Bracing for Catastrophe
On communication: “Its absence was an absolute show-stopper.”
On the federal government’s role: “When it’s obvious that a part of the country is in trouble, the federal government should not have to debate archaic [states’ rights] laws about stepping in and controlling the situation.”
On volunteers: “Health care personnel showing up in a disaster zone without a formal request are likely to get in the way. Many are ‘medical voyeurs’ with no real training to deal with the situation, like podiatrists stopping by a highway accident.”
Kelen could go on. As director of the Center for Emergency Preparedness and Response (CEPAR), it was he who was in charge of mobilizing teams from across Hopkins Medicine to aid hurricane victims on the Gulf Coast. With his senior staff, he pulled together three separate groups, including one with no fewer than 109 doctors, nurses, pharmacists and techs. That team was all set to depart when the 250-bed field hospital they had been asked to staff folded for lack of patients.
Breakdowns like these highlight what Kelen has called the “seat-of-the-pants approach” we as a nation bring to crises. “There is very little science behind the practice of disaster planning and response,” he laments.
Now the professor and chairman of the Department of Emergency Medicine has a chance to change some of that. Along with Lynn Goldman, a professor of environmental health sciences at the Bloomberg School of Public Health, Kelen is directing a Department of Homeland Security “center of excellence” specifically devoted to studying how we can best respond to and prepare for disasters.
The Center for the Study of High Consequence Event Preparedness is a national consortium of 32 universities, nongovernmental organizations and federal agencies, all led by Johns Hopkins. It also includes six of the University’s schools, plus the Applied Physics Lab and the Health System. “For our projects, we have chosen from among our Hopkins colleagues and from across all the entities in the consortium,” says Kelen. “We have brought together disparate disciplines, people who haven’t normally worked with each other.”
So if, say, a project involves a radioactive bomb in Baltimore, computer scientists would build detailed computer models that simulate the physical effects of the event. Engineers would figure out what bridges would likely be taken out. Economists would determine the repercussions on the city’s business and commerce. Social scientists would predict how people would react, and so forth.
Out of the methods developed by the Center will come a multidisciplinary graduate course to train future leaders, scholars and researchers in disaster response, as well as a comprehensive, academic textbook.
Who knows, 100 years from now, much as people today visit the Osler Textbook Room in Billings where Hopkins’ first physician in chief penned his renowned book, tomorrow’s medical historians may stop in at Kelen’s corner office in the 1830 Building to see where he compiled The Principles and Practice of Disaster Preparedness and Response.
Kelen arrived at The Johns Hopkins Hospital in 1982 when emergency medicine was in its infancy, a newly minted, but little-noticed, division within the Department of Surgery. A Canadian, he planned to spend a couple of years training in Baltimore but wound up accepting a faculty position. “I just got caught up in the potential of this place, in its whole academic mission. It was such an exciting place to be.”
Part of the excitement had to do with the emergence of HIV/AIDS, then an untapped area of research that few were studying. Kelen jumped in and his academic career took off. “Unfortunately,” he says, “it was on the back of a serious illness. But that is the way of academia. People often make careers out of the misfortune of others.”
He believes, though, that his work saved lives