On September 11, 2001, Darlene York, then a critical care technician, rushed to Liberty Park with a team from her medical center, Capital Health System. She listened to doctors talk about the best ways to care for the victims they were sure that they would soon be fighting to save. "We waited, and waited," she says, "but there was nobody."

That day changed her life.

"It was a very humbling experience," she says. "I couldn’t do anything then, but I vowed that if anything like that happened to my hospitals, we would be ready." She is convinced that the other shoe will drop, that there will be a next time. "We just don’t know when," she says. "I couldn’t do anything on 9/11, but, by golly, I can now."

Soon after 9/11, Capital Health, which includes two Trenton hospitals, Fuld and Mercer, embarked upon implementing an ambitious emergency preparedness plan. Reporting to John Hodgkinson, the medical center’s operations manager, York was

part of the process from the beginning, and is now emergency management coordinator.

Putting together a plan, and making sure that it will work, is an enormous undertaking. At Capital Health it has involved everything from stockpiling generator fuel to applying for grants to purchase Geiger counters – and consulting with a nuclear physicist on the best ones to buy. York readily admits that it’s impossible to be 100 percent prepared for every single emergency, but that doesn’t mean that she isn’t working on it pretty much 24/7.

"When Katrina struck," she says. "I couldn’t fall asleep until I could figure out where we would put every one of our patients in both facilities (in a similar emergency)." Hours later she had mentally maneuvered those on ventilators over to power sources in safe places. She had found secure spots away from windows for every patient. She was ready to rest – at least for that night. "There is always more to do," she says.

Capital Health has done a lot already. It has enough food and water to last for three days – and in light of Katrina is considering upping that amount. It has back-up power to keep heat, elevators, air conditioners, and many lights on. The emergency rooms and operating rooms have back-up power too, as does the dispatch center. Fuel to keep the generators going is stored on-site. Should parts of the hospital be unusable, there is a 450-square-foot heated tent that could fill some needs.

As instability grew in New Orleans, law and order frayed badly. Security could be an issue anywhere, and Capital Health has addressed it. "We have a back-up plan," says York. "We can lock up the whole facility with the flip of a switch."

Because Fuld is a certified regional trauma center, serving Mercer County, adjacent parts of Middlesex, Somerset, Hunterdon counties, and nearby areas of Pennsylvania, its security is especially important. "The State Police came out to look at it," says York. "The Office of Counterterrorism has been here." Each group, in fact, has made many visits, and taken lots of notes. A plan is being developed for the trauma unit, and will be ready soon.

Meanwhile, Capital Health has been working on its own decontamination plan. Its decontamination trailer was recently pressed into service in New Orleans, where it cleaned off the boots and clothing of rescuers who had been walking in

God-knows-what. The medical center’s shower tent made the trip, too, as did its misters, which provide air conditioning-like cool with ice and fans.

Decontamination is extremely important and is one of the areas that York has her personnel practicing again and again – and all the while she is on hand to take pictures. "I show them when something is wrong," she says. "Once you are suited up, you can’t go anywhere." Procedures must be followed and discipline must be maintained so that suited rescuers don’t inadvertently spread contamination.

Well aware that there are all sorts of disasters – most of them on a far smaller scale than a terrorist attack – York recounts a recent incident involving a car crash on Route 1. "The victim was covered with gasoline," she says. He needed to be thoroughly cleaned before he could enter the hospital. "We have people with respiratory problems in there," she explains. Breathing in gas fumes could be dangerous – and possibly fatal – for them.

Capital Health’s emergency plan extends to every department. The materials manager, for example, has entered into agreements with his vendors to make sure that the medical center could get extra supplies quickly. "If we need it, we can get it in a heartbeat," says York. That goes for everything from IV supplies to medicine – and beyond. In the Congressionally-mandated TOPOFF 3 biological disaster drill last April, "our morgue was overfilled," says York. Called upon for a solution, the materials manager had a refrigerated truck delivered.

The medical center also holds its own drills, and even provides for redundancy by having employees assigned to one hospital switch with their counterparts and drill at the other facility. "The water sources are a little different. The power sources are a little different," York points out.

While employees should be able to step in and function at a moment’s notice in either hospital, in any disaster it is important to know who is responsible for what. At Capital Health there is a tree-of-command chain. If there is a major

decision, perhaps concerning evacuation, it is up to the COO to make the call. But should he not be available, there is a back-up.

There could be a situation, conversely, where no one would be going anywhere. No evacuation decision would need to be made, but it might be necessary to house employees, perhaps for a long time. "They call it ‘shelter in place,’" says York. "You can’t expect a nurse to work if she is worrying about her children." She is now drawing up a plan to make it possible for the hospital to house staff and their families during an emergency.

And what if a surgeon could not concentrate while his beloved basset hound was threatened by rising water? "Hmmm. I hadn’t thought of that," says York. "But I’m thinking about it now!" Sheltering staff – let alone their pets – would be a challenge, she says. "It wouldn’t be easy. We would need a way to keep an eye on the kids. And what if someone were on medication?" After ruminating for just a second, York declares: "If there is a way, I’ll find it."

