Hospital Centralizes Response Protocol, Streamlining Operations During Crisis

Matthew Hersh

When a South Brunswick woman appeared at the University Medical Center at Princeton emergency room last month with a substance that she thought was anthrax, there could have been two initial responses by hospital staff and patients waiting for treatment: chaos or control.

Fortunately, it was the latter that prevailed, but because the women chose a public venue in which to report the substance, which was quickly revealed not to have been anthrax, hospital officials were all the more motivated to implement a new system that they had, at the time, been on the verge of launching.

Following a 2005 directive from the Corzine administration to hospitals and organizations throughout the state that are involved in emergency preparedness, the hospital’s parent company, Princeton HeathCare System, has assembled its Incident Command Center: an emergency chain of command combining hospital operations with an information distribution system that makes possible a quick handling of potentially large volumes of patients. The center, or ICC, is effectively based on the National Incident Management System created by the federal Department of Homeland Security.

So if the anthrax scare were real, impacting a large number of individuals, it would have set into motion an operation where an in-house physician, pre-selected based on knowledge of infectious diseases, would serve as a medical technical advisor and all hospital staff would know who was in charge during that particular event, and potentially averting a disastrous situation.

The ICC, which is essentially a mobile unit composed of several computers, an assortment of communications devices, and pre-established emergency response procedures, can be set up anywhere at UMCP within about 20 minutes, according to the administrative director at Princeton HealthCare System’s Merwick Rehab Center Ryan Wismer, who toured media representatives around the ICC last Friday. Other equipment located at the ICC includes maps of the hospital, the immediate area, and the region; special vests that delineate the emergency response chain of command, and televisions. The center is also equipped with emergency power and lighting in case of a power outage.

The ICC improves interaction between emergency response organizations as well, Mr. Wismer said. For instance, UMCP will work with Capital Health System and Robert Wood Johnson University Hospital in the event of a large-scale emergency event.

“In the past, we might have called the person leading operations a ‘CEO’ or a ‘director,’ but now, everybody running the ICC, at any hospital is called an ‘incident commander,’” Mr. Wismer said.

“If I call up another hospital, everybody should know who I’m talking about if I’m looking for a particular counterpart.”

During a regular workday, the most senior vice president of a hospital would serve as the incident commander, but since emergencies can strike at any time, Mr. Wismer said, which is why the ICC provides a scenario for as many potential situations as possible. At 3 a.m., for example, the incident commander would be a designated senior nurse.

Other roles assigned include a public information officer, who would be in charge of disseminating information outside the hospital; a medical technical specialist installed to advise the ICC in how to proceed;and an operations chief to establish the availability of beds, isolation rooms, and equipment both in-house and in outside facilities.

Secure phone lines would also be established to allow hospital staff to contact outside agencies, including municipal police departments and fire departments, EMTs, Hazardous Materials teams, the state police, and the state Department of Health.

Mr. Wismer said the hospital has been conducting drills for about three months prior to the ICC’s official launch. “We’re putting this out there, particularly to staff and the public, so they understand when it gets scary like in an anthrax situation, they need to feel secure that there’s an organized method to dealing with an emergency,” Mr. Wismer said.

Most facilities, including Princeton HealthCare System, had previously employed an in-house ICC, “but they chose how to do it, and there was no real structure.” Since 9/11 those old protocol systems have “essentially become inadequate,” Mr. Wismer said, offering a sobering assessment of systems previously put into place: “The state of emergency preparedness in the U.S. is not 100 percent, so this is really new to a lot of hospitals.”

The Joint Commission on Accreditation of Healthcare Organizations, which evaluates the operational practices at health care facilities, does include an emergency preparedness component in its assessment, but the ICC plan “has really become the emphasis,” Mr. Wismer said.

While the ICC at UMCP is a temporary, mobile unit, Mr. Wismer said it is likely that permanent ICC facilities would be included in new hospitals, including Princeton HealthCare System’s planned campus in Plainsboro: “Most likely, in a disaster, the place that people are going to migrate to is a hospital. We would be a beacon and people need to be secure that when they arrive here, there’s an organized way we would take care of them.”

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