With few attack survivors to treat, surgery center staff collect blood

Terrorist attacks raise question: Are you prepared for a disaster?

On the morning of Sept. 11, when terrorists attacked the World Trade Center towers and the Pentagon, nearby same-day surgery departments already were handling their first cases of the day. When they received word of the disasters, they finished those cases, canceled surgeries for the remainder of the day, and then stood by ready to offer minor treatment to a heavy caseload of survivors that never came.

But one group of enterprising same-day surgery personnel, one of whom had a husband at the Pentagon she couldn’t reach, refused to wait and do nothing. By 11:30 a.m., the staff at Inova Surgery Center in Falls Church, VA, noticed that a few hundred patients were lining up outside to donate blood at the donor center, which is located downstairs from the surgery center.

Shifting gears to fill a need

"Obviously the blood donor center was not prepared for that, so our nurses became very proactive," says Sheree Lopez, RN, director of ambulatory surgery at Inova Surgery Center and Inova Fairfax Hospital Surgery Center, also in Falls Church. The surgery center staff turned the center into a makeshift blood donor center, and in doing so, they found purpose in the face of senseless tragedy. "We saw the positive, the best part of what happened," Lopez says. "We saw community members coming together to do something that was so uplifting."

The nurses brought about 150 waiting blood donors into the facility, she says. "We put them in the waiting area, in every nook and cranny we could find," she says. The atmosphere was highly emotional, as donors hugged and even exchanged telephone numbers. "We watched three romances blossom while people were waiting to donate blood," Lopez says.

The outpatient surgery nurses handled preassessments, screenings, blood pressure checks, and needlesticks. One anesthetist, who remained on site after others were told to report to the hospital, helped start the IVs. The blood donor center sent a phlebotomist to handle blood draws. "We helped with nourishment and post- procedure recovery: getting patients into recliners and giving them something to eat or drink," she explains.

At the end of the day, the nurse whose husband worked at the Pentagon had learned he was not injured, and 150 persons had donated blood at the surgery center. The blood donor center handled an additional 200. "The [surgery center] staff was phenomenal," Lopez says. They were proactively looking for things to do. It made them very uncomfortable to play the waiting game. When they said this is something we could do, this was a win-win for everyone." (See "Surgical supply company gets products to hospital," in this issue.)

Near the World Trade Center

At Saint Vincents Hospital Manhattan, less than three miles from the World Trade Center towers, the first cases were under way in outpatient surgery when the hospital declared a disaster. The outpatient surgery ORs are combined with the inpatient rooms, says Dorothy O’Neill, RN, senior staff nurse. "We immediately tried to finish up rooms and free up as many ORs as possible," O’Neill says. In fact, the Albany-based New York State Health Department asked hospitals across the state to consider delaying elective surgery scheduled for that day.

Lisa Autz, BSN, director of ambulatory unit and recovery room, said the stage one recovery area was used for all of the patients in the ORs, including inpatients. The main recovery room was used as an extension of the emergency department, Autz says. Several nurses from the outpatient surgery staff went to the recovery room and treated a few burn victims and several firemen, police officers, and bystanders with injuries, O’Neill says.

One early priority was to contact patients who had cases scheduled for later that day, Autz says. The staff realized that those people might not be watching television. Also, the staff notified patients already at the center, whose procedures hadn’t started, that their cases were canceled. The staff calmly explained that because the nearby streets were closed and many subways and trains were stopped, the patients would have difficulty going home.

Getting patients home

People were reassured that they could stay in the hospital until transportation was available, Autz says. "When transportation opened up, we let them know," she says. The managers also had to address transportation home for patients who had completed surgery and for staff who had completed their shifts. They coordinated transportation with the police department, which had set up a temporary satellite office at the hospital. Car services picked up most patients and staff. The ambulatory surgery staff kept police informed when the car services needed to go through the police barricades. In fact, the police department assisted a few nurses by providing transportation home or to a bus or train.

