What will you do if disaster hits your ORs?

SDS programs share lessons from quake, tornado

When two outpatient surgery departments faced disaster in the past year, they learned just how important it is to participate in disaster drills and to come together as a team when a crisis hits.

There was no warning when an earthquake hit Hawaii at about 7:10 a.m. on Oct. 15. Because the quake hit on a Sunday, no outpatient surgery procedures were in progress at Kona Community Hospital in Kealakekua. The 6.7 magnitude quake caused a couple of dozen injuries but no fatalities. However, the quake caused damage to all three ORs, including fallen ceiling tiles, cracked walls, along with dust and debris, says Dawn Brewer, RN, BSN, CNOR, nurse manager of surgical services. Total damage to the hospital was estimated at $5 million, which included staff overtime and lost surgeries.

The surgery staff learned how important teamwork is. "A lot of our surgical staff came in within an hour and were helping to clean the OR and do everything to get it fully operational," Brewer says. The work paid off. In less than one hour, one OR was fully functional for emergencies. However, the others were closed to elective surgeries for nine days, she says.

Staff called each patient and rescheduled elective surgeries, Brewer says. Staff continued to show up for work during the following nine days, Brewer says. "If they were not needed in the unit, they went elsewhere to help with the cleanup and getting the rest of the hospital up and running," she says. Initially, only 10% of the hospital was operational.

For future disasters, Brewer says it would be helpful to have a list of persons in the community who might be able to help in a time of disaster. "They could be community volunteers or others that might be available when an emergency hits," she says.

Once the ORs were ready for elective surgery, the public relations staff provided that information to area radio stations and print media. The medical staff services office informed physicians.

The twice-a-year disaster preparedness exercises, which the outpatient surgery area participated in, were helpful in preparing for the earthquake, Brewer says. In fact, the hospital has just completed a drill about three weeks before the disaster. Participating in the drills helped the staff be clear about who would be on the response team and who would be the coordinator in an emergency, Brewer says. "It's helpful to do that every year, so you're not running around in a panic at the time of a true emergency," she says.

Include your insurance agent in your drills, to determine what services they may be able to provide in a disaster, sources suggest.

A recent study from The Joint Commission found that community-based preparation for — and response to — disasters requires more effective communication and planning among health care providers and other responders.1 The study also found that national benchmarks are needed to measure and promote emergency preparedness planning.

Tornado hits in the middle of a drill

Sumner Regional Medical Center in Gallatin, TN, learned about the importance of disaster drills in April 2006 when a tornado came through the community in the midst of a drill that had been planned for two years.

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, 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 says. The hospital immediately called a Code Yellow (tornado), locked down the facility, and moved patients to center corridors. There were approximately 10 patients in the same-day surgery (SDS) preparation/discharge area and ORs when staff received word of the impending tornado, says Debbie Harper, RN, staff nurse. In the prep area, "we pulled patients out of rooms with windows and put them in hallways or rooms where there were no windows," Harper says.

One outpatient surgery procedure was being finished when staff received word about the tornado, says Tricia Place, RN-C, staff nurse in the operating room. The staff were thankful that the surgery was being conducted in one of the inside ORs with no windows, Place says. The surgery was finished, and the patient was taken to a recovery room, she says.

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 1¼ miles of the hospital. The Category 3 tornado hit the ground for 20 minutes and caused about 35 injuries and seven fatalities.

The disaster drills were helpful in that they indicated to the same-day surgery area what kinds of supplies they might need in an actual disaster, Harper says. Ironically, the supplies for the drill had been moved out of the area when the drill was canceled, and they had to be brought back after the tornado, Harper says.

No one was allowed to be discharged for several hours until the tornado warning was canceled and it was determined that the roads were safe for travel, she says. "There was a lot of damage in our town," Harper says.

The outpatient surgery prep/discharge area became an overflow treatment area for the emergency department (ED), she says. SDS staff treated fractures, extremities, cuts, and contusions, Harper says. "It wasn't our norm." Most of those patients were treated and released, she adds.

The typical admitting routine didn't work well in a disaster situation, Harper says. She hopes that future disaster planning will address patient flow and patient identification, she says. "We were down to a staff of three in our department, and they were having to send us people from throughout the hospital to help," Harper says. Also, in the midst of a disaster situation, it can be difficult to take the time to find a job for everyone, she adds. "It let us know that next time we could be better coordinated on using our help," Harper says.

The OR staff provided help to the ED and to the SDS treatment area, Place says. The staff also became supply runners for medications that were needed in different areas, she says.

Do you use just-in-time delivery?

Disaster preparedness is a two-way street, and it's important that the hospital managers 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, [providers] that utilize 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," Kuhny says.

Additionally, you may want to have contracts in place for cleaning and glass boarding, sources suggest. Also, consider having a contract with a contractor who knows the layout and the needs of your facility, they advise.

It's essential to set up effective communication strategies before disaster occurs, Kuhny says. Internally, communicate the plan to the members of your staff so they understand their roles, she advises. Also, communicate planned improvements internally after an exercise. For example, managers may determine during an exercise that they are unable to easily identify the number of beds available and to locate patients. "That would be an improvement that needs to be communicated in terms of the people responsible for beds and the people responsible for caring for patients," she says.

Make sure your disaster exercises are meaningful, she emphasizes. "They make a difference," Kuhny says. "You learn from them. They're not just done to meet the requirements."

Reference

  1. Braum BI, Vineman NV, Finn NL, et al. Integrating Hospitals into Community Emergency Preparedness Planning. Ann Intern Med 2006; 144:799-811. Web: www.annals.org/cgi/content/full/144/11/799.

Resource

The Joint Commission and Joint Commission Resources recently cosponsored a conference on emergency preparedness that included a profile on the Gallatin, TN, tornado. For presentations and more information from the conference, go to www.jcrinc.com/14226.