Emergency preparation still lagging in St. Louis Part 2: Communications failures plague hospital
This article first appeared in the St. Louis Beacon, Dec. 3, 2010 - On Oct. 27, just after 10 a.m., Barnes-Jewish Hospital nurse Darryl Williams received a message that no emergency department manager wants to get: An earthquake measuring 7.7 on the Richter scale had collapsed buildings and bridges and buckled roads in the St. Louis area.
"Stand by for multiple victims and casualties," the note instructed. By 10:40, 25 people had arrived, some on stretchers, others limping, many with crudely splinted limbs and most covered with blood. One emergency physician triaged the moaning crowd.
"It's like sorting," Williams explained. "You're dying; you're not; you go over here and get an X-ray."
The quick triage determined that five needed to go to the operating room -- STAT.
"This gentleman has a chest injury — something's actually penetrated his chest area — and he needs to get to the OR," Williams said.
If the patient looked less than worried, it was because he knew he'd be OK. His blood was actually fake and the earthquake was really a mock disaster, one of two such events hospitals must stage every year for accreditation.
While it's not unusual for a few dozen people to stream into the Barnes emergency room over the course of an hour on any given day, a disaster would likely strain even this emergency-oriented wing of the hospital.
"Usually, you might get four or five at a time," Williams said. "In a disaster, they could all come in at once."
A Scripted Disaster
Lacking only a director calling, "Lights, camera, action," the bowels of the Barnes emergency department felt like a movie set. Numerous "victims" including Community Emergency Response Team (CERT) volunteers and Lutheran High School South students pulled off award-winning performances.
Had there been a "best actress" trophy, it would likely have gone to a supposedly inebriated woman in a wheelchair, carrying her thumb in a jar -- the result of an unfortunate keg party injury.
"Give me another beer," the woman wailed, convincingly slurring her words. "If I were sober right now, I'd be totally freaking out."
As similar scenarios unfolded at 23 other local hospitals, including St. John's Mercy, St. Luke's and St. Anthony's, Barnes was also dealing with a damaged Queeny Tower building. The compromised structure meant that fragile medical intensive care patients had to be evacuated to a nearby surgical unit.
During this evacuation by medsled — flexible sled-like transports meant for maneuvering bed-bound patients down stairways — some teenage participants broke character with jokes and giggles. Still, the students have serious thoughts about a future in the medical field.
"We're in a group called Future Professionals in Medicine, and we heard they needed volunteers for this," said Jenny Wuerffel, 17. "They gave us sheets of paper that had our names, our gender and our symptoms. Mine says I have a bilateral femur fracture."
Most of the 400 hospital employees (out of 9,300 total staff) involved in the drill were not as well-informed. Before the drill began, details such as what kind of disaster and how many victims were kept secret. Still, they knew to expect a mock emergency on that particular day.
"The victims look pretty real and we don't (want to) scare anybody," Williams said. "We wouldn't want somebody in the ED to start getting worried and calling home."
Communications At Core Of Flaws
One hour, 50 disaster victims and two real-life cardiac arrest emergencies later, relative calm returned to the Barnes emergency room. By 11:30 a.m., Williams was assessing whether they had enough dressings, medications and other supplies to take care of patients. (They did.) He reassured a nurse who struggled with the rapid pace.
"You just do your normal job — on fast speed," Williams said.
But even an on-top-of-its-game ED couldn't have prevented the problems that plagued the mock emergency, mostly in areas outside the emergency department. At a Nov. 2 meeting, representatives from all participating departments gathered for a post-mortem.
Many of the issues cited by emergency manager Teresa Wineland were a direct result of poor or faulty communications, including a significant paging delay:
- Failure to establish a family-care center
- Lack of interpreters
- Patients transported to the wrong destinations
- Inadequate phone service in the command center
Some command center phones only dialed out; others just rang in, which added to the confusion for some at the helm.
"I don't know how anyone knew what was going on during the entire two hours," engineer Mike Stachowski told the group about his maiden experience in the command center. "It seemed like a mess to me."
One result of the mayhem: A family care center, typically set up as a location for families to get word about missing or injured relatives, was never established during the drill. The director of spiritual-care services received conflicting information about what building and which room was designated for the center.
"Spiritual care ran around for an hour and a half between where they should have been set up and where the command center thought it was set up," Wineland said.
Paging Snafu Has Ripple Effect
One of the most pervasive flaws in the disaster drill was in the paging system. Beginning with the very first page — announcing the drill — pages got "stuck" in the system, creating critical delays in information delivery.
Some employees never got word of the exercise until it was over. Others received data that were no longer relevant. Instructions about the need to boil water for sanitary reasons or limit water usage came late or not at all, robbing medical personnel of important decision-making information.
"They might need to decide, 'OK, we need to go ahead and get X done now if we need to limit our water'," Wineland said.
Paging delays caused patient transporters to arrive as much as an hour late. It also meant interpreters didn't know to show up for several grieving families. One possible solution: Next time, one interpreter will stay on site in the ED.
American Paging doesn't know why the backup occurred, according to Wineland. While she's working with the company to figure it out, she noted that Barnes is replacing the paging system with two-way texting in the spring of 2011.
Some at the roundtable called the drill an exercise in "managed chaos." Others were impressed with what went right and a few emphasized that the point of drills is to make and learn from inevitable mistakes.
"It's not that we failed, but the question is, how do we adjust?" said Lawrence Olatunde, director of Spiritual Care.
Touting the value of ongoing exercises, Barnes' director of environmental health and safety Jerry Glotzer minimized the problems and praised the process.
"These issues are small potatoes" Glotzer said. "And we are more prepared with every drill because more people are trained."