Disaster surge fails to fluster ED staff
Disaster surge fails to fluster ED staff
Things were a little slower than normal on Tuesday evening, March 25, in the ED at Caritas Norwood (MA) Hospital. That all changed in an instant when 48 patients arrived — 33 in a single busload — who were victims of a commuter train wreck in nearby Canton. All of the patients arrived between 6 and 6:30 p.m.
Kathy Merrigan, MSN, RN, ED manager, says the department's thorough disaster planning, the facility's "Code D" disaster response plan, and outstanding support from staff — some of whom came in to work without even being called — all contributed to a successful response.
The department swung into action almost immediately, she recalls.
"I was home eating dinner with the TV on when one of my kids saw on the local news that there had been a train collision in the next town over," Merrigan says. "Five minutes later I got beeped."
David Geller, MD, director of pre-hospital services, had a similar experience. "I was out shopping in Wal-Mart when I got a cell phone call from the chief of pathology," he recalls.
This notification system was part of the Code D plan, says Merrigan. "The disaster call list was activated, and some nurses who were on the floors came down initially on their own or were asked to do so by their nursing supervisor, which pooled extra resources for us," she recalls. "I also had three staff members come in on their own who had seen the news, as well as several nurses who work in the hospital but not the ED."
Geller says, "One of the nice things about being in a community hospital is that you live and work in the same area, and the nurses are likely to know the victims or their relatives. I heard dozens of nurses called in to ask if they could help."
Five RNs and two ED physicians were mobilized to the day surgery area, which was used to house the overflow patients. "People were triaged, and if they were not acute they were sent to that area, which is only used from nine to five," notes Merrigan. It was very appropriate because it had stretchers and supplies, she says.
However, the 28 beds in the ED and the 20 in the day surgery area were not sufficient, "So we used a lot of hall beds," notes Merrigan. None of the injuries were life-threatening, and 45 of the 48 injuries were nonacute, she says.
Supplies in the ED proper were not an issue, says Merrigan, "but we did have to add supplies to the day surgery area."
They also needed wheelchairs, she says. Ancillary personnel such as transport staff obtained the wheelchairs as well as stretchers, Merrigan says.
Those personnel weren't the only ones who came in handy, says Geller. "We had a whole bunch of secretaries and nonmedical people who had been assigned to disaster response, and that was just fabulous," he says. "People could run and take care of things for us while we focused on patient care." For example, he says, they ran over every X-ray reading so Geller didn't have to search for view boxes. Because the hospital uses digital readouts, he explains, the readings saved him the time of calling up the actual pictures on the computer, which requires typing in the patients' name and other information to obtain access.
The ED also made special accommodations for family members, says Merrigan. "We put them in a conference room next to the library, which was part of our disaster plan," she notes.
Members of the security staff who were posted outside of the ED, which also was part of the plan, were able to direct family members upstairs, accompanied by a registration staff member. "People will tell you this really ran better than some of our drills," says Merrigan. "Part of it was because acuity was low, but we were definitely well prepared."
The time of day was was a positive factor as well, notes Geller. "In the middle of the night, it's much harder to mobilize people and, of course, at that hour the day surgery space was available," he points out.
Still, notes Merrigan, preparation always could be improved, particularly when it comes to communication. "It was a challenge to communicate with the area where the family members were," she says. "We have a fairly new tracking system, we but could have utilized it better if there had been a laptop up there."
One of the facets of the disaster plan that Geller particularly appreciated were the "downtime charts" that were provided. "They were very 'bare,' with the understanding that we would pull them together more completely the next day," he says. "They were only about one-third the size of a normal chart."Things were a little slower than normal on Tuesday evening, March 25, in the ED at Caritas Norwood (MA) Hospital.
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