How preparing for the worst pays off

Norbert von der Groeben

Kate Surman, Brandon Bond, Carole Kulik and Sridhar Seshadri gather in the hospital command center.

Imagine that Homeland Security officials issue a warning about possible attempts to sabotage water supplies across California.

On Nov. 17, the Office of Emergency Management for Stanford Hospital & Clinics and Lucile Packard Children’s Hospital led hundreds of employees from both hospitals through just such a scenario as part of a statewide emergency exercise.

Only three weeks later, OEM faced an actual water crisis when the ground floor of Packard Children’s flooded. But largely as a result of OEM’s preparation and training, including exercises like the one on Nov. 17, the crisis was quickly contained. It never affected patient care or safety.

Preparing for the worst is what occupies practically every hour of every day of the four full-time OEM staff members, according to administrative director Bernadette Burnes-Line. OEM trains hospital employees in emergency response and preparedness; forges emergency-response partnerships with local cities, counties, institutions and businesses; develops plans for every imaginable hospital emergency, including (but not limited to) earthquakes, fires, explosions, floods, act of violence, viral pandemics, radioactive fallout and bioterrorism; closely works with staff from the School of Medicine and Stanford University on campuswide crisis-response strategies; and stocks emergency supplies and equipment, such as decontamination tents, burn-trauma caches and portable generators, at locations on and off the hospitals’ grounds.

“We live our motto of ‘together prepared, together ready’ in all our planning in our program,” Burnes-Line said.

By 9 a.m. the day of the Nov. 17 exercise, OEM had convened top-level administrators, clinicians and other staff in the hospital command center, on the third floor of Stanford Hospital. The group faced two key challenges: To keep the hospitals functioning without tap water, which is used for everything from hand washing and cleaning rooms to heating and cooling the buildings; and to accommodate the inevitable surge of new patients sickened by tainted water.

More than 50 volunteers from the hospitals and local community acted as sickened or potentially sickened patients inundated the emergency department, which that day happened to be already very full. Almost all hospital staff had a part to play, from the CEOs in the command center to the housekeeping staff, who practiced cleaning patient rooms without water, said OEM director Brandon Bond.

“Everyone rose to the occasion and came together as a cohesive team,” Bond said. “Of course, there was some learning that took place and opportunities for improvement that we identified, but that’s why we drill: to see what works and what doesn’t, and be prepared when it really happens.”

Norbert von der Groeben

Brandon Bond sets up a decontamination tent as part of a demonstration.

And then something really happened: On Dec. 10, a chilled-water line serving both hospitals failed, flooding the ground floor of Packard Children’s with as much as 2 feet of water and temporarily forcing the relocation of nine Stanford Hospital patients. In this real-life emergency, the payoff of the Nov. 17 exercise became readily apparent, Bond said. For example, the command center was immediately activated and emergency response was quick, including turning off tap water in Packard Children’s for about four hours to determine whether it had been contaminated. (It hadn’t.) During that time, bottled water was distributed to all the inpatient units there, as had been practiced during the exercise. The cause of the water-line failure is still under investigation.

In 2010, the Joint Commission, the major accrediting body of U.S. health-care organizations, recognized OEM for best practices and quality of care in emergency management in two separate surveys. “The hospitals are a recognized leader in emergency preparedness, and our goal is to continue advancing the field,” Burnes-Line said.

She and Alexander Schubek, program manager/trainer, have received achievement awards from the Palo Alto/Stanford Citizens Corps Council, Santa Clara County and the U.S. House of Representatives for their work in the community on emergency and disaster preparedness and response efforts.

OEM also develops new tactics to prepare for, mitigate and recover from disasters. In the fall of 2009, the office tested the idea of using a drive-through emergency clinic. Mock patients were examined and treated behind the wheel. It’s a model that could be especially useful after a bioterrorism event or during a viral pandemic, such as those that occurred in the last decade with SARS and the H1N1 virus, said Eric Weiss, MD, an associate professor of emergency medicine at Stanford who works part-time as OEM medical director.

“We can use the patient’s vehicle as a self-contained isolation compartment to limit the person-to-person spread of germs,” he said. “So not only is it an effective social-distancing mechanism, it also allows us to see patients faster than we are able to in a regular examination-room setting.”

The results of the study were so successful that the Santa Clara County Department of Public Health gave the OEM a grant to develop a written, illustrated plan for drive-through clinics that could be distributed to hospitals throughout the county and shared with other counties, as requested, throughout the nation. The study also was presented at the California Hospital Association’s 2009 and 2010 Disaster Planning for California Hospitals conferences in Sacramento and at the 2011 Joint Commission and Joint Commission Resources’ Annual Emergency Preparedness Conference in Arlington, Va.

Burnes-Line and Weiss said the OEM also plays an important role in developing and strengthening emergency-response partnerships with local agencies, organizations and businesses as diverse as the SLAC National Accelerator Laboratory, Palo Alto Medical Foundation, Stanford Shopping Center and Palo Alto fire and police departments. “One of the things you don’t want is to be getting to know your partners in the middle of an emergency,” Burnes-Line said. “We want these relationships to be well-established.”

In the event of a surge of patients from local communities, the OEM has established plans for doubling up patients in rooms, converting non-clinical space, such as the cafeteria, into clinical space and ensuring quick access to emergency supplies. And while three emergency generators would be used to supply power to vital patient-care functions during a blackout, many other devices, including certain types of lighting, would stop getting electricity. In this case, OEM keeps on hand flashlights and headlamps to ensure staff can continue caring for patients. It even has a plan for sheltering animals and pets in a catastrophe.

All of this is to say that if it can happen, the OEM is planning to deal with it. But for all the disaster preparedness it has undertaken, Bond emphasized that the most important factor is overall community readiness. “I cannot stress enough how vital it is for community members to be prepared themselves, to get involved with their community emergency-response teams and be sure they have basic first-aid training and supplies, CPR training and emergency food and clothing,” he said. Such preparation will relieve stress from both emergency responders and the hospital in a disaster situation.

The OEM has published a 54-page emergency preparedness guide, “Ready!” that can be downloaded from the office website, http://stanfordhealthcare.org/health-care-professionals/allied-healthcare/oem.html, and that details how to prepare for and get through just about any emergency. The site also has links to several other emergency-preparedness resources.

John Sanford is a writer in the communications office for Stanford Hospital & Clinics.