Although every ED is unique, one thing is certain: None have remained unchanged in the aftermath of 9/11. Here, ED Management gives a one-year follow-up to the terrorist attacks, asking the questions "How has your disaster plan changed in the past year?" and "What is your single most pressing concern now?" Here are responses of ED managers:
"We completely overhauled our disaster/readiness training and response plan following the events of 9/11. This included a review of the management of the command center depending on the scenario presented. Once the plan was complete, training began at a high level, with all managers attending a session about the new processes. The managers were responsible to fan out that training to the respective units. The entire emergency staff received mandatory HazMat training including chemical, biological, and nuclear exposures. We purchased Level B suits, and training in the suits was conducted. Security and registration staff were trained by the safety department. We then began a series of internal drills to work with the suits and scenarios."
— Andrew G. Wilson, MD, FACEP, Chief of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI
"On Sept. 11, we were already in the process of revamping our emergency preparedness in light of the [Joint Commission on Accreditation of Healthcare Organizations] standards, which had been updated and published in January 2001. In the post-9/11 world, we have considerably broadened the process through the participation of more administrative leadership. The 9/11 disaster clearly concentrated the minds of senior management in a new way, and it has been helpful in gaining the attention and support of others in the medical center. Making it all real is the greatest challenge to our ED. Staffing is tight, everyone has a nursing shortage, and staff members are constantly challenged to do more in a world of shrinking resources. Training and drilling staff is a time- and money-intensive activity, and without regular practice, knowledge and skills atrophy. Detailed plans mitigate this difficulty to some extent, but only just so much. Initial management of patients — mostly children — who present with a rash or complaint of chickenpox can serve as a drill for alerting staff to the need to manage a patient with an infectious rash. Evaluation of such real-life occurrences can help ED leadership in evaluating their preparation for a possible smallpox presentation. However, chickenpox incidence is diminishing as more infants receive the vaccine."
— Steven J. Davidson, MD, MBA, Chair, Department of Emergency Medicine, Maimonides Medical Center in Brooklyn, NY
"We have now totally redesigned our disaster plan. Before 9/11, our plan was based on a multiple-casualty scenario. Now we have modified it to include bioterrorism and radiological emergencies. To this end, the hospital has undergone [Hospital Emergency Incident Command System] training. The budget request for an improved decontamination facility was approved very rapidly. We now have much improved capability in this regard. The ED staff feel much more confident that we can manage these types of emergencies. The most pressing concern concerning disaster preparedness is still the chronic high occupancy of the hospital beds and the inability to manage any surge capacity that we would need if there were to be a disaster. We have no space in the hospital, the ED is full, and we have patients in the waiting room waiting for monitored beds. To ask the ED to now manage an additional patient load, let alone 500 patients exposed to HAZMAT or smallpox, is unreasonable."
— Alasdair Conn, MD, Chief of Emergency Medicine, Massachusetts General Hospital, Boston
"Our preparedness is more beefed up, and disaster planning is significantly improved. We have frequent updates, classes, and alerts from the Greater New York Hospital Association, which acts as our communication hub from the Mayor’s Office of Emergency Management. The hospital is exploring ways to make the institution more safe and resistant to terrorist threats/activities. My biggest concern is the money and time to train staff. We are doing this on overtime and backfill, and will be overrunning our budgets, I am sure. I am glad that my institution is as far along in the planning process. Some of my colleagues are much further behind than we are. None of us feel we are truly ready, especially after 9/11."
— Laura Giles, RN, ED nurse manager, Mount Sinai Medical Center, New York City
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