Hospital has explosion drill

GLOVERSVILLE – A woman came running into the Nathan Littauer Hospital emergency room Tuesday with a baby found in the rubble of an explosion.

“This baby needs help!” she yelled as she stood at the central desk.

Meanwhile, Hannah Palsgraff had arrived at the hospital with head trauma from the same explosion.

Fortunately, the scenario only was an emergency response drill.

The hospital and volunteers acted out the scenario of treating victims of an explosion at a local school.

“We’re a community hospital,” said Cheryl McGrattan, vice president of marketing for the hospital. “It’s important that we let the community know we are prepared and show them they can depend on their community hospital for everyday use and, God forbid, a disaster like this.”

The hospital began planning the scenario about two years ago after receiving a $21,000 Department of Health grant to establish a disaster response plan, said Security and Emergency Management Supervisor Carrie Newkirk.

“The purpose of this drill was to triage the patients as soon as they arrived and get them to where they needed to be treated within the hospital,” Newkirk said. “A disaster situation would actually go smoother than this.”

She explained that in a serious situation, the ER wouldn’t be as crowded with media personnel and hospital evaluators.

“In that type [of] situation, we would limit the amount of people that could come in and out of here,” Newkirk said.

At around 9 a.m., the hospital received the initial mock call stating there had been an explosion at a local school and the severity and number injured were still unknown.

The emergency room staff immediately went to work by determining the number of staff available on hand and preparing various equipment and beds that would be needed in the event of a disaster. The staff also separated sections of the emergency room for various levels of injury.

The staff had a “burn cart” on hand with a variety of dressings and other medical items that would be needed in the event of an explosion in which several victims may have been burned.

The second mock call to the emergency room came about 10 minutes later saying victims were en route to the hospital. At that time, the hospital team was informed there were 14 patients, but the extent of each injury was unknown.

In the event of a disaster in which EMS brings in a large number of patients for immediate care, the EMS crew will determine the extent of the injury on-site and tag each patient based on the severity of the injury, said Critical Care Manager Bonnie Looman.

The hospital ended the drill with two green patients, two yellow patients, nine red (critical) and one black (deceased).

She explained that each patient is tagged on a color-coded scale from one to three, with one being the most extensive injury.

The hospital had four registered nurses, one licensed practical nurse, a work clerk and two doctors on hand for the drill, and more staff would be on call if necessary.

“Anything we need we will get,” Looman said.

For one of the doctors on hand, experiencing a disaster isn’t a new experience. Dr. Robert Werblin said he was called to an Albany area hospital in 1972 after an airplane crashed.

“You never really know what to expect, but it is important to be prepared,” he said.

When the victims initially arrived and Werblin was able to determine the extent of the injuries, he quickly notified the work clerk more nurses and radiologists would be needed to keep up with the demand. He later made an order to notify Albany Medical Center Hospital they would be transfering some of the patients there.

The victims who were flowing into the emergency room had a variety of injuries and were being brought in under their own power, in wheelchairs and on stretchers. Some of the injuries included burns, cuts, head trauma and amnesia. Some of the injuries were significant cuts to the legs while others were more severe with items lodged in their eyes or head.

The nurses offered words of encouragement to the scared and confused victims.

The victims were students from the Hamilton-Fulton-Montgomery Board of Cooperative Educational Services’ New Vision program. They have an interest in the health- care profession.

Palsgraff, a senior from Johnstown, was acting like a 10-year-old who had head trauma and was experiencing amnesia.

“I was supposed to act like a 10 year-old, so it was pretty easy just looking around all confused,” Palsgraff said. “I also did things a confused kid would do like remove the blood pressure device from my arm when the nurse put it on.”

The victims were between the ages of 6 and 20. Some patients were pregnant.

The woman with the baby had the child wrapped in a blanket when she came into the hospital yelling for help.

McGrattan said the hospitals in the Boston area took in 15 to 30 patients after the explosion occurred earlier this month at the finish line of the Boston Marathon.

NLH can handle about the same number adequately, she said. In the test scenario, the hospital had 14 victims. Other people acted as concerned parents.

The parents rushed into the emergency room and were redirected by a “parent liaison” to the cafeteria, where they were given patient updates as they became available.

McGrattan said once their child was in stable condition, the parents would be notified and escorted to their child.

One of the six evaluators, Susan McNeil, said the patients she followed were assisted by nurses and physicians quickly.

“It is not abnormal for it to be this calm during a disaster,” McNeil said. “I’ve watched these people at work, and their communication skills that they have with each other is great. They are calm, keeping everyone together and notified. Even though this is a drill, this is not any different than I see them when I happen to be here when a situation occurred.”

In a disaster situation, McGrattan said, the media would have a location outside the facility where press conferences would be held to give the public updates. She said the hospital has been working on communicating with the public via social networking sites, where the public could find minute-to-minute information during a disaster.

Laurence Kelly, CEO and president of the hospital, said he would have canceled all elective surgeries in the event of such a disaster.

He said the hospital has prepared for other scenarios such as an H1N1 outbreak and a chemical workers exposure scenario in which victims are taken through the process of being decontaminated before entering the hospital.

“We have procedures for a lot of things, and over time, we should practice every one of them,” Kelly said.

McGrattan said the hospital had about 24,000 cases in the ER last year.

She said that every year, hundreds of people come in with serious injuries from hiking or snowmobiling.

Following the drill, the hospital staff went into a closed “hot wash” session in which staff members discussed the drill and what could be improved.

“These drills can reveal our strengths while also illustrating areas for improvement as we respond to a mass-casualty incident. There is always room for growth and new things to discover,” McGrattan said after the meeting. “This year, we learned that setting up multiple phone lines in our command center allowed us to get resources to the Emergency Care Center quickly. We also learned that regular updates from the Emergency Care Center to our liaisons stationed in the family meeting center is imperative. We reviewed staffing measures to make sure we had staff allocated to the right places, helping those with the most need first. We also reviewed security measures and lock-down needs, because with a possible crime – such as a bombing – access to police for crowd management would be limited.”