Last month, the U-M Health System put its staff to the test, conducting a region-wide disaster exercise involving multiple departments and procedures, as well as 34 other hospitals in Washtenaw, Wayne and Monroe counties. Hospitals are required by the Joint Commission to conduct two exercises (or real events) annually, and off-site buildings and clinics are required to conduct one exercise annually.
The Oct. 4 drill simulated the detonation of an improvised nuclear device in Detroit, resulting in 150 simulated victims arriving at the Adult Emergency Services (AES) and new Children’s Emergency Services (CES) at the U-M Hospitals and Health Centers. The full-scale exercise was intended to increase hospital all-hazard preparedness and to specifically increase hospital and regional nuclear incident preparedness.
One hundred victim scenarios were simulated at AES with 50 more at the Children’s ED. The drill gave UMHS an opportunity to test our Code D (Disaster) Plan, Burn Surge Plan, Radiation Incident Procedures, and decontamination operations. It was also the first ED drill conducted at the C.S. Mott Children’s and Von Voigtlander Women’s Hospital.
More than 75 Emergency Department staff volunteered to come in on their day off to participate in the drills. Nurses, physicians, ED techs, Environmental Services, Clerical Services, Radiation Safety Service (Occupational Safety & Environmental Health), Security and Entrance Services, Department of Public Safety, Safety Management Services, Emergency Preparedness, and more participated in the drill and its evaluation.
Victims were played by more than 30 UMHHC staff, U-M School of Public Health employees, Emergency Medical Technician students from Huron Valley Ambulance, and children of staff members who volunteered to be victims during the drill. Volunteers drew cards instructing them on their roles, which included patients exposed to radiation or contaminated with radioactive material, burn victims, and victims immobile or unable to hear or see.
Volunteers were dropped off in front of both emergency entrances and triaged by ED nurses through the decontamination tent as necessary, before entering the ED. Some of the volunteers agreed to get wet to allow staff the opportunity to practice decontamination processes.
What We Gain
Bruce Cadwallender, Director of Safety and Emergency Management, along with Carrie Wright, Emergency Management Specialist, planned and executed the drill for UMHHC, in partnership with many other staff and faculty from AES, CES, and other departments.
“To paraphrase from military experience, we perform the way we train,” said Cadwallender. “When we press ourselves in drills and exercises, we practice critical skills, while also identifying opportunities for improvement.”
“Conducting exercises and drills helps our organization to identify our strengths, test our emergency plans, and identify gaps in our overall response to incidents,” says Wright, who writes the UMHHC emergency response plans and develops the exercises to test these plans.
Occupational Safety and Environmental Health/Radiation Safety Service were represented well, with six RSS staff members participating in the exercise. The group provided simulated health physics support (including pre- and post-decontamination monitoring of victims) and helped evaluate the drill’s adherence to the established UMHHC Radiation Incident Procedures at both EDs.
“Practice makes perfect and when we have the opportunity to exercise our abilities in mass casualty response from a healthcare perspective it can only increase our chances of properly handling a critical situation in crucial time,” added Matthew Walter, M.P.H., C.I.H., Environmental Health and Safety representative, Safety Management Services.
Walter served as an Adult ED Safety Officer, which involved identifying and correcting unsafe conditions during the decontamination of victims. He also made sure staff remained safe while managing the response process.
After the clinical portion of the drill, participants attended a debrief session to discuss strengths, lessons learned, and improvement opportunities. Many suggestions involved patient flow and staffing needs. Additional observations for improvement dealt with decontaminating patients, contamination control, and controlling the traffic flow into the ED.
Emergency Operations During a Disaster
In the afternoon, the second phase of the exercise focused on activation of the Emergency Operations Center (EOC). The EOC is a dedicated, fully staffed and equipped room used to manage emergencies and disasters. The EOC was staffed by members of the Incident Management System Team (IMS) from Hospital Administration, Office of Clinical Affairs, Public Relations, Safety Management Services, Hospital Security, Facilities, Materiel Services, Nursing, Legal, MCIT, Admission & Bed Coordination, Infection Control & Epidemiology, Survival Flight, Social Work, EOC support staff, and physician leads from Nuclear Medicine, Trauma Burn, Hematology/Oncology, Otolaryngology, Ophthalmology, Pediatrics, Hospitalists, AES and CES.
The role of the IMS team is to work together to manage the event. This includes managing the communication response internally among UMHS staff, externally to the public, and also with other hospitals impacted by the simulated disaster scenario.
Public Relations staff practiced getting the word out about the disaster through media, social media, and internal channels. Other team members gathered information from departments on supply management, pharmaceutical supplies, blood supplies, bed capacity, and potential cancelation of elective surgical cases. Departments responded to these requests for information as they would in a real event. IMS Team discussions included the expected influx of patients requiring decontamination and treatment, staffing for a prolonged event, staff safety, access control, traffic control and whether to evacuate or shelter-in-place.
“Each year, we design our exercises to stress and stretch our capabilities, to find out where our weaknesses are so that we can improve our planning and response,” says Wright. ”This exercise highlighted why it’s so important for departments and units to know their role in our overall Emergency Operations Plan, maintain their departmental Continuity of Operations Plans, and exercise their own plans. Planning and exercising your plans is the best way we can stay prepared for our staff and patients.”
For questions, contact Carrie Wright: firstname.lastname@example.org.