Protecting Hospitals During Disasters

     Reports of a suspected bioterrorism attack have sparked panic in the community. Worried residents swarm the region's major hospital for diagnosis and treatment and confusion quickly turns to chaos. Military helicopters thunder onto the hospital's helipad, where dozens of police officers disembark to battle a disaster within a disaster—pandemonium on hospital grounds in the midst of a public health emergency.

     This was just part of the action-packed script for a landmark emergency training event in San Diego in summer 2008. Believed to be the first large-scale disaster event to link federal, state and local government agencies with private-sector healthcare officials, the drill enabled participants to practice what it really takes to secure the campus of a major hospital during a crisis.

     Led by the U.S. Customs and Border Patrol and the San Diego Police Department, the Golden Phoenix '08 hospital protection event also included personnel from San Diego County's EMS system, the U.S. Marine Corps, FBI, DEA and Department of Homeland Security. What differentiated this exercise from previous events was the involvement of the host, Scripps Memorial Hospital La Jolla, part of the nonprofit Scripps Health system in San Diego.

     Ever since September 11, 2001, government, law enforcement and public health agencies have stepped up training efforts to improve their emergency response capabilities. But now hospitals and health systems are starting to enter the planning mix by developing their own disaster readiness protocols and engaging their public-sector counterparts on an operational level. In response to the 2001 terrorist attacks, Scripps Health created an office of disaster preparedness to establish disaster response strategies for the health system. With four emergency departments, two trauma centers and two urgent care centers, Scripps—like all hospitals and health systems—is one of the region's first responders to local disasters. Historically in a disaster, as many as 80% of patients will take themselves directly to the hospital and bypass the prehospital provider system.

     The Golden Phoenix '08 exercise was specifically designed to test the operations, communications and security capabilities of multiple agencies and Scripps working together in an emergency on a major hospital campus. It served as a bellwether for future emergency and disaster training efforts by breaking through old assumptions that hospitals are self-sufficient during disasters—somehow fortified against a public surge and the disruption to care this would cause. This drill served notice that private healthcare personnel must work shoulder to shoulder with other first responders in the community to ensure hospitals are protected as key community assets during times of disaster.

     Here's a glimpse into the organized mayhem that transpired last July at Scripps Memorial Hospital La Jolla:

• 6–9:15 a.m., Unified Command: Law enforcement, military and public safety representatives from the federal, state and local levels establish and operate a unified command post at the hospital, with Scripps disaster preparedness officials participating—a rarity for a private hospital in a public, multiagency drill.
• 8 a.m., Hotload: Two CH-46 Marine helicopters land on the hospital's helipad, where 25 police officers in full decontamination gear disembark and proceed to the hospital's main entrance.
• 8:10–8:30 a.m., Traffic Checkpoint: Law enforcement officers in full Class C protective suits deploy barricades and form a vehicle checkpoint at the main traffic entrance, inspecting vehicles, monitoring radiation detection and ensuring an orderly ingress. Scripps nurses also dressed in decon gear are on hand to assess and fast-track emergent patient situations.
• 8:30–8:40 a.m., Washdown: Fire and hazmat personnel execute decontamination procedures on a suspected contaminated victim identified at the checkpoint.
• 8:40–9:15 a.m., ED Surge: Marine volunteers playing the role of an agitated public mob and patients storm an outdoor ED surge tent. Police practice security measures to ensure order and keep patients in line, while Scripps nurses start triage of mass casualty surge.

     After the dust settled, Scripps joined its public-sector counterparts in extensive debriefing meetings. Some of the preliminary key takeaways gleaned from a healthcare delivery perspective included:

• Hospitals are wide-open facilities with myriad points of entry, requiring significant advance planning and multiple agencies to effectively secure in times of crisis.
• Hospital protection must be actively practiced with an array of public agencies and hospital staff, on hospital grounds; there is no substitute for hands-on, collaborative training.
• The planning must be ongoing; lessons learned must be applied in future exercises, as an investment in ensuring patients' access to high-quality care.
• Hospitals need to be committed to emergency response year-round, not just when the need arises; they also need to speak the same language as their public-sector counterparts, including the HICS and NIMS operational terminology.
• Significant emergency care can be delivered outdoors in surge tents, but hospital medical staff should be on hand to conduct initial triage while police maintain order.
• EMS agencies and other public safety first-responder agencies need to start interfacing with their local hospitals; there is no firewall in the hand-off between EMS, law enforcement and hospital.
• Technology tested at the event may allow better linkage between the radio frequencies of various agencies; further testing will be key to optimizing interagency communications.

     Chris Van Gorder, FACHE, is president and CEO of Scripps Health.