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Philadelphia train crash tested hospital security


Emergency drills, new communication technology helped facilities prepare

Philadelphia train crash tested hospital security

Emergency drills, new communication technology helped facilities prepare

 To hear them talk about an average day, safety officials at hospitals in Philadelphia say they're used to a chaotic environment.

So it was no surprise that the staff knew just what to do when word first came into the ED at Temple University Hospital just after 9:30 p.m. on May 12 that an Amtrak train had derailed on the major Washington-New York rail corridor running through the city.

Within minutes, at least seven hospitals in the greater Philly area, including Temple, received warning to get ready to receive hundreds of patients, from busloads of "walking wounded" to critically injured patients coming in via ambulance.

At the same time of the influx of patients, hundreds of law enforcement officials, concerned family members and friends, and media outlets immediately descended on the hospitals, hoping to get any information they could.

Temple, one of the busiest Level I trauma centers in the city, got the first alert about the tragedy at 9:47 p.m. through the city's Knowledge Center, an online emergency communications portal used to connect all hospitals in the area with emergency response personnel. A minute later, the facility went into a "Code White, Level 4" status, which basically means all hands on deck, and the hospital had about 10 minutes to mobilize 40 physicians and prepare to receive the first of 54 critically injured patients.

"I walked the halls that night and I saw what I call the 'Temple spirit,' " says John N. Kastanis, FACHE, president and CEO of Temple University Hospital, Philadelphia. "We were a well-oiled machine that night. We were prepared and it really showed and we got a lot of positive recognition."

Ultimately, speed was to blame for the crash, which killed eight people and injured more than 200. Investigators estimated the train was traveling over 100 miles per hour on a curve meant to be taken at less than 50.

Philadelphia hospitals have been getting lots of praise in the media about how well they handled the response to the train crash. Of course, nothing ever goes as planned without lots of planning, and hospital staff that responded that night reflected on the major security concerns hospitals dealt with, and what lessons could be learned from the few mistakes they made.

Communication. In any emergency, good communication is critical, and the hospitals involved in the Amtrak derailment response all will boast about how the Philadelphia area has one of the best emergency communication systems in the country. What's the secret?

The answer lies in that Knowledge Center, a web-based incident management platform that allowed all hospitals to communicate instantaneously with the Philadelphia Office and Emergency Management and other emergency agencies that responded to the scene.

Within minutes of the incident, the system allowed incident commanders to keep hospitals updated on the status and ETA of patients, assess the number of beds available, and keep track of where patients were being transported to so that families could be updated.

"We are always talking about intercommunication with agencies, and that was one of the aspects [of the response] that worked just as it was supposed to," says John Ward, director of safety and materials management for Einstein Healthcare Network, Philadelphia. "We were in constant communication with our hospital association and other hospitals in our preparedness zone."

In addition, Einstein has been working on creating and training a specialized response team to deal with future cases of Ebola or any other incident requiring a rapid response of individuals trained in decontamination or triage. In the case of the train crash, officials did not know at first if it was a terrorist attack or involved hazardous materials that could affect the safety of the hospital.

"We didn't have to gear up, but certainly in the back of your mind you're wondering if this was a terrorist incident, and if maybe one of the patients was involved," Ward says.

Patient tracking is one of the aspects of the emergency communication that hospitals are always working on; knowing where they are going can help direct frantic loved ones to the right place and cut down on the security stresses of staff members dealing with a surge of visitors.

At Temple, the ability to track patients in real time through Knowledge Center helped not only to have all patients accounted for within four hours, but also helped make it easier to reunify families that were being sequestered a safe distance from the hospital, including a family from Singapore that had three separate members on the train go to three separate hospitals.

"A lot of family and friends were going from ER to ER around the city," says Kastanis. "We had some pretty irate family members who insisted on barging into the ER, but we of course did have to attend to the patients' medical needs first."

Cooperation with law enforcement. In any major incident that could potentially involve terrorism or criminal activity, you can bet that the police and other law enforcement agencies will swarm your hospital looking to question witnesses. Unfortunately, those people are likely your patients. You need to have a plan in place to cooperate, but ensure your staff can do their jobs.

"Needless to say, in today's world filled with terrorism, there was an underlying concern from authorities of what caused the disaster," says Kastanis, who added that agents from the FBI, Homeland Security, and other federal agencies swarmed the hospital to gain information about foreign nationals on the train. "There was some keen interest in where these folks were from and the purpose of their ride."

In most cases, hospitals had a plan in place to deal with the authorities already. It's difficult?and perhaps legally impossible?to tell a federal agent he can't do his job and question a potential suspect, but at the same time there needed to be mutual understanding that while the hospital would cooperate, the priority was to stabilize and treat the patient first. The responsibility largely fell on the public relations or security teams, but in some cases, such as at Temple, the hospital already has a dedicated police force that increased on-site staff from four to 30 officers to help liaison with local and federal authorities and keep order.

"As soon as the incident happened, there was someone assigned from the police department, a supervisor trained in incident response," says Ward. "It was very much a community-involved event, so we had assistance from everyone."

Perimeter security. Keeping the right people inside your building, and keeping the wrong ones out while keeping track of the whole situation is hard enough work on a normal day. When a large-scale incident inundates your facility and takes the attention of the majority of your staff, there better be a plan in place to control the perimeter.

In the case of most hospitals during the Philadelphia train crash, plans were in place to lock down the facility and limit the number of entrances that were available for people to come inside. Critical ER space was cleared?either by discharging non-critical patients or moving others to rooms inside the hospital?to allow for triage activity in the ED. Perimeter video surveillance was activated and security staff were swarmed to entrances to verify anyone coming into the facilities.

Einstein immediately went into a lockdown situation when it found out about the potential arrival of a busload of 35 to 50 "walking wounded" patients.

The facility's four "trauma pods" at the main ambulance entrance were cleared within 30 minutes and patients and staff reassigned to allow for 15 extra beds and about 20 ER staff.

In the meantime, security staff monitored cameras to watch any coming into the building, whether by ambulance or on their own through the ER doors.

Public relations and media. In the event of a tragic event that requires the entire scope of your facility's resources, the place will be flooded with well-wishers, Good Samaritans looking to help, clergy, and media looking for information. For the most part, these are good things that show how great the community is. But you need to be ready for them, and ready to deal with any surprises.

Public information officers were valuable resources, providing information while giving an extra layer of security keeping media and other onlookers at bay. Perhaps the most important lesson taken from an event as overwhelming as the train tragedy is to make sure staging areas are designated in advance, and practiced during drills so that it's second nature moving people to these areas.

Drills and preparation. Hospitals that dealt with the train crash in Philadelphia say that regular training was what prepared them for such a large-scale event.

"We regularly schedule exercises for these kinds of scenarios, large and small, at least once a year that involves a [mass casualty incident]," says Ward. "You get more bang for your buck by testing multiple parts of your plan."

A good "all hazards" approach to emergency management is not only required by The Joint Commission and CMS, but is also good practice, he says.

At Temple University Hospital, each employee goes through a mass casualty response course, as well as an eight-hour decontamination course, and then is required to take an annual refresher. In addition, drills are an everyday part of working there, and a busy ER and trauma department allows staff to constantly be using their skills.

To prepare, facilities should focus on training exercises that test protocols, stressing resources and staff with surges of patients, how to work with decontamination procedures and PPE, and what to do if you need to send patients to alternate care sites, says Wesley Light, manager of emergency preparedness at Temple.

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