Hospital Teamwork Amidst Crisis

NYU Downtown couldn't get these lights right away because the city's supply was being shipped to St. Vincent's Hospital, the "trauma center." Staff turned to General Electric, the lighting company, which came through with a large supply. "For everything we did, we had to circumvent the system because of the lack of communication," Goldschmitt says. The hospital had enough generators until the full repair of electricity, partly because people brought their own lamps, Joliver adds.

Joliver comments on how ICS worked that day: "We had people working in critical, minor surgery, minor and major trauma, and inhalation treatment areas. We were divided into teams; each team had two doctors, two nurses and other workers from the hospital. By mid-day, other hospitals were assisting."

Problem Areas: Communicating and Documenting

Following the tragedy, hospital administration reviewed how the disaster unfolded, what was good, what was bad, what worked in spite of the plan and what worked because of the plan. Two areas that were problematic for NYU Downtown were communications and record-keeping. It was impossible to document everything that was done there on 9/11 because there were too many patients. The hospital has redesigned those parts of the system to make them more efficient.

"The Joint Commission on Hospital Accreditation reviewed all of the plans we did and the things we accomplished and they were more lenient than we were," Goldschmitt says. "They thought we did an incredible job; we were more critical about what we might have been able to accomplish."

The biggest issue to work on is a way of having secured communication between city hospitals. Goldschmitt brought this to the city council's attention through a committee he is on.

"When we were getting all of the patients in, we had to transfer some out so that we didn't fill the hospital completely. We had to get supplies; we had no steam, so we had to get our equipment sterilized. We had no way of contacting the different hospitals to do that. Even though the city could set up a borough command for police and fire with walkie-talkies and communicate with the hospital if they chose, it was hard to identify anyone who had any idea of what was going on. Without the command center, you now had four or five different agencies all trying to man the disaster simultaneously. But nobody was reporting to one central agency.

"Even if the command center is lost, the city has to have alternatives for communication so there can be the same pyramid structure to answer to one group or person in the city as well as in the different hospitals. The hospitals have to have some kind of secured communication lines, whether it be a special phone line that goes through or cellular phones that will work even if there's a satellite problem. We don't have the exact way of rectifying the problem yet, because we're one hospital out of many. We can't influence the decisions for other hospitals as well. That is something the city is going to have to decide on."

The issue with documentation turned out to be fairly simple, continues Goldschmitt. The hospital created a new one-page form that can list all important patient information. This form consists of check-offs and quick fill-ins that capture information NYU Downtown would need to get names and addresses of people, notify family members and list prior medical treatments. "Our problem was that we didn't have enough clerks who were trained in registration and medical record-keeping to get all the information. This way, you have a sheet that anybody could pick up and use. That's the key of ICS--anybody can do it. Documentation was one part of our system that wasn't for just anyone to handle," Goldschmitt says.

The hospital is working on handling other potential issues now: bioterrorism, hazardous materials and nuclear problems. The renovation of a mass decontamination unit is set to break ground in the fall.

Erin Flynn is founder of Flynn Media, a New York-based communications firm that offers writing, editing and publicity services. Erin can be contacted via www.flynnmedia.com.