NYU’s Downtown Manhattan Hospital was one of many victims of the Sept. 11 terrorist attacks. The hospital is just blocks from the World Trade Center and was a primary care site on that tragic day. In fact, it was overwhelmed with too many victims to count. On a typical day, the hospital treats about 100 people. After the terrorist attacks, hospital officials estimate that doctors and nurses treated more than 1,200 casualties.
The hospital lost $32 million as a result of that day, Healthcare IT News reported. The chaos of the moment, and an inadequate system to manage the colossal surge in patients, resulted in details – important details – slipping through the cracks. Officials from NYU Downtown estimate they registered and tracked only about 10 percent of the patients who came for emergency treatment on Sept. 11, 2001. Because there weren’t adequate records, the hospital had no means to obtain reimbursement for a massive amount of the cost.
Today, there’s less reason a hospital like NYU Downtown should suffer such a financial blow as the result of inadequate disaster management systems – even in an unprecedented event like Sept. 11. Hospitals across the country, such as Latter Day Saints Hospital and New Orleans’ Oschner Medical Center, are deploying technology to develop disaster management systems that serve as guides and recorders during a crisis. Systems such as these will mean that decision-makers can now take action with vastly improved efficiency and results. A good disaster management system must be able to recommend responses and capture, analyze and track relevant data so important action steps are not overlooked
A New Role for Information Technology
Sept. 11 was a wake-up call for the healthcare industry. The tragedy highlighted the necessity of disaster management plans that can adapt to the most extreme circumstances. We all hope there’s never another calamity on the scale of Sept. 11, but we also now know to be ready for anything. Unfortunately, attacks by foreign terrorists aren’t our only worry. We’ve seen massive casualties caused by domestic terrorism in Oklahoma City, man-made disasters like Three Mile Island and natural disasters like Hurricane Andrew. Even an event like the Great Blackout of August 2003, when much of the East Coast lost power, could cause incalculable problems.
Moreover, not all disasters are external and leave the hospital intact and operating. Some disasters will impact the fabric, personnel, and resident patients of our institutions directly. For example, I was at George Washington University’s Medical Center last year when a gas explosion under the street induced not one, but two successive evacuations of key hospital facilities. Simply put, hospitals must be prepared with a comprehensive disaster management plan so they’re ready for the unexpected, effective during the crisis, and financially solvent in its aftermath.
Mandated-readiness is coming from other sources too, like JCAHO, the Joint Commission on Accreditation of Healthcare Organizations. Since Sept. 11, disaster management has been designated one of JCAHO’s seven "environments of care." JCAHO is looking for hospitals to move beyond disaster management plans to disaster management programs. Agreed, tested and executable programs are required, according to the 2003 JCAHO white paper "Health Care Emergency at the Crossroads: Strategies for Creating and Sustaining Community-Wide Emergency Preparedness Systems."
"There is a fundamental need for templates and scalable models for community-wide preparedness to guide planning before, and actions taken during and after, an emergency," the paper noted.
JCAHO’s requirements are numerous and specific. They include:
48-hour to 72-hour standalone capability, including stockpiling of medications and supplies.
Organizing around an incident-command format, with provision for robust interaction with other agencies in the community.
The capacity to deal with a biological or chemical incident and the provision of decontamination facilities for all hospitals.
There is one more key concern that JCAHO has expressed: making care for caregivers a high priority. That means providing things like personal protective equipment, vaccinations, prophylactic antibiotics, chemical antidotes, and counseling – and also to assure that caregivers can attend to their family concerns, including two-way information on their status and that of their family members.
It is fascinating to note that 62 percent of the emergency department nurses at St. Vincent’s Medical Center, the hospital at the center of the 9/11 medical response, had spouses or partners who were first responders. What could this mean? Perhaps sociological and psychological risk to communities from a mass casualty event are very highly concentrated among your the hospital staff.
Technology and Disaster Management
Hospital administrators and employees must embrace and practice a disaster management program so it will be tested and reliable during the galloping, intense tempo of a real crisis.
This preparation starts with day-to-day surge management. If hospitals can refine and imbed their surge management skills and processes – when patient surges are slight instead of drastic – they will be that much better prepared when a major disaster strikes.
In addition, effective surge management is financially beneficial. An emergency room that can take in a few more patients than available beds without lessening the standard of care will generate additional revenue, preserve its reputation, and gain referrals. Effective surge management also means fewer resources will be unnecessarily consumed, especially expensive staff time.
In order to meet these new requirements, hospitals must turn to information technology.
A computer-based disaster management system, in the form of a digital mentor should be available to a hospital before, during, and after an incident. The system would replicate the ability to understand context, mental frameworks, logic, rules of thumb, and problem-solving processes that a "live" expert would bring to a task, and be able to adapt to the particular circumstances of a specific incident.
Prior to an incident, the system would provide an assessment of a hospital’s state of readiness, help generate a disaster management plan and support disaster management training. During a crisis, the system would guide decision-makers through the process of setting up an incident command center, evaluating the situation assessment and response, issuing job action sheets, identifying treatment protocols, and managing crisis communications, all while tracking patient flow, costs, and process effectiveness. Finally, after the disaster, the system would capture the lessons learned and identify remediation opportunities.
To make it more concrete, let’s take a real-life scenario – a chemical HAZMAT incident creates massive casualties in your town or city. The incident commander should be able to quickly:
Determine the appropriate alert level based on the nature, extent, and proximity of the incident.
Identify the chemical agent involved based on the symptoms and other indicators displayed by the casualties – even before the patients arrive at the hospital.
Determine the treatment protocol for the chemical agent.
Access guidelines to create an appropriate decontamination center.
Alert all required disaster management administrative and clinical personnel.
Hand out configurable job action sheets customized for the specific incident.
Track required staffing, beds, drugs, supplies and equipment, and needed replacement levels and staff rotation during an incident.
Track expenses incurred for later reimbursement.
Access scripts for crisis communications with the media and public.
Capture lessons learned for use in recovery and remediation after the incident and preserve vital know-how.
Share data with other software applications, systems, and agencies.
The same system that guides decision-makers through disaster management situations can also streamline day-to-day operations. Managing supply levels, identifying supply and labor inefficiencies, and meeting accreditation requirements are just a few of the everyday applications of today’s more advanced computer-based systems.
Disaster management systems can help preserve a hospital’s reputation and level of patient-care, both on ordinary days and extraordinary days. The pressures we face today require that we integrate effective disaster management programs. Like NYU, communities depend on local hospitals at their most desperate moments. It is imperative that we be prepared.
Paul Dimitruk is CEO and founder of PortBlue (www.portblue.com), a leader in transforming knowledge into software through expert systems technology.
"Appeared in DRJ's Winter 2007 Issue"