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Solid plan, 'gut instinct' are disaster response keys
Bridge collapses, ED manager makes judgment call
When a bridge that links Minneapolis and St. Paul, MN, collapsed early in the evening on Aug. 1, it touched off a series of events and tragedies that unfolded rapidly amid much confusion and conflicting media reports. Fortunately for the 24 patients brought to the ED at nearby Hennepin County Medical Center in Minneapolis, there was anything but chaos and confusion among the staff.
In fact, says John L. Hick, MD, medical director for emergency preparedness at Hennepin County, "Within hours afterward, we had resumed pretty normal operations at the hospital."
This efficient response was due to effective planning and quick thinking on the part of William Heegaard, MD, MPH, assistant chief of emergency medicine. Heegaard was the senior staffer present when the disaster occurred, and it was his decision to call a Code Orange (the hospital's highest-level emergency) earlier than some ED managers might have.
"We initially got a quick report from one of the paramedics who had had contact with the police, who told us a bridge had perhaps gone down," he recalls. "I was running a critical case at the time, so I just asked them to keep me abreast of the situation."
A few minutes later, the control center for the Hennepin ambulances informed the ED they had sent multiple rigs to the scene, so Heegaard knew it was more than just a small event. "However, there was no way to assess how many patients to expect," he adds.
At this point, it was about 6:20 p.m. (The bridge collapsed at 6:07.) While Heegaard did not officially call a disaster, "we contacted the charge nurses, started to ask about resources available, and got a status report of the ED at that point," he says.
He started reviewing what to if it became necessary to clear the ED for an influx of victims. He contacted the chief of emergency medicine and told him to turn on his TV. "I also called the on-call surgeon, alerted him, and asked him to make sure to have a couple of extra people he could call if need be," says Heegaard.
Shortly thereafter, after speaking with ambulance personnel and people on the scene, "it became obvious this was an event that could potentially overcome all our resources," says Heegaard. While the information still was relatively sketchy, with no idea of how many victims might be on their way, "I had a gut feeling that calling a disaster response was the right thing to do," he explains. "After all, we could always call it off." The time was about 6:30 p.m.
From that point on, says Heegaard, there was "a massive, impressive response." Team Center A — the ED's main area for the sickest people — was cleared out, as the patients were immediately admitted or moved into Team Centers B or C. As for the patients who had been in those areas for lower acuity, "we discharged the people we felt comfortable with, and admitted a few," says Heegaard. The Express Care area was cleared. In the "special care" area, reserved for intoxicated patients and prisoners, the patients were discharged, and it became the triage staging area.
"At that point, we also elected to divert any nontrauma critical patients and communicated to those on the scene that we would take all critical patients," says Heegaard. "We had cleared out about 25 beds for them and had 10 fully staffed ORs up and running within an hour."
The ED had a relatively quick rush of six seriously injured patients, he recalls. "I initially managed those patients and pulled faculty from Teams B and C into the critical care area," Heegaard says. He knew he had to manage the patients with his current staff for about 10 minutes. Soon, another faculty member who had heard about the disaster drove in to work. A page went out to all staff, and "pretty quickly, we had three faculty and accompanying residents to manage the critical care area," says Heegaard.
Faculty soon replaced residents managing Teams B and C. There also were several faculty members, nurses, and physicians assistants available to manage patients who were not critical. There were 14 cubicles available by then in the Team A area.
Of the 24 patients received by the Hennepin ED, six were critical (one eventually died), 10 were serious (primarily spinal and other blunt-force injuries), and eight were treated and released in less than 24 hours. "We were really lucky that we did not have that many 'criticals,'" says Hick. "We had very rapid and impressive staff and facility response."
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