Biomedical Engineering Reference
In-Depth Information
16 The Clinical Engineering
Department Role in Emergency
Preparedness
DUANE MARIOTTI
For decades the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) has required
hospitals (and other accredited agencies) to have
a “disaster plan” and show functionality of this
plan via semi-annual drills. Clinical Engineering or
Biomedical Engineering Departments may or may
not participate in these drills. However, experience
has shown that in an actual crisis all staff have a role
in the emergency response.
What is a disaster?
The ideal definition of a disaster is a short
term event which overloads the ability of normal
agencies to respond in a timely and expected
manner. Basically a disaster is when you have
more going on than you have people or solutions to
correct. This may sound familiar to hospital (and
field service) technical staff. Frequently, there is a
“crisis” in the Operating Room or Intensive Care
Unit that requires immediate intervention.
As an example, at midnight a telemetry trans-
mitter in the step-down unit fails. The nurse
has some free time, changes the lead wires, and
changes the battery and still nothing on the central
monitor. She goes to the drawer where the spare
telemetry transmitters are and swaps out the defec-
tive unit, places a defective sticker on it and leaves
a message so it can be picked up and repaired in
the morning.
Same scenario, but when the nurse goes to
the drawer, there is no spare transmitter. She has
the Clinical Engineering technician on call paged
and connects up the transport defibrillator/monitor
to the patient so the ECG may be monitored.
The technician comes in, pulls a spare transmitter
off the on-call shelf and assists the nurse with
connecting it to the patient. He assures the ECG
is present at the central station, sees that all other
waveforms look acceptable and goes home and
back to bed.
A little different scenario: The nurses all realize
that only one patient's ECG is available on the
central station. No other ECG's are displayed.
There are suppose to be sixteen patients displayed
on that central station. The second central station
is only displaying half the ECG's.
All three of these scenarios are crises. In health-
care, crises are dealt with routinely. The word
“triage” (to sort), is routinely used in medicine to
determine who gets what resources when, based
on their medical condition. But, the last scenario
is a disaster. There are not spare transmitters for
twenty-three patients, there is not enough staff
to check every transmitter, and while the Clin-
ical Engineering department has a loner central
station monitor, that does not appear to be the cause
of the failure. These patients are in a step-down
unit for advanced ECG monitoring, and it is not
available.
This is an example of an internal disaster in a
hospital. Other internal disasters may include sewer
pipe breakage and sewage knee deep in the base-
ment of the hospital, water main breakage (or any
flooding), significant network failures, a hazardous
materials spill, a hostage situation or a fire.
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