Capital Health System, 750 Brunswick Avenue, Trenton 08638. Al Maghazehe, CEO. 609-394-6000; fax, 609-695-8865. www.capitalhealth.org

Applying Anthrax Attack Lessons at RWJohnson

Janice Stout has been with Robert Wood Johnson for 30 years, first as a nurse, recently as emergency preparedness coordinator, and now as vice president for corporate compliance.

Optimum preparedness, she says, "is all about cooperation." This too is an outcome of the horrors of the September 11 attacks. "Before 9/11 the emergency coordinators didn’t even know one another," she says. "Everybody has given emergency preparedness a lot more attention. It’s become a much bigger issue. Now her hospital is supported in an inter-connected net of resources. It has close ties with local police departments, the township and state health departments, and other area hospitals. "It’s very different from a few years ago," she says. "Everyone knows everyone. We’re looking to integrate plans."

While others drill for disasters, Robert Wood Johnson has been through the real thing. It was ground zero in the anthrax attacks that occurred in the fall of 2001, serving hundreds of terrified people. Nearly all of the people who flocked to the hospital were perfectly well, but dealing with so many of them at one time provided important experience. "We revised our plan to better handle a lot of people in a short time," says Stout. "Triage was very important."

Should a number of people actually be exposed to a biological weapon, the hospital is prepared. It has an outdoor decontamination unit that opens right into its emergency room.

Even though her hospital had lived through a real disaster, Stout says that it found the TOPOFF 3 drill extremely helpful. The hospital already had a phone chain to connect employees with the hospital, but as a result of the drill it added the phone chain to its intranet, and posted emergency updates there too.

The drill also tested the hospital’s chain of command. "The incident commander had a heart attack and died," says Stout. And who took over? "I did," she says.

The Hamilton hospital has provisions for food, water, medications, and power in case of an emergency, and also for less tangible – but potentially even more important – back-ups.

"We back up patient information off-site every day," says York. The hospital also backs up financial information and other data, but not as often. She stresses the importance of keeping treatment updates absolutely current. This back-up could make all the difference to patients in the middle of, say, a chemotherapy regimen. Should the hospital be down for a long time, as was the case in New Orleans, doctors treating a cancer patient in a distant city would have a full record of treatment to date, and could pick up at just the right place.

So vital is this information that York says her hospital is looking beyond its daily back-up. "Katrina made us think more about back-up of patient records," she says. "We’re evaluating additional off-site storage to have extra back-up."

Robert Wood Johnson University Hospital, 1 Hamilton Health Place, Hamilton 08619. Christy Stephenson, CEO. 609-586-7900; fax, 609-584-6525. Home page: www.rwjhamilton.org

Bringing in Expert Help

Nancy Panarella is director of emergency services at the University Medical Center at Princeton. That means that she is also heavily involved in implementing an emergency management plan. The plan, she says, "covers almost every aspect of the patients’ day. It covers every department."

The hospital has an emergency preparedness committee, which meets every quarter, and it holds two drills a year, "one internal, one with the community," says Panarella. Still, preparing for every eventuality is a daunting task. "Emergency management is ever-changing, because the environment is changing so much," says Panarella. In order to respond to any scenario in a world where a terrorist wreaks havoc one day and a hurricane displaces millions the next, the medical center put itself in the hands of an expert.

"We hired Fisher Safety to train the staff," says Panarella. "They’re training across the continuum – nursing, behavioral health, engineering, environmental health, the Merwick Care Center." Managers from every part of the hospital will

take part in the training.

Each year the hospital revises its vulnerability plan. "We rate events by severity," says Panarella, "blizzard, flood, terrorist attack." There are plans for each eventuality. In the case of a blizzard the hospital has "an extensive

network" of employees and volunteers on call to brave snow drifts with their SUVs to bring in essential staff.

A lot of the hospital’s planning involves the more common disasters – the snow, rain, and wind events. "A hurricane is far more likely than a nuclear attack," Panarella points out. Still, the latter disaster has not escaped the hospital’s

notice. It has invested in radiation detection devices.

The hospital has back-up power to cover many functions, and it is tested once a quarter. It also has stockpiles of food and water. "In light of Katrina, we’ve increased our supplies," says Panarella. "We have, at the very least, a three-day food supply, and a five-day supply of water."

Princeton hospital has evacuation plans that would involve discharging the most critically ill first. Since it owns two nearby facilities, Merwick and Princeton House, it has readily available options. Like other hospitals in the area, it would also cooperate with other health care facilities to find beds and care in case of an emergency. But, also like other area hospitals, Princeton has not yet come up with an evacuation solution to a region-wide, New Orleans-style disaster.

Panarella could be speaking for any area hospital when she says: "It’s difficult to say what we would do to evacuate the whole facility out of the area."

Princeton HealthCare System, 253 Witherspoon Street, Princeton 08540. Barry S. Rabner, CEO. 609-497-4000. www.princetonhcs.org

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