Ready for Anything?
Hospitals take the lead in preparing for terrorist attacks.

by Bob Kronemyer

(November 2002) - The attacks of 9/11 were a definite wakeup call for the roughly 150 hospitals in Indiana. While the state and federal governments began examining emergency preparedness in a new light, Indiana’s hospitals didn’t wait for mandates, instead choosing a proactive approach in preparing for a bioterrorist or terrorist attack.

According to Spencer Grover, vice president of the Indiana Hospital & Health Association in Indianapolis, even before 9/11 "generally, there were things in place. As a former hospital CEO, I know that we had disaster drills and disaster plans, although probably not as thorough of plans for weapons of mass destruction or bioterrorism."

Since 9/11, "I think there has been a lot more assessment and planning–both by the individual hospital and the hospital and the community," Grover says. Relationship development has been emphasized. "By developing relationships with contacts in the community on a daily basis, we can more easily switch to a disaster mode," Grover notes.

These valuable contacts include the local health department, the Emergency Management Agency, emergency medical societies, ambulance associations and fire departments. "Enhanced communication leads to better coordination," Grover says.

Long-term goals shared by all the parties center on early recognition and a robust response to disaster. "There needs to be a lot of communication statewide," Grover observes. "It is also going to be expensive to build extra capacity, such as providing off-site areas to take care of the overflow of patients who require hospitalization."

Each of 10 regions in Indiana has been asked to make available 500 additional beds. "Schools, old hotels, nursing homes, psychiatric facilities and rehabilitation hospitals are being considered," Grover says. "It helps if these centers already have oxygen supplies, beds and equipment." Some existing patients may be moved to less acute-care settings and replaced by more critical patients.

"The major area that we are investigating is expanding our decontamination facility with more showers in order to accommodate a greater number of patients," says Keith Kahre, emergency medical services and security coordinator at St. Mary’s Medical Center in Evansville. The 500-bed hospital will likely enlarge its decontamination facility in the emergency-room department. "But it will all depend on the amount of grant money we receive from the federal government."

St. Mary’s is also studying how its air quality is impacted by quarantined patients potentially contaminated with such maladies as smallpox. Education of the ER staff is also key. "Recognition of patients who have been contaminated or exposed to a biological agent is important," Kahre says.

Health-care professionals are also on heightened alert to report to the local health department patients with flu-like symptoms. "Could this be a bioterrorism incident?" Kahre relates. "We want to get the health department involved earlier, so epidemiologic investigations can get under way. Where is the common thread?"

The hospital has honed in on two scenarios. The first is a biological agent–such as anthrax, botulism, plaque or smallpox–because "you won’t know about it for two or three or four days, or maybe even longer, after the incident has occurred," Kahre says. "By then, multiple patients would have come into the facility and spread the contamination." The second scenario is a chemical event involving loads of people exposed to a chemical agent. "We need to have decontamination facilities large enough to handle that."

After 9/11, St. Mary’s formed a task force to better prepare for disaster. A nearby facility with three vacant floors has been designated as an alternate care site. "We want to make that facility safe in air quality as well, in the event patients need to be quarantined for a communicable disease," Kahre explains. Without funding, however, "it will probably be very difficult and problematic for hospitals around the state to get up to speed in preparedness."

In any case, "hospital preparedness is an ongoing process," Kahre says. "There is never an end-point. You can never be prepared 100 percent of the time for every conceivable disaster. And prior to September 11, a lot of things were not on our radar screen, but now they are."

At Clark Memorial Hospital in Jeffersonville, officials have closely evaluated security at the 234-bed facility, including how people enter. For a lockdown situation, "we need to be able to secure the premises," states Fred Horlander, vice president of hospital support service. During a community disaster, "people will immediately gravitate to the hospital because of family members being injured." Training in treating patients affected by biological weapons has also intensified in the emergency room.

Clark Memorial Hospital has reciprocal agreements with other area health-care facilities to handle patient overflow. "We are right across the river from Louisville, so we have a lot of beds at our disposal," Horlander says. In addition, "we continue to work with the local civil defense and the hazardous materials organizations, so we can be part of any planning." The hospital is also hopeful that state and federal grants will allow improvement in decontamination and training of staff in bioterrorism.

At Parkview Hospital in Fort Wayne, personal protective equipment has been upgraded to include air-purifying respirators and gloves that are more impervious to chemicals. The 540-bed hospital has also expanded its capability for decontamination from two shower areas to 10. Moreover, "we’ve been involved in protocols for off-site triage," says Sue Grace, director of safety. The hospital has also drafted a policy to administer mass prophylaxis, such as a vaccine or antibiotic that would need to be distributed throughout the community within a short time period.

Parkview Hospital has identified the city’s Coliseum and university facilities for potential patient overflow. As a whole, "we want to do more education and for all our staff to be trained on the Incident Command System," which is a comprehensive process for managing any type of emergency. "This system is ideal for a 24/7 operation," Grace says. For instance, people on duty know whom they are responsible for calling in case of a disaster.

"Although there is still a great deal that needs to be enhanced, I feel hospitals are probably ahead of the game because they have been required for many years to conduct at least two disaster drills a year to test their response to emergencies," Grace conveys. Fortunately, hospitals also have emergency generators for around-the-clock operations in case of a power outage. Like other Hoosier hospitals, Parkview Hospitals is vying for part of a $2.3 million federal grant to help with bioterrorism preparedness.

Indiana University Hospital, part of Indianapolis-based Clarian Health, has selected a bioterrorism preparedness officer. There is also a task force working on policies and procedures related to the threat of bioterrorism. In addition, "there has been a lot of talk about stockpiling of medications. But this is something that we do not encourage the public to do. Neither is it something our institution does," says Suellyn Sorensen, a clinical pharmacy manager. "When you start stockpiling medications, you run the risk of having a falsely elevated inventory that could cause drug shortages in other parts of the country."

Instead, Indiana University Hospital maintains a reasonable supply of the various drugs needed in the event of a bioterrorist attack. "Our distributors, in turn, would be responsible for ensuring that we receive a continued supply of drugs after some type of attack has occurred," Sorensen explains.

Infection-control policies and procedures have also been closely monitored and updated at hospitals across the state. "Hospitals have been working with their pharmacies to make sure that they have all the necessary vaccines and injections in case of a major event," Dr. Sorensen says. In general, Indiana is pursuing "a very organized and thoughtful approach in preparing for the most likely scenarios."

Rod Bosley is systems director of safety and risk management at Union Hospital in Terre Haute. "Even before 9/11, we were working on a process to deal with the whole issue of terrorism," Bosley says. "I look upon emergency-preparedness plans as living documents that are constantly being changed and upgraded as we learn more about a situation." From a hospital perspective, "9/11 has given us an opportunity to interact with a lot of outside agencies on a much deeper level than before. This includes federal, state and local levels," Bosley notes.

The 350-bed Union Hospital has been working directly with the Emergency Preparedness Task Force, established by the State Board of Health. "We also have mutual-aid agreements with surrounding health-care facilities," Bosley says. Additional bedding and staffing are paramount. "Security for crowd control is also important. We have specific areas where we would put families without impeding the existing treatment protocols."