A clinical perspective on emergency planning

Through his work as director of the Center for Disaster Medicine and vice chairman for emergency preparedness at Massachusetts General Hospital in Boston, Paul D. Biddinger, M.D., is bringing a clinician’s perspective to hospital emergency planning. Recently, HFM talked with him about the center’s work.

The Biddinger File

CV

• Director of the Center for Disaster Medicine and vice chairman for emergency preparedness in the department of emergency medicine at Massachusetts General Hospital (MGH), Boston
• Medical director for emergency preparedness at MGH and at Boston-based Partners HealthCare
• Director of the emergency preparedness research, evaluation and practice program at the Harvard T. H. Chan School of Public Health in Boston; also holds appointments at Harvard Medical School and the Chan School
• Special adviser to the Massachusetts Medical Society’s committee on preparedness
• Medical officer for the MA-1 Disaster Medical Assistance Team in the National Disaster Medical System in the Department of Health & Human Services

Education

• Medical degree, Vanderbilt University School of Medicine, Nashville, Tenn.
• Residency training in emergency medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston
• Bachelor’s degree, international relations, Princeton (N.J.) University

When was the Center for Disaster Medicine (CDM) formed and what is its purpose?

The Center for Disaster Medicine at Massachusetts General Hospital (MGH) was formally founded in 2014, although its origins and staff have their roots in the hospital’s initial efforts in 2001 to answer questions about emergency preparedness that were raised after the 9/11 attacks in the U.S. CDM is a division within the hospital’s department of emergency medicine and oversees preparedness and emergency management efforts at MGH. The CDM also exists to assist other health care systems regionally, nationally and internationally with their efforts to prepare for, respond to and recover from disasters and other major incidents.

Our center comprises a team of physicians, nurses and administrators with decades of expertise in health care emergency management, emergency medical and surgical care, security, hazardous materials, biological threats and health system operations. It has an advisory council that includes members from many departments of the hospital, including the facilities, and buildings and grounds departments. Members of the center work closely with local, state and federal planning and response agencies, and collaborate on associated committees as part of their extensive involvement in community planning. In addition, several members of the CDM team are active members of regional, national and international disaster medical response teams and have collectively deployed more than 50 times around the globe.

For the hospital and our community, the center works to continually improve and enhance the hospital’s readiness for disasters and emergency situations of all types through effective training and exercise efforts, critical review of internal and external events, and the ongoing development of innovative research and response programs.

What lessons have you learned from weather-related disasters as they relate to clinical response?

Ten years ago, when we looked at the effects of Gulf Coast hurricanes and other events, we realized that there were major problems with some of our existing plans for disaster-response actions, including our plans for hospital evacuation. As we look forward, I think that planners need to consider the predicted effects of changing weather patterns and consider the possibility of catastrophic scenarios. I am, however, encouraged that regarding the Gulf Coast hurricanes as well as those the U.S. experienced this year, we appear to be much better able to evacuate hospitals when needed and to work together as a system to respond to major disasters compromising hospital operations.

You advocate for a multidisciplinary approach to emergency planning. Who exactly should be involved?

Because good hospital emergency planning really means having systems, structures and plans to be able to successfully manage any event that disrupts normal hospital operations, it is essential to have a broad range of members on the hospital’s emergency planning committee. At minimum, I think the ideal committee should include leaders from the hospital’s emergency management, facilities, clinical, security, information systems (IS), supply chain, communications, safety and dietary departments. The group also needs a strong senior executive leader and sponsor to ensure that their recommendations get traction. Broader membership, including experts in infectious disease, employee health and well-being, psychiatry and social work, and others are always welcome.

What are some architectural issues hospitals have to think about regarding resiliency for weather events?

The increasing frequency, severity and magnitude of high-heat days is one example, which can put a strain on the buildings’ cooling systems and increase patient volumes. However, hospitals also should consider that most areas are expected to see increasingly severe winds and storms with greater amounts of precipitation in a single event. Many of the current building codes and flood maps adopted by federal and state entities do not yet take these precautions into account, so hospitals may need to gather their own information about the predicted changes in their areas to make informed decisions about the best choices when constructing new buildings and retrofitting older ones.

What are some engineering issues hospitals must think about regarding resiliency for weather events?

As I mentioned, hospitals really need to think about how their facilities may be affected by the specific effects of weather changes in the coming 30 to 50 years. They also should question whether the utility services in their areas are also vulnerable to these changes.

Some of the possible engineering interventions that may be needed as hospitals look at their facilities may include a need to further protect their generators, fuel pumps, transfer switches and other parts of their electrical supply; a need to be able to maintain their cooling systems during municipal power failures; a need to limit the heat gain from sunlight within their buildings during the day; a need to protect the basement and ground levels of the facility from increasing flooding events; and many other similar needs.

What IS issues should emergency planners focus on when preparing for weather events?

As health care has become increasingly dependent on IS and technology, the safe delivery of health care services depends on reliable IS almost as much as it does on electricity or heating and cooling. Therefore, it is essential that emergency planners understand how their IS assets are affected by different disasters.

For example, some hospitals don’t plan for enough computers to be on emergency power if the municipal electricity fails. This likely leaves too few computers available for nurses, physicians, pharmacists and others to be able to deliver the usual care using IS for medication ordering and administration, radiology services and clinical documentation.

Hospitals need to treat not just their central servers and data closets as essential for clinical care, but should ensure that clinicians can use their IS assets whenever possible.

What types of disasters in addition to weather events have you been studying at the center?

As you can tell, we are working hard to identify the elements and characteristics of a robust emergency plan to deliver care safely during IS downtime events. Some of our other work has been ongoing for more than 10 years, such as our work on chemical and radiation events, as well as on safe hospital evacuation. Other work is more recent and includes how to safely respond to emerging infectious diseases as well as how to decide whether to shelter in place or evacuate when faced with an anticipated disaster event.