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Systems of Survival

Emergency nursing director Lisa Nummi and David McQuaid check the HEICS vests Bayview staff will don during a crisis.

If one thing worries Howie Gwon, it's smallpox. Not whether there are medical policies to deal with it (there are). Nor whether the Centers for Disease Control and Prevention would bring vaccine (it will). But whether you know what you would do.

"There's a sense in some quarters," says Hopkins Hospital's disaster control administrator, "that someone will tell you what to do. But in that case, when it's time to implement the disaster plan, you would be too anxious about yourself and your family to listen."

Gwon's advice? Decide now that you'd stay put and get vaccinated. If you don't, Gwon says, you could subject yourself and your loved ones to exactly the danger you were hoping to evade.

A year ago, we didn't contemplate such things. Today, every part of Johns Hopkins Medicine has planned for scenarios once considered unthinkable.

Last October, Hopkins Hospital added Operation Orange--a blueprint for victims of a biological attack--to its longstanding codes for situations that would tax the Emergency Department (Operation Yellow) or several areas of the hospital (Operation Red). Similar plans are being refined for chemical and nuclear incidents. But it's not only medical staff and administrators who need to understand their roles. Every department has been asked to draft a plan, and Gwon has been leading tabletop exercises to help managers at all levels educate their staffs. "People need to know what to do, and what not to do, especially if they've been exposed to something," he says.

At Johns Hopkins Bayview--home to Maryland's sole burn treatment center and one of only three Baltimore-area hospitals designated to treat patients who've been contaminated by hazardous materials-training also has been stepped up. Besides adding an emergency management section to its intranet, the medical center requires everyone, including house staff and the newly hired, to learn its new method for handling crises. Called the Hospital Emergency Incident Command System (HEICS), it provides nearly 50 "job descriptions" (incident commander, logistics chief, patient tracking officer) that allow virtually any staff member to take on clear-cut duties during a disaster.

"One of the biggest problems can be chaos and everyone wanting to control the situation," says David McQuaid, Bayview chief operating officer. "HEICS brings structure, and it can be expanded or scaled down as needed."

Howard County General Hospital also uses HEICS and has held drills to familiarize staff with it. "If something happens in Baltimore," says Tim Kelly, director of quality and risk services, "there are all kinds of hospitals. Here, we're it. We've always worked closely with the county police and fire department, but it's helpful to have that Hopkins link. We've modeled our bioterrorism response plan on Hopkins Hospital's."

At the Home Care Group, where communication and transportation are key, global positioning devices have been installed on all delivery trucks, and a tower has been added to the roof of Broening Highway headquarters to boost the existing two-way radio system. Back-up medical suppliers have been identified, off-site records access has been shored up, and building security, now linked to Bayview, has been tightened. "We know how to manage crises," says Linda Scott, senior director of home health services. "We've had tornadoes, hurricanes, snow, power failures. Now we're looking at how to provide care if patients are quarantined in their homes."

Even computer-driven Johns Hopkins HealthCare, which handles health insurance contracting and other indirect patient care, has been busy. "Our biggest issue is keeping the system running," says special projects director Sue Phelps, who's been honing a business-recovery plan that addresses simultaneous crises like telephone outages and flooding. "We've also been working on ways we can support the hospitals, such as how our system could be used as a back-up."

"The devil," says Gwon, "is always in the details." But one thing is clear: Everyone has been doing a lot more "what if" planning.

-Mary Ann Ayd



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