Biomedical Engineering Reference
In-Depth Information
commonly lack adequate training in commu-
nications procedures or equipment operation.
This should come as little surprise, because
similar complaints are expressed about everyday
operations—that is, a system that does not work
well under normal conditions should not be
expected to do so under extreme stress. Few
facilities devote planning or resources to external
communications. Although most acute-care facili-
ties are able to use the Hospital Emergency Area
Radio network, it was designed for short communi-
cations between EMS providers and EDs as well as
limited interfacility traffic; it was not intended for
continuous heavy traffic among multiple parties.
Many hospitals host licensed amateur radio oper-
ators during disasters; the ham networks provide
an important communications resource, allowing
voice, data, and even video transmissions among
incident scenes, hospitals, emergency operations
centers, and other critical facilities.
1.4 Observations
Milsten [16] surveyed 22 years of incidents in
the United States and abroad, identifying a broad
list of hospital challenges (communications and
power failures, water shortages and contamina-
tion, structural damage, hazardous materials expo-
sure, facility evacuation, and resource allocation),
accompanied by general suggestions (such as
developing plans and procedures for disasters).
The observations on which the discussion and
conclusions in this chapter are based on multiple
sources:
Direct personal observation (generally as
controller or evaluator) of tabletop, func-
tional, and full-scale exercises, along with
actual incidents such as tornadoes, ice storms,
floods, hazardous materials spills, and multiple-
casualty events.
•
Personal communications and written after-
action reports from local exercises and actual
incidents elsewhere.
•
1.6 Security
Security staff in most hospitals that have them
are private guards, either hospital or contract
employees.Most are unarmed andhave nopowers of
arrest. Although their responsibilities vary consid-
erably, most are there as deterrents and to restrain
violent patients or visitors. Hospital security is an
important part of JCAHO's “secure environment,”
protecting patients, staff, visitors, information, and
the physical infrastructure [22,23]. Some hospitals,
particularly large ones in urban areas, employ sworn
law enforcement officers, either on contract or as
employees. Regardless of the type and powers of
security staff, the trend of minimal staffing applies
across the board, commonly resulting in inadequate
coverage for most facilities. Recurrent security-
related challenges have internal and external foci:
lockdown and the role of local law enforcement.
Lockdown is a common constituent of hospital
emergency plans, but there is little consistency
to its definition, even between facilities in the
same community. In its ideal use, lockdown is an
incident management tool that allows hospital staff
to assert or regain control of a situation that appears
or escalates with little warning. Lockdown is
Published observations and after-action reports
from three large-scale exercises: TOPOFF
(May 2000) [17], Dark Winter (June 2001) [18],
and TOPOFF 2 (May 2003) [19-21].
•
Hospitals consistently encountered challenges in
the following areas: communications, security,
decontamination, staff training, staff protection,
and exercise design and conduct. The most signif-
icant aspect of these observations may be their
consistency: the challenges and pitfalls encoun-
tered by hospitals and the agencies supporting
them are definable and reproducible—and thus
predictable. As such, there is value in their descrip-
tion, discussion, and analysis.
1.5 Communications
Intrafacility communications during exercises and
actual events have been described as “difficult,”
“inconsistent,” “marginal,” and “nonexistent.”
Phones are overloaded, radios—when available—
are insufficient in number, range, and frequency
options (or a combination of those), and staff
