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Last month Tennessee, along with Alabama, Arkansas, Kentucky and Mississippi, endured the deadliest tornado rampage in two decades. The National Weather Service (NWS) confirmed more than 80 tornadoes from level EF0 toEF4 touched down across these states on February 5-6, bringing a death toll of 59. Thirty-three were Tennesseans.

These tornadoes wreaked havoc that will take much time to heal, but they also offered an opportunity for hospital safety directors to assess the strengths and weaknesses of their emergency management systems (EMS) which ensure their ability to care for casualties of disaster. All hospitals work with code systems to categorize events and perform regular drills to coordinate the staff. Hospital systems adhere to emergency management association (EMA) strategizing at the federal (FEMA), state (TEMA) and county systems. The majority also utilize HICS (Hospital Incident Command System), a method designed to assist the healthcare environment in improving their EMS planning, response and recovery capabilities for planned and unplanned events.

Local hospitals discuss their EMS plans in the event of oncoming calamity.

At Baptist Memorial Hospital-DeSoto, safety and environmental management teams prepared for the impending severe weather throughout the day, removing debris from the campus grounds and assessing staff numbers, patient beds and blood availability count. They also watched weather reports from the boardroom which acts as a temporary command center during emergency events. When the first tornado was reported southwest of Hernando, MS, after 4 p.m., Walt Grace, assistant administrator at Baptist-DeSoto communicated with corporate administrators, the DeSoto County EMA and the sheriff’s department to determine the level of alert the hospital should take. A spotter on the 10th floor watched the clouds roll in while others stayed tuned to local and national weather report services. At one point it was confirmed to be headed directly for the hospital.

“We were ready to move patients if necessary,” said Grace. “We made sure blinds were closed in windows. We quietly called certain departments to move patients out of rooms on the southwest side, and moved them quietly out of those rooms and put blankets over them.”

It was important, he maintained, not to excite staff and patients or incite panic, which is why it was decided to stay in standby alert instead of going to full alert. At the last minute the clouds went northeast and Baptist-DeSoto only saw one emergency patient from the event, a man who had been blown off the road in his car.

Dedicated to streamlined communication between all their hospitals and staff, the Methodist Healthcare System utilizes advanced communication technologies to coordinate emergency planning. Operating under the HICS plan, the staff organizes different levels of preparedness including patient care, equipment and environment. Marianne Fournie, corporate director of system ED services for Methodist Healthcare explained their three-pronged system.

The first facet is the Hospital Resource Tracking System (HRTS), a statewide Web-based program that assesses the capacity for ICU, including beds, ventilators and other vital inventory. Next is the EM System, a communications system that reviews ED capacities and links up with local EMS and all departments in the Methodist system for optimal surge routing. Finally, the saturation tool reports the saturation level of emergency department staff, number of beds, current patients and prospective incoming patients. Designed to keep saturation levels balanced, extra doctors can be called in.

Tornado Tuesday, coined Fournie, was an optimal situation for a drill because it was a disaster during the peak of flu season.

“We expected an influx of patients,” Fournie said.

As the tornadoes touched down throughout the city, fortunately very few people were hurt. There was no influx, but it served to identify areas for improved communication.

“The event that didn’t happen ended up a successful learning opportunity,” said Fournie. “We know communication is going to be our greatest challenge.”

Fortunately, she said, the EM system has servers located in other parts of the country, which means if Methodist, or even Memphis loses power, the EM system will work.

The Regional Medical Center at Memphis, (the MED) operates differently. At any given time, ventilators are breathing for 70 patients and 70 babies. While the MED is considered an obvious choice for trauma casualties, that doesn’t mean all ED surges should go there. The MED utilizes HICS, keeping people on standby while paying attention to intelligence for an impending disaster situation. During last month’s tornadoes, MED staff maintained a heightened sense of alert but never needed to deploy full alert readiness.

Safety director Stephen Shunn explained his goals in maintaining and improving not only EMS at the Med, but within the city. The MED’s emergency department has five patients at any given time. If that doubles over a three hour period, it’s a surge. When they reach capacity, they can only accept trauma patients. A recent pandemic flu drill served to demonstrate how to work with the community to route non-trauma patients to the appropriate ED.

Hospitals must collaborate with each other in larger events such as earthquakes, chemical spills and terrorist attacks. For Memphis, the greatest threat is earthquakes due to the lack of structural preparedness for such an event. Shunn is vice chairman of the Shelby County Regulatory Hospital Disaster Planning Council which connects and oversees disaster preparedness in the city and region. Through this, Shunn keeps track of drills – when to do them, what’s been done, and any possible weaknesses.

“We do cooperative planning together,” said Shunn. “People expect more of the MED and I think we deliver.”

Shunn is also working with different organizations on initiatives like making the coding system universal and the upcoming Vigilant Guard drill which will include the involvement of bordering states and all local responders, acute care hospitals and the National Guard.



March 2008

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