000 people to the city.

Sioux Valley Health System is a vast hospital system with 24 hospitals, 94 clinics and numerous other related facilities spanning across South Dakota, Minnesota, Iowa and Nebraska. Sioux Valley is one of the largest employers in South Dakota and is constantly outgrowing and expanding its main campus in the heart of Sioux Falls. Sioux Valley Hospital is one of two major healthcare facilities in Sioux Falls, as well as a Level II trauma center.

Some might say that a hospital in South Dakota, in a city with a population 50 times smaller than that of New York City, has little to be concerned about regarding disasters. But the fact is that the American Midwest is plagued by weather events like tornadoes, floods, severe winter blizzards and cold, intense heat, thunderstorms and powerful winds. Moreover, in addition to the natural disasters, the state is a major agricultural center, with thousands of farms and ranches that rely on chemicals. These chemicals are transported via a major interstate system that spans across the state in all four directions.

The Preparation Process

One of the first things a planning team has to realize is that whether a disaster event is intentional or accidental, it will produce certain similar outcomes: physical damage, potentially large numbers of casualties and the spread of contamination. This is true whether it's intentional or accidental - imagine a chemical leak or spill producing many contaminated patients, all of whom need decontamination prior to treatment.

Sioux Valley's hazard vulnerability analysis (HVA) showed that for us, the probability of an industrial or transportation accident involving chemical spills was higher than that of a terrorist attack. We realized that if we began to look at intentional and unintentional events as similar CBRNE (chemical, biological, radiological, nuclear and explosive)/hazmat types of incidents, we could develop an "all hazards" approach to disaster preparedness.

Roles All Around

The first step to disaster preparedness for a hospital, as for any entity, is to identify what resources will be necessary to function in extreme circumstances. Normal hospital operations require coordination from multiple departments. Each department has a specific task during regular business. To think that such departments will not have roles in a disaster will lead to an ineffective plan.

Many hospital disaster committees are too small and do not encompass everyone who needs to have a role. This can lead to too many responsibilities on one person, and an ineffective overall effort. Departments that are active during normal patient care activities should also be expected to be active during large-scale events.