Mount Auburn Healthcare Connection

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A bomb goes off. A plane or train crashes. Biological agents are delivered through the mail. No one likes to think about these unlikely but possible disasters; however since 9/11 we have all become more conscious of how vulnerable we are to the most unexpected catastrophes. Mount Auburn Hospital staff has become more conscious as well, and has focused intensely on an expanded disaster preparedness program.

Ted Curcio, M.D., an emergency medicine physician at Mount Auburn Hospital, who shares the position of disaster coordinator with Mike Nelson, M.D., says “Our goal is to prepare the entire hospital for any kind of mass casualty incident that would overwhelm the resources we normally have available on a daily basis.”

Several years ago Mount Auburn Hospital formed a disaster preparedness committee, consisting of a multi-disciplinary group of physicians, nurses, managers, and other staff members. The challenge for the committee was to prepare the hospital to care for a large number of patients in a short amount of time. The emergency department needed to prepare to quickly admit patients, send home patients with minor conditions, and create a holding area and treatment plan for the more seriously injured patients.

Not surprisingly, a hospital has to run differently during a disaster than during regular business hours. Quickly bringing more resources into the hospital is an important part of any plan. Consequently, the hospital has developed a call-in system with alpha numeric pagers that the emergency department staff carries with them all the time. In addition, pagers are carried by key administrators, as well as key people on the hospital’s medical and surgical staffs.

In order to communicate effectively in the midst of a disaster, the committee has been implementing a framework for response called the Hospital Emergency Incident Command System (HEICS). The framework is modeled after systems established by other organizations that handle disasters, such as EMS (emergency medical system), fire and police departments. The basic concept is that each person contacts a limited number of other individuals who in turn contact others so that no one person is overwhelmed by the massive communication that needs to take place. It’s an hierarchical system, such as in the military, so there’s a commander and an administrator in charge of each department. All major hospitals in the Boston area have started to implement this system; however, Mount Auburn Hospital has been a leader in disaster preparedness and had one of the first communication systems in place.

Dr. Curcio says, “The beauty of HEICS is that it can be used for any kind of mass casualty, whether it’s a train crash or a biological attack or a bomb going off in a crowded area. We are able to tailor the system to the magnitude and type of disaster taking place and pull together the resources we need very quickly.”

In addition to working within Mount Auburn Hospital, the other important part of disaster preparedness is working with other hospitals in the region. In a mass casualty situation, one hospital will not be able to handle everything so Boston area hospitals meet regularly to plan how to efficiently distribute and care for patients. Mount Auburn Hospital also participates on the Local Emergency Planning Committee, run by the Cambridge Fire Department, which also includes other hospitals, universities, and biotech companies in the Cambridge area.

In order to be truly prepared, all good plans need practice. Consequently, Mount Auburn conducts at least four disaster drills a year, which are rehearsals for implementing the systems in place. Some of these drills are “live patient simulations” that use volunteers who act as patients and go through a decontamination and other processes that might occur during a disaster. Other drills involve discussions of specific potential disasters, and communication drills also take place to insure that all pagers work and all the call lists are in place.

Large-scale regional disaster drills have also taken place in the Boston area. In early June, Mount Auburn Hospital participated in a regional drill involving all local hospitals, state agencies and federal agencies.

Mount Auburn is also at the forefront of decontamination, as one of the only hospitals in the region that has a separate hazardous materials decontamination room—a room that has been set up and in use since the hospital was constructed. If someone is exposed to any kind of potentially hazardous material, whether it’s chemical, biological or radiological, healthcare workers in appropriate attire are able to decontaminate that person.

If a mass casualty of any kind occurs, Dr. Curcio advises people who are not sick or injured to follow the national government’s “shelter in place” guidelines, which advise that if you are in a safe place, you should stay there. In a disaster situation, hospitals will need to deal with those who need care and not be overburdened with those who are panicked or curious but not injured. Also keep in mind that during a disaster, emergency information will be available on the emergency broadcast system, on radio and TV, as well as the Internet.

Disaster preparedness is an ongoing activity at Mount Auburn Hospital. The disaster communication part of the plan is activated each time the government raises the terrorism alert level to orange. When that happens, the hospital ensures that all its pagers are working and checks on the resources it has available. Dr. Curcio says, “We make sure all our lines of communication are open and operating properly in case an emergency does occur.”

“We have learned some hard lessons from 9/11,” says Dr. Curcio. “People living in our area should be comforted to know that Mount Auburn Hospital is well prepared to handle a major disaster. We have been training and drilling for the past several years and are becoming better prepared all the time. Obviously, we hope we never have to implement our plans, but if the worst happens we want to reassure the public that we are taking a leadership role in disaster preparedness.”