Terrorism drill shows ED response plan flaws

ED managers also see weaknesses in drill itself

In the world of bioterrorism drills, this was something special: TOPOFF3, a program mandated by Congress and sponsored by the Department of Homeland Security, simulated terror attacks in several locations in the United States — including the entire state of New Jersey. ED managers who participated in the New Jersey drills said they learned important lessons, not only about the weaknesses in their own response plans, but about the structure of the drill itself, which they hope will make future drills even more instructive.

The $16-million weeklong New Jersey drill, which took place the week of April 4, 2005, simulated the spraying of deadly pneumonic plague launched from a sport utility vehicle to gauge how hospitals would react if a real attack hit U.S. soil. The "death count" statewide was 5,961. (In the state of Connecticut, by comparison, which only had designated hospitals participate, there only were 200 "deaths.")

"This was the first time such a drill has occurred on statewide basis," notes Valerie Sellers, senior vice president of planning for the New Jersey Hospital Association, in Princeton, who coordinated the New Jersey effort. Planning was a two-year process, she says.

"The drill involved every acute care hospital in the state, as well as some specialty and rehab facilities," Sellers says. "It was an opportunity for hospitals to test the effectiveness of their emergency response plans."

How did the hospitals do? "I think it went very well," says Nancy Sierra, MD, FACEP, medical director for the ED at St. Michael’s Medical Center in Newark. "We got positive feedback from a federal inspector who was here observing."

St. Michaels "played" for one day (hospitals could play for up to three days), starting at 8 a.m. "We cordoned off one section of our ED and kept our regular ED process going, but the area where our drill patients were brought was totally separate from where the real patients were," she recalls.

One of the most valuable lessons her staff learned was how to coordinate communications within the hospital when there is a disaster, Sierra explains. "We learned how to funnel what we had to do to our leader," she says. Every one wants to do their own thing in their own timing during a time of disaster, "but even I had to report up to our leader right away," Sierra adds.

If she needed something, Sierra couldn’t simply call the storeroom, she says. She had to call the drill leader, and the drill leader would make the call.

As a result of the drill, St. Michaels also is amending its disaster handbook. "In our original handbook, the cordoning off process is not there," she notes. "We stepped out of our handbook, and it worked."

Communications of another kind were a problem at St. James Hospital, also in Newark. "We have a pager system that is supposed to page everyone in a disaster — and it did not work," reports Barbara Golding, RN, director of nursing for the ED and med/surg. "Some managers did not get the page on their pocket pagers, and we will look into why they didn’t."

The staff also have portable radios, and they tried to use them frequently during the drill, "but we found they were not wonderful," she says. "You couldn’t always hear; but in most of these situations, you could use a phone." Nevertheless, Golding adds, she is looking into different vendors.

How drill could be improved

Golding says she sees room for improvement in the drill itself. "It would have been better if the drill was longer, because that would really test your system," she asserts. "If a real situation were longer, you’d test your ability to get staff here."

One of the things no one was able to test — but that would have been critical if there had been a plague — was whether the EDs would have run out of supplies, Sellers says.

"They can either draw from existing vendors or go to another state, but if you were dealing with plague, supplies would be depleted," she adds. In TOPOFF, they assumed 28 other states were affected. "You could very quickly run out of supplies," Sellers says.

In addition, mortuary services were not tested realistically, she notes. "We did not have enough live people as victims," she complains. "If every place exceeded capacity, what infrastructure is there in place to relieve them? What is the hospital’s plan? You can’t just have bodies stacking up in the ED."

Participants were encouraged to provide feedback on the drill, Golding says, and further changes in emergency response plans are forthcoming from the Joint Commission on Accreditation of Healthcare Organizations. The agency has announced it will be revising its standards for emergency management drills.

Sources

For more information on disaster drills, contact:

  • Barbara Golding, RN, Director of Nursing, ED, and Med/Surg., St. James Hospital, 155 Jefferson St., Newark, NJ 07105. Phone: (973) 465-2865.
  • Valerie Sellers, Senior Vice President, Planning, New Jersey Hospital Association, 760 Alexander Road, P.O. Box 1, Princeton, NJ 08543-0001. Phone: (609) 275-4261.
  • Nancy Sierra, MD, FACEP, ED Medical Director, St. Michael’s Medical Center, 268 Dr. Martin Luther King Drive, Newark, NJ 07102. Phone: (973) 465-2865.