Crisis planning, which encompasses preparations and training for snowstorms, mass-casualty events and any number of other emergency scenarios, has always been a part of operations at hospitals like Sentara Martha Jefferson and Sentara RMH. However, the volatility of today’s world requires an increased focus on preparedness and safety for patients, visitors and staff, with planning that includes drills for specific types of incidents and regular communication with staff about those processes.
All of the hospitals within the Sentara network recently standardized their communication protocols for emergency situations, according to Scott Masincup, NRP, CHEC-II, emergency management manager at Sentara RMH. Before the standardization, for example, the phrase “code white” might have meant a snowstorm at one hospital and a mass-casualty incident at another. Now, systemwide codes and descriptions ensure clear emergency communication within and among Sentara hospitals. “Standardizing our communications helps us ensure that our staff knows what to do when emergencies arise,” Masincup explains.
At Sentara RMH, such preparations include everything from fire training to responding to an active shooter, currently the most requested safety training module at the hospital. “We go to our departments, allow staff to voice their concerns, and help them understand how to evacuate or protect themselves and our patients, should these kinds of events arise,” Masincup says.
To carry out emergency training, the Sentara RMH emergency management team works with state and federal agencies, as well as local fire and police departments, with hospital staff often training alongside those groups. Regular drills ensure that both hospital staff and outside emergency personnel are up to date on protocols, and also serve to foster a sense of partnership among different teams of caregivers.
In addition to taking part in drills, Sentara RMH staff members also receive safety information via computer-based training, emails, flyers, team meetings and other means. Cybersecurity, another area of growing concern, is closely monitored at the Sentara corporate level, since all of the system’s hospitals use the same computer network and electronic medical records system.
Masincup notes that drills provide excellent learning opportunities for staff. “It’s OK to find something you need to fix, because that’s how we improve,” he says. “I hope we’re preparing for situations that will never arise, but it’s imperative for us to be prepared, given the current dynamics in our society.”
Mass Casualties in Charlottesville
Since last summer, people in Charlottesville are painfully aware of those dynamics. Emergency management planners at Sentara Martha Jefferson Hospital had learned weeks in advance that people from around the country were planning to attend a controversial—and potentially contentious—“Unite the Right” rally in Charlottesville’s Emancipation Park on Aug. 12, 2017. This advance knowledge gave hospital leaders and staff the time they needed to prepare, says Chief Operating Officer Amy Black, DNP, RN, NEA-BC, the administrator on call during the weekend of the rally.
While the hospital already had a mass-casualty plan in place, planners held daily meetings during the week preceding the rally to evaluate staffing needs and identify gaps in their readiness plans. Sentara Martha Jefferson staff also worked with representatives from the University of Virginia Health System, as well as city and university public safety officials, to help make sure needed preparations were in place. “We decided to prepare for the worst and monitor events as they progressed,” Black recalls.
Planning for the rally weekend included assessing the kinds of injuries the hospital might see. While Sentara Martha Jefferson isn’t a trauma center and doesn’t ordinarily see gunshots or similar traumatic cases, “walk-in” injuries of those sorts certainly were possible. To address such a scenario, Sentara Martha Jefferson planners made arrangements to send those patients outside the area, if U.Va. Hospital happened to be overburdened. “This was a moving event, and we couldn’t predict what would be happening,” Black says. “We had to prepare for anybody who might come through our doors with a traumatic injury.”
Beyond preparations at the hospital itself, additional fracture trauma supplies were moved to the newly opened Sentara Family Medicine at Fifth Street Station in anticipation of walk-in patients at the facility, which is just minutes from downtown Charlottesville and the rally location. In Harrisonburg, Sentara RMH also was prepared to help, if needed, with additional facilities and decontamination equipment.
In the end, Sentara Martha Jefferson ended up treating 15 patients with injuries, ranging from head trauma and fractures to lacerations, due to events associated with the rally. The hospital didn’t treat any of the patients who were directly hit when a car crashed into a crowd of people on Fourth Street that afternoon, but several of the patients who received care at Sentara facilities that day were injured as a result of crowds fleeing from the car.
Now many months removed from the events of Aug. 12, hospital staff is still dealing with the aftermath and impact on their community, according to Black. “I think it’s still on their minds—that kind of conflict is just not what they’re used to seeing in their community,” she says. “In spite of the violence that occurred that weekend, I think the staff at Sentara Martha Jefferson truly rose to the occasion and did whatever we needed to take care of our patients.”
While Sentara Martha Jefferson’s mass-casualty plan worked well that day, hospital planners did learn some valuable lessons for the future. Among such insights, Black says they realized that chaplains and support staff from the employee assistance program should be involved earlier in the planning, and that space for patients’ family and friends should be located closer to the Emergency Department.
“Hopefully nothing like this will ever take place again in our community,” she adds. “Since we can’t foresee the future, however, the crisis management teams at Sentara Martha Jefferson and Sentara RMH will continue to prepare and train for these types of events, to ensure that we’re ready to respond when needed.”