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Preparedness:
Hospital Readiness
Dan Hanfling, MD
Director of Emergency Management and Disaster Medicine for
Inova Health System and Co-chairman of the Northern Virginia Emergency Response
Coalition
Thursday, July 18, 2002; 4:30 p.m. EDT
The events of Sept. 11, 2001, the ensuing anthrax attacks and other
terrorist activities have brought the United States to a heightened
level of awareness. Nowhere is this more evident than in American hospitals -- relied upon to respond quickly and effectively in the event of a public health disaster.
In the past 10 months hospital administrators have taken a hard look at their crisis management plans and considered how to more effectively respond to large-scale emergencies.
Dan Hanfling, MD, director of Emergency Management and Disaster Medicine for
Inova Health System and co-chairman of the Northern Virginia Emergency Response
Coalition, was online Thursday, July 18 at 4:30 p.m. EDT, to discuss efforts made in the metropolitan area to improve hospital readiness.
Hanflingis also a physician in the emergency department at Inova Fairfax Hospital and serves as operational medical director for the Inova AirCare medevac helicopter.
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Washington, D.C.:
Are local hospitals prepared for future emergencies -- is there any equipment or supplies that we're lacking?
Dan Hanfling, MD: Readiness for each and every one of the potential threats we may face must be based upon a sound, "all-hazards" approach. This requires a flexibility in response capability, based upon a solid understanding of the risks threatening our community.
We have addressed this issue in Northern Virginia by creating the Northern Virginia Emergency Response Coalition (NVERC), which includes 14 regional hospitals, and representatives from departments of Public Health, local Fire and Rescue agencies, local law enforcement and other emergency responders.
The NVERC has addressed local disaster preparedness needs on a regional basis by creating a comprehensive response plan. This also includes purchase and use of personal protective equipment, coordinated disaster training exercises and a developing regional communications protocol.
In the context of this coordinated planning, we are better prepared for what the future may hold than we were prior to the events of last Fall.
Scranton, Pa.:
Dr. Hanfling,
We're in the same bizness!
Do you think that the current training -- HazMat supplemented with WMD -- for healthcare is enough? Or is it time to completely rethink the educational needs? Add indepth courses to medical/ nursing training; require certain remedial courses to increase the knowledge base for all areas and all medical professions?
Dan Hanfling, MD: I believe it is time for us to rethink some of the essential concepts regarding the response to potential disaster events that might occur. We hear a lot of attention paid to weapons of mass 'destruction', which are really more likely to be weapons of mass 'exposure', especially as they relate to the use of biological, chemical and radiological threat agents.This means that as healthcare providers, we are likely to see large numbers of patients who will require our care and attention. These 'potentially exposed' patients will seek treatment at our hospitals and emergency departments.
The current training efforts must reflect the reality that hospital emergency department staff, and hospital providers in general, are truly the new 'first responders'. A comprehensive training program, that begins as early as a portion of the core curricula for medical, nursing and other allied health professionals is certainly necessary. And I agree that ongoing training and education for established health care providers will be required given the large amount of information that now must be learned.
Washington, D.C.:
I know that GW Hospital has some kind of decontamination capability, and that it is the only hospital in D.C. to do so. (Forgive my being really vague -- I can't remember exactly what this unit is!) Do other hospitals have any plans to provide similar services?
Dan Hanfling, MD: In fact, in compliance with accreditation standards that govern hospital operations, ALL hospitals have decontamination capabilities. GW Hospital was one of the first facilities in the nation to create a dedicated mass decontamination capability, truly ahead of its time.
Many hospitals around the country are now doing the same, and are developing protocols to handle large numbers of potentially exposed patients.
Inova Health System has also been focused on this critical need for a long time. In addition to adding fixed mass decontamination capabilities, we are in the midst of a system-wide mass decontamination training program that is teaching our hospital responders the safe use of personal protective equipment, what you might think of as gas masks, and the proper way to conduct decontamination.
Furthermore, the protocols that we are using for the response to a chemical terrorism event have been shared across our entire region through the Northern Virginia Emergency Response Coalition (NVERC).
