Preparedness, Communication, Cooperation

When a natural disaster or terrorist event occurs, local medical professionals and emergency management authorities may find community resources and personnel stretched to the limit by rapid influx of many injured patients. Smoothly and rapidly evacuating an overflow of patients to regional health care facilities in unaffected areas saves lives.

Medical staff at University Hospital (UH) recently practiced such a scenario during a drill conducted by the National Disaster Medical System (NDMS): In the early morning hours of Monday, May 23, an earthquake centered in northeastern Arkansas created a ring of damage and injuries as far away as Memphis, Tennessee, closing roads and limiting communications. Affected states requested federal emergency assistance, and NDMS kicked in. Local medical staff triaged and stabilized a number of patients for transport to regional health care facilities that have volunteered to serve as NDMS hospitals, UAB Hospital Safety Manager Dennis Stanek explains.

As 1 of Alabama's 17 NDMS hospitals, UH provides about half of the 827 beds available in the state. During the May drill, UAB's Emergency Department (ED) evaluated and treated 29 mock patients, including a handful of individuals who arrived in Birmingham from Pensacola, Florida, via a C-130 aircraft, which allowed medical personnel to practice off-loading patients. The exercise, called Lifesaver 2005, was the first full-scale live NDMS exercise in the region since 1999.

"This was an unusual drill because we had advance notice of the number of victims and their condition — it was really a best-case scenario for an emergency situation," Stanek says. "We had time to consider how to move patients into our facility quickly while minimizing the overall impact to the hospital. As in every drill, we learned valuable information that helps us prepare for real events."

Stanek prepped drill volunteers for maximum realism, and he notes that live mock patients contribute significantly to the authenticity of such exercises. "Staff learn much more when real people are involved. Real patients have anxiety, make demands, and ask lots of questions. Once, during a drill that used pieces of paper as patient stand-ins, I observed someone stacking the papers onto a single stretcher," he says. "You can't stack real people!"

National Catastrophic Care

NDMS, a section within the U.S. Department of Homeland Security and the Federal Emergency Management Agency, supports federal agencies in coordination of federal medical response to major emergencies, including terrorist attacks and natural, transportation, and technological disasters. NDMS moves medical teams, supplies, and equipment to affected areas and evacuates injured individuals to hospitals in unaffected areas for definitive medical care.

"In our continued increased-risk environment, it's important for us to work with NDMS to prepare for large-scale emergencies," Thomas Terndrup, MD, professor and chair of the Department of Emergency Medicine and director of the Center for Emergency Care and Disaster Preparedness, says. "The North Pavilion is still a new facility, and live exercises increase staff confidence and ability to deal with a disaster, helping us pinpoint areas that need improvement."

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to perform at least two emergency drills each year — a patient influx exercise and a drill with community involvement, Stanek says. UAB's next live exercise will take place this fall.

Some 65 Federal Coordinating Centers (FCC) are located throughout the nation in major metropolitan areas with proximity to transportations hubs. FCCs act as liaisons between federal agencies and local hospitals, coordinating communication, patient evacuation, and medical team and equipment deployment. Birmingham's Veteran's Affairs Medical Center is Alabama's only FCC.