ED Accreditation Update
Tornado hits in middle of disaster drill, and communication helps and hinders response
Know fellow responders, and get correct information, equipment
A Category 3 tornado hits during a four-county disaster exercise that's been planned for two years. Although that scenario seems improbable, that's exactly what happened to hospitals in the Nashville, TN, area last year. The tornado hit the ground for 20 minutes and caused about 35 injuries and seven fatalities.
Because of the drill, ham radios had been activated, and those radio operators reported a tornado was moving through the state. The drill immediately was suspended.
Mark Schultz, director of safety at Sumner Regional Medical Center in Gallatin, TN, saw a TV report that indicated with an arrow where the tornado was headed. "The tip of the arrow was where the hospital is," he recalls. The hospital immediately called a Code Yellow (tornado), locked down the facility, and moved patients to center corridors. About four minutes later, Schultz heard a police officer on the radio say, "There it is." Schultz went out the back door and saw the tornado, which came within a mile and a quarter of the hospital.
Joint Commission: Improve communication
The disaster proved the importance of disaster preparation and good communication. A recent study from The Joint Commission found that community-based preparation for — and response to — disasters would require more effective communication and planning among hospitals and other responders. The study also found that national benchmarks are needed to measure and promote emergency preparedness planning. The study led to an October conference on emergency preparedness, cosponsored by Joint Commission Resources, where the Nashville, TN, disaster and others were profiled. (For presentations and more information from the conference, go to www.jcrinc.com/14226.)
In the aftermath of the tornado, Sumner Regional lost power and communications, and administrators relied on their radios to find out what was happening. When reports circulated that there might be a second band of severe weather, Schultz contacted his brother who lived outside the area and said, "Get on the Internet. I need a weather report every five minutes."
Another communication problem occurred when an emergency responder went to the local college, which sustained a large amount of damage. He reported on the radio, "The college is destroyed. There must be hundreds of injured." Hospital administrators who heard the transmission geared up for a massive influx of trauma patients who never materialized because the report was incorrect, Schulz says.
In the initial chaos after a disaster, hospitals receive a lot of conflicting information, warns Pamela K. Hoffner, MSN, RN, emergency preparedness coordinator at Vanderbilt University Medical Center in Nashville. Nashville-area hospitals are considering having one joint information center to verify information before distributing it, she says.
The injured patients who were treated at Sumner Regional, mostly for cuts and bruises, were not able to be transferred to Nashville because the roads were closed, Schultz says. In light of that problem, traffic rerouting after a disaster is being discussed, Hoffner says.
Another problem uncovered during the disaster response was the emergency operations center at Vanderbilt, which has one wall made mostly of glass. "When the siren went off, we had to pick up and move to an interior room, all the while trying to keep our operations center open," Hoffner says. The administrators now are looking at moving the center's location permanently or adding hurricane shutters to cover the glass, she says.
One area of the tornado response that did work well was EMS, whose staff triaged and treated dozens of patients on the scene, rather than transporting everyone to the hospital, Schultz says. "We didn't get hammered nearly as bad as we would have if they hadn't done that [treatment] at the scene," he says.
Know your community response team
Disaster preparedness is a two-way street, and it's important that hospital leaders understand what they will require from the community, says Louise Kuhny, RN, MPH, MBA, CIC, associate director of standards interpretation at The Joint Commission. "If disaster lasts more than a few days, hospitals that utilized just-in-time delivery of linens, supplies, and foods might need some of the things from the community if they can't get them from their regular suppliers," she says.
Schultz discovered the truth of that statement firsthand after the tornado. Because of the drill preparation, all contact numbers for local emergency providers were up to date. "We knew everyone's e-mail [addresses] and faces," he says. "Everything was at a heightened sense of preparedness, but I guess that's why you drill."
This familiarity paid off when the hospital needed ventilators immediately. Although the vendor rep had been instructed how to avoid heavy traffic and closed roads when making the delivery, he didn't follow the directions and became stranded in traffic.
Schultz knew who to contact, due to his previous employment with the local fire department and from face-to-face lunch meetings with local disaster response leaders. He called the sheriff's department. "I told them there's a white van out there somewhere with 10 ventilators," he says. "The police found him, pulled him out of traffic, and got him to us on back roads that were still open."
When nurses had difficulty getting through the roadblocks, Schultz called the dispatcher, whom he knew personally. "Thirty seconds later, I heard her on the radio," he says. "She's instructing field officers to let them through."
Sumner Regional lost power after the tornado, even in the incident command center. This situation points to the need to think about what technology you will lose in such a scenario, including computers, TVs, and radios, Schultz says. To prepare for the future, Schultz is purchasing uninterruptible power supply (UPS) batteries for his computers. The batteries, which cost about $200 each, can be purchased from office supply stores, he says.
Cable, cell phones may not work
In these times, everyone has become accustomed to modern technology, such as cable TV and cell phones. On a day-to-day basis, local electronic communications, such as cable TV and cell phones, are necessary for updates on community events and disasters. But during a disaster in which the electrical and cable infrastructures are destroyed, the hospital must have backup systems that are wireless and battery-powered. During the severe weather, the hospital relied on cable TVs for weather reports and other information, Schultz says. When the cable went out, "we were running around the hospital looking for bunny ears," says Schultz, referring to the old-fashioned TV antennas.
As occurs in essentially every major community incident, cell phones were out of commission, he says. "Everyone wants to call everyone they know and tell them they saw a tornado, and the cell phone networks can't handle it," he says. Although one hospital in the district was supposed to have priority on cell channels, it didn't happen, Schultz says. Cell phones were useless, except as Rolodexes, he says. "You need to have redundant systems," he advises.
Land phone lines and radios remained operational after the tornado, Schultz says. Most agencies in his counties use ultra high frequency (UHF) and very high frequency (VHF) radios, which cost less than $300 each, he says. "If I have a radio, I have communication," Schultz says. Even if the base station fails, portable UHF and VHF radios still allow communication, he says.
Schultz' hospital has a radio frequency license and its own frequency. Anyone with a radio, such as the fire department staff, can talk to anyone else with the same equipment. "It's very beneficial," Schultz says. "When it hits the fan, they know Channel 3 is the hospital, and they'll chime in and ask, 'What do you need?'"
Don't forget the plan
The important thing to keep in mind after a disaster is for you and your staff to follow your disaster plan, Schultz says. "Too often, in an emergency, you forget the plan and do what you have to do," he says. Plans were written for a reason, he emphasizes. "You were thinking logically and rationally when you did it," Schultz says. When responding to a disaster, take a few minutes to read the plan so it's fresh in your mind, he advises. "You can read a tornado plan in two minutes," Schultz says.
A Category 3 tornado hits during a four-county disaster exercise that's been planned for two years. Although that scenario seems improbable, that's exactly what happened to hospitals in the Nashville, TN, area last year. The tornado hit the ground for 20 minutes and caused about 35 injuries and seven fatalities.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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