Washington, D.C.:
My wife is pregnant, and I am concerned that the shock of a major terrorist incident might prompt labor (or that she might be in labor when such an incident occurs). If local hospitals were to be flooded with victims of terrorism, would you expect that more "routine" activities like labor and delivery would proceed as normal?
Dan Hanfling, MD: Congratulations!
Hospitals recognize that routine care delivery will still be required, even in the setting of an large-scale disaster event. Babies are born, people have strokes and heart attacks, cars crash and these patients all still need to be cared for.
Some care delivery may be altered. For example, on September 11th, elective surgery cases were cancelled throughout the metropolitan DC region, as the anticipated need for operating rooms for injuries from the Pentagon prevailed. As the day went on, and the flow of patients subsided, hospital activity returned to its usual pace. But even in those first chaotic hours, acute medical emergencies were being cared for without interruption.
Dan Hanfling, MD: More attention needs to be focused on the financial burden that hospital disaster preparedness entails. Up to this point, there has been a fairly hefty designation of Federal dollars to the Public Health and traditional first responder communities, which are very deserving of this support. However, hospital funding is still woefully inadequate if we are to accomplish a truly seamless, "all-hazards" disaster response capability. Money is currently going from the Federal government to State governments, but little has made it down to the local hospital communities, with very few exceptions. This has got to be addressed quickly by our political leaders.
Augusta, Ga.:
I understand that the CDC's ACIP has made recommendations concening smallpox immunization and, if necessary, containment. These seem to be based on an assumed low probability that smallpox will be used as a weapon. One CDC official replied to my query on this topic, that the risk of vaccinating everyone is too great to justify doing it now, which he put a 1 per 1,000, and that the ring containment is the plan that's worked before to eliminate smallpox.
If you've seen the scenario exercise, "Dark Winter", and if you believe it to be a reasonable assessment of what could happen, without much trouble on the part of any terrorists who actually have access to smallpox, then why wouldn't we crank up production of a vaccine and at least offer it to those who want it? It seems that widespread immunization, even if spotty, would vitually eliminate smallpox as a terrorist tool of choice.
Thank you for your comments.
Dan Hanfling, MD: This may be one of the most complicated issues of our time.
Smallpox, if used deliberately, will potentially have devastating effect the world over. And yet, in the absence of credible information that suggest its impending release, the widespread immunization of the general population with the currently held stock of smallpox vaccine is tinged by significant risk. It's known side effect profile is such that there might be needless death and injury from use of this vaccine, again, in the absence of a compelling reason to use it now.
The United States government has contracted for a new, safer vaccine product, currently in production, and might prove to be a better choice.
Charlottesville, Va.:
Who are the members of NVERC?
Dan Hanfling, MD: The Northern Virginia Emergency Response Coalition (NVERC) is comprised of the 14 hospitals in Northern Virginia, including those in Fairfax County, Arlington County, City of Alexandria, Loudoun County and Prince William County. It also includes representatives from the corresponding public health departments and Fire/Rescue agencies. Participation of the law enforcement and emergency management communities are also solicited when required.
It is co-chaired by Dr. Yorke Allen (Virginia Hospital Center - Arlington), Craig DeAtley, PA and myself, and we have been meeting regularly since mid-September to coordinate our regional disaster preparedness response plans.
This includes the development of a communications clearinghouse plan that we call MEDCOMM,which is in direct linkage with the District of Columbia's Hospital Mutual Aid Radio System (H-MARS). We have also been successful in signing a regional hospital Memorandum of Understanding governing the need for shared resources and healthcare personnel in the event of a large scale event occuring close to home.
Arlington, Va.:
What was the biggest lesson area hospitals learned after Sept. 11?
Dan Hanfling, MD: We need to come together as a health care delivery system. The old disaster preparedness mantra used to be "play together, respond together." Now, with the added complexities that we encounter in this new threat environment, we will all be better off if we "PAY together", then "play together and respond together."
Hospital disaster preparedness does not come cheaply, and so if for no other reason than improving on the bottom line, we must truly coordinate our response capability so as to take advantage of our collective buying power.
And once this occurs, everything else seems to fall into step. Shared resources leads to shared protocols and procedures, and so on. And in the final analysis, we expect that promotion of this unified response will ultimately result in better patient care delivery and improved patient outcomes.
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