Shake up staff with a disaster drill that begins with unconventional news

For example: Flu epidemic would start slowly

When Sarasota Memorial Hospital in Sarasota, FL, recently held a disaster drill that was intended to prepare staff for a highly infectious disease outbreak, the hospital put a pharmacist in charge.

"I'm leading the drill, and the [managers in the] security office, who normally run the drills, don't know anything more about the drill than anyone else because they want to drill their team too," says Deborah J. Larison, PharmD, BCPS, a clinical pharmacy specialist in emergency medicine at Sarasota Memorial Hospital.

"Only two of us know the full scale of the drill," Larison says. The staff don't even know when the drill would be held, although employees were repeatedly sent notices and updated information about an infectious disease outbreak.

Five days before the drill was held, Larison sent out a health alert via e-mail and text pagers. It clearly stated that this was an exercise for training purposes and a drill. But its intention was to build up to the day of the drill by releasing small bits of information that health care providers would use to help determine the extent of the disaster. "What we've done differently for this drill to overcome the pandemic flu [drill] fatigue is a ramping up," Larison says.

By "ramping up," she refers to a ramping up of information that will be necessary for staff to learn in the case of a real disease outbreak.

"We've had meetings over the last 14 weeks, and at each meeting we practice a different piece of our plan and make sure it's appropriate and up-to-date," Larison says. "Over the last 14 days, we leak out pieces of the drill that we would normally know in advance."

For instance, the hospital would notice an increase in patients with flu-like symptoms.

"So we're leaking out information to the house early and saying, 'Now at this point, we have this many patients we think are infected and this many health care workers who are ill or whose children are ill, and they can't come into work,'" Larison says.

The pandemic drill involves an all-hazard approach and involves a fictional germ that features both viral transmission features, meaning it can replicate rapidly and is easily passed from one person to another, and it is a bacteria so that the staff's ability to obtain antibiotics when needed can be tested, Larison explains.

In the week before the drill is held, the staff will receive notices of patients who might be infected, as well as some health care workers who are sick or who have sick children, Larison says.

The drill health alert issued five days before the drill gave staff this information:

"Pseudorhinoviral tuberculareus-associated pulmonary infections continue to cause mortality in Africa and the Southeastern United States.

CDC is requesting that states report all cases of "influenza-like" pulmonary bacterial infections in U.S. residents who may have traveled to Africa in September-November 2008.

Since October, the Disease Surveillance System has collected information on deaths among African nationals due to laboratory-confirmed bacteria, including the presence of other medical conditions and viral infections at the time of death. From Oct.16, 2008 through today, 99 deaths from this illness have been reported to WHO from 23 hospitals in Zambia and other African countries. There are 75 confirmed cases with 44 deaths in Florida. Each death has been associated with multi-organ failure after a flu-like illness, high fever, headache, fatigue, muscle pain, weakness, swollen lymph nodes, cough, and bloody sputum. In the late stages, the illness usually involves multi-organ failure, septic shock, and death. The disease appears to have approximately 7-10 day incubation and be easily transmissible among humans in close contact with each other. It has been reported to have a high mortality rate, which has yet to be quantified in the United States. However, mortality in Africa continues to surpass 65%…"

The point of having the disaster drill drawn out over time is to teach staff how to collaborate to make certain they have enough supplies and medications to handle a situation that appears to be the beginning stage of an infectious disease disaster, Larison says.

"We're telling people to imagine a scenario several weeks in advance so they could talk to each other and say, 'Do you have enough of this and enough of that?'" Larison explains. "So on Tuesday, by the time we get to the drill, people have more pieces of information, just as they would in a real life situation."

During this period of ramping up, hospital employees become interested in the drill and even excited as the leaked information impacts their particular departments, Larison says.

"It's a new thing we wanted to try to make our drills more realistic and to build-up the anxiety like in a real scenario," Larison adds.