Working Together for Disaster Readiness
The local hospital, the Police, Sheriff’s, and Fire Departments, area schools, nursing homes and home health agencies, Emergency Medical Service providers, and other public entities all deal with some sort of crisis or disaster, small or large, every day, and all of them have good procedures in place for managing these crises. But what if there were a sudden mass casualty disaster that caused
harm to a large number of people or might even threaten to harm the whole county? A natural or man-made disaster, an infectious disease outbreak, a terrible traffic accident or explosion involving large numbers of people? The possibilities are endless.
Two Carthage nurses who recently took new positions related to emergency preparedness at ETMC Carthage began looking at these questions and felt that it would be very helpful for all these separate entities if they joined together on occasion as a centralized group to ensure cohesive communication between each other, to know each other and everyone’s role, and to have plans in place for those times when they might be required to all work together because of the scope of the disaster.
At ETMC Carthage, Shelbea Comer is the Emergency Room Unit Manager and Trauma Coordinator and also the Emergency Preparedness Officer for the ER. Brandie Best is Quality Improvement Coordinator for the hospital and is over Environment of Care, Risk and Safety, Infection Control, and Hospital Preparedness. They contacted Jim Young, Panola County Emergency Management Coordinator, who shared their enthusiasm for the idea, and the creation of the Panola County Emergency Preparedness Coalition was underway.
Shelbea explains that the hospital participates every other year in a regional disaster drill, held by the Regional Advisory Council (RAC) to meet mandated state and federal requirements. Panola County is located in RAC-G, which is the Piney Woods area. The RAC works with state and even national entities in order to have resources available from a wider area as needed. Often organizations choose to do a local emergency drill in the years between the regional drill, but this year, with the new coalition forming and meeting in such close proximity to the regional drill, the group decided to include a local drill on the same day as the regional drill that would test not only the hospital and emergency room, but would allow the other entities to play a role in it as well.
At 7 a.m. on April 28, the regional simulation began, with a “call” to ETMC that an emergency in Lufkin was requiring evacuation of 200 patients, and a request to see how many ETMC could take. The ER agreed to take seven, and the seven “patients,” really Panola College students, were actually transported there and “treated.” Some of them were nursing students and EMS students who wanted the professional benefit of watching how the drill worked. Several Drama Department students helped do make-up and moulage to make the “injuries” look real and also did a very credible job acting as media representatives and concerned parents/families of the “victims.”
Shelbea says, “Then at about 10 a.m. the local drill began, with a simulated bus wreck out by the ballpark. Brandie called it in as a drill to 911 so they could respond. At the scene, students were on the bus with various “injuries.” Allegiance EMS, the Fire Department, and the Police Department all responded. The police secured the scene and roped it off and were responsible for crowd control and scene safety. Paramedic Carrie Elder and EMT Stephanie Page had control of the scene, evacuating the walking wounded and beginning triage on the remaining ones who could not move. Ashley Morris, the nurse for the jail, was also an enormous help, taking over the triage station. One ‘patient’ was critical and needed to be air lifted, but Air One actually got dispatched on a real emergency to Pittsburg at that time, so that part of the drill could not be completed. However, seven “patients” were transported to the Carthage ER. They all had victim cards specifying their injuries, vital signs, and other information about their condition, and they were removed from the bus on backboards and MET tagged (Medical Emergency Triage) by the emergency personnel.
Brandie explains, “The MET tags are color coordinated, black for DOA (dead on arrival), red for critical emergent (patients who will be staying in the ER), yellow for urgent (who might need x-rays or other tests or procedures and will be sent out of the ER), and green for non-urgent. Sometimes conditions change after a patient arrives in the ER, so nurses are constantly re-triaging to determine if any patient’s status needs to be updated.”
She adds, “I cannot properly express how grateful Shelbea and I are to the people who helped plan, organize, and run the drill, specifically Randy Liedtke (representing the Fire Department); Jim Young (Emergency Management Coordinator); Carrie Elder (District Supervisor for Allegiance EMS); Ashley Morris (nurse for the county jail); Blake Smith (representing the Carthage Police Department); and the entire ETMC Carthage staff. They were all so completely professional and serious about it, 100 percent invested, and just absolutely indispensable!”
The Emergency Preparedness Coalition was born through preparation for the drills, but they will now be meeting regularly in order to remain updated and informed about activities in the RAC and other considerations of mutual interest to all involved in community preparedness. More than 50 members comprise the coalition and represent ETMC Carthage, the Department of Health Services, the Panola County Sheriffs, Constables, Emergency Management, and jail administration, the Carthage Fire and Police Departments, local funeral homes, Allegiance EMS, the Panola County judge’s office, pharmacists, Panola College and Carthage Independent School District administrators, City of Carthage mayor’s office, and all the nursing homes and home health organizations.
Shelbea and Brandie both feel that it is important that the community be aware of what the local hospital’s designation as a Level IV Trauma Center means. “It sounds like a low level compared to Level I Trauma Centers,” explains Shelbea, “but it’s so much more than people realize. The main difference in the designated levels is in-house availability of specialized practitioners, equipment, surgery, and other specialized resources, but all the designated units are held to higher standards than undesignated emergency rooms or urgent care centers. They must all maintain certain levels of staff training and education, stay up to date on all the proper procedures for treatment, have a rigorous performance improvement and audit program, and go through very extensive surveys that look at everything on all charts. They must be highly acountable for everything! ETMC Carthage also has decontamination equipment and supplies and keeps up with training for that. We did a simulated drill on those procedures recently, too. And our ability to stabilize and transfer patients to higher level trauma units has saved so many lives, with the closest Level I in Tyler or Shreveport.”
Brandie agrees and adds, “Allegiance EMS has advanced cardiac life support equipment and can do IVs and intubations. And with today’s technology, this facility does have a lot of access to those Level I facilities and the specialized practitioners, and the staff takes great advantage of that in serious trauma or other life-threatening situations. We really have an almost global involvement with them; they’re just not inside our doors.”
What a blessing to our community to have so many people, both in our local hospital and in the Emergency Preparedness Coalition, dedicated to the saving of lives and the development of disaster readiness procedures that everyone hopes and prays will never be needed!