Managers of the facilities involved with the Sept. 11 disaster emphasize that planning, policies, and drills are critical elements of being prepared for an external disaster. In fact, the Inova Fairfax system held an external disaster drill the Saturday before the attacks, Lopez notes. "I feel we were very prepared," she says.

The policies and procedures are being re-examined in the light of what happened on Sept. 11, Lopez adds. For example, the facility administrators realized that there are more than 70 potential entrances and exits into Inova Fairfax Hospital. "They have tightened up on security, and they are looking at [how to secure] doors," she says.

In the aftermath of the terrorist attacks, the Chicago-based American Hospital Association (AHA) issued a disaster readiness advisory that includes descriptions of likely biological or chemical agents that might be used in a terrorist attack, along with a self-assessment checklist to ensure readiness. (To see chemical/biological agent checklist, click here. For information on how to access the advisory and other materials, see "Resource" at the end of this article.)

What is required for accreditation?

The Accreditation Association for Ambulatory Health Care of the Joint Commission on Accreditation of Healthcare Organizations says facilities need to have a plan for the role they play in a disaster, says Ann Kobs, MS, RN, president and CEO of Cape Coral, FL-based Type One Solutions, which advises health care organizations on accreditation issues. "It’s not just a disaster in your building, such as if you’re hit by a tornado, but you also have a role in community disasters," Kobs says.

Your requirements are based on your scope of service, she says. She suggests that outpatient surgery providers pay particular attention to the following Joint Commission environment of care (EC) standards:

EC1: lists seven plans you must have: utilities, fire, employee safety, hazardous materials, security, emergency preparedness, and medical equipment;

EC2: explains that you must not only have a plan, but your staff members must know their role;

EC3: explains how you evaluate your plan.

One outpatient surgery manager interviewed by Same-Day Surgery says she is completing a hazard vulnerability analysis, as required by the Joint Commission, that identifies whether your disaster plan addresses the disasters most likely to occur.

"Anything that we score a 3 or 4 on [meaning some elements of the plan are not in place], we’re going to make the policy more specific," says Lori Theriot, RN, director of nursing at Acadiana Surgery Center in New Iberia, LA. (See "Acadiana Surgery Center external disaster plan," in this issue.) The center scored a 100 on its last survey. "My external disaster plan is not very specific, in terms of if there is a war or terrorist attack in Acadiana Parish," she says.

Resource

The Oct. 3 Disaster Readiness Advisory from the American Hospital Association (AHA) in Chicago can be accessed at www.aha.org/Emergency/Readiness/ReadinessIndex.asp. Another Disaster Readiness Advisory was sent Sept. 21 and is available at www.aha.org under "Disaster Readiness." That web page contains other information from the AHA and other sources on disaster readiness.

Sources

For more information on disaster training, contact:

Lisa Autz, BSN, Director, Ambulatory Unit and Recovery Room, Saint Vincents Manhattan, 153 W. 11th St., New York, NY 10011. Telephone: (212) 604-7598. Fax: (212) 604-3920. E-mail: lautz@saintvincentsnyc.org.

Ann Kobs, MS, RN, President and CEO, Type One Solutions, 166 S.E. 18th Terrace, Suite A, Cape Coral, FL 33990. Telephone: (941) 574-8318. Fax: (941) 574-8814. E-mail: Aejbbk@aol.com.

Sheree Lopez, RN, Director of Ambulatory Surgery, Inova Fairfax Hospital Surgery Center, 3300 Gallows Road, Falls Church, VA 22042-3000. Telephone: (571) 226-5931. Fax: (571) 226-5919. E-mail: sheree.lopez@inova.com.

Lori Theriot, RN, Director of Nursing, Acadiana Surgery Center, 110 Andre St., Suite 300, New Iberia, LA 70563. Telephone: (337) 364-9680. Fax: (337) 364-9689. E-mail: asc@drpstokes.com.