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Food plant explosion tests burn center’s surge plan


September 1, 2009

Social media Web sites take prominence during disaster

For University of North Carolina (UNC) Hospitals in Chapel Hill, a previous industrial accident paved the way for a smoother emergency response when a massive plant explosion occurred.

A major subplot of the response is the growing role of social networking Web sites such as Twitter, Facebook, and YouTube in hospital communication with staff members and the public during emergencies.

“I found out about this event over Twitter,” says Dalton Sawyer, MSc, CHEP, emergency preparedness coordinator at UNC Health Care, who subscribes to the Twitter feeds of several local newspapers and television stations. “I was sitting in my office and that little text came up on the screen. Maybe 90 seconds later, my pager went off.

“I know a lot of hospitals are shunning or moving away from social media, but we fully embrace Twitter and YouTube for disseminating information to the public and the media as well,” Sawyer adds.

UNC’s medical news office workers Twittered impromptu press releases as the response to the plant explosion evolved and posted updates to a hospital blog and video of press conferences to YouTube.

Social sites tie into Joint Commission

The hospital uses YouTube to get public safety and health videos out in advance of large gatherings at the university, such as the annual Halloween revel or college basketball games.

UNC also plans to establish a presence on Facebook. Informal groups of staff members already use a Facebook group to communicate during bad weather.

Sawyer says such Web sites play into expectations of the The Joint Commission (formerly JCAHO) for hospitals to build redundancies into communication systems and not rely on traditional phone notifications, which sometimes fail (see emergency management standard EM.02.02.01).

“The emerging social media fits directly into emergency management,” Sawyer says. “It’s also great for rumor control.”

Explosion touches off command center

The blast occurred 35 miles away from UNC in Garner, NC, at a plant where ConAgra Foods makes Slim Jim meat snacks.

Investigators believe the blast was a result of workers venting a natural gas line being hooked up to a commercial water heater, reported The News & Observer in Raleigh, NC. The explosion killed three workers and injured more than 40 others.

Seven of the injured workers came to UNC Hospitals. The North Carolina Jaycee Burn Center at UNC Hospitals is one of only five burn centers in the Southeast, so there was immediate concern of a surge of patients needing burn treatment because the center generally runs with a full census.

Once word of the blast got out over a recently activated response network for emergency medical services and hospitals, Sawyer and his colleagues set up an incident management team in the ED. Responders on the scene anticipated four to eight patients would be sent to the hospital’s burn center.

Of the seven patients they ultimately received, three came from the scene and four from other healthcare facilities. UNC had also activated the Southern Burn Plan, which included ongoing discussions with Wake Forest University Baptist Medical Center’s burn center in Winston-Salem, NC, as well as burn centers in neighboring states.

Previous experience sharpened response

“Ironically, this was the second time in six years that we’ve dealt with something like this,” Sawyer says, citing the 2003 West Pharmaceuticals explosion and blaze in Kinston, NC, which killed six people and injured 36—a dozen of whom ended up at Sawyer’s facility.

“Our emergency operations plans had been revised dramatically since 2003 to implement some of the lessons learned,” he says.

One improvement to the plan was a tiered response. In the case of the ConAgra blast, UNC used the lowest level, or tier 4 response, which began with a command center in the ED away from the patient care area.

The emergency operations plan refinements since the West Pharmaceuticals explosion can be summarized simply: Deal with the patients you’re given with a measured approach, but plan for the worst-case scenario.

Applied to the Slim Jim blast, UNC was treating three incoming patients with the appropriate number of staff members.

But the incident team was planning for six or more patients and stood ready to deploy more resources when those patients showed up—but not until they showed up.

“We got right up to the edge, and we knew what the steps were going to be, but we never had to institute our surge plan, with the exception of the burn center,” says Sawyer.

Clearing out needed beds

As a function of the surge plan, burn center staff members worked with other units in the hospital to move patients who could safely continue their care in critical care beds elsewhere in the facility.

Although the burn center was full at the time of the explosion, three beds were cleared for the three incoming critical patients and a fourth was cleared two hours later for a patient from an area trauma center.

Three more burn patients, transferred from a regional hospital, were admitted that evening. These patients were admitted to areas of the hospital adjacent to the burn center.

Had the event produced even more patients, UNC Hospitals would have moved some incoming burn patients to other ICU or step-down units within the campus. The plan called for all patients to continue to receive treatment from nurses and doctors from the burn center.

That’s important because burn patients pose special challenges to caregivers that the average patient doesn’t, including loss of motor function, pain management issues, and infection risks.

Keep environmental services in the loop with disaster prep

A critical but often overlooked aspect of emergency planning is housekeeping. Clearing rooms and quickly getting them ready for more critical patients requires immediate response from environmental service workers.

During an emergency response to a plant explosion, the North Carolina Jaycee Burn Center at University of North Carolina (UNC) Hospitals in Chapel Hill had two housekeeping teams standing by in the burn center.

When necessary during the response, housekeeping workers immediately moved into action to aid in preparing rooms for incoming victims.

Although there is no specific Joint Commission emergency management standard about housekeeping during a disaster, EM.02.02.11 talks about managing patients during emergencies, so there may be tie-ins there.

Source: Dalton Sawyer, MSc, CHEP, emergency preparedness coordinator, UNC Health Care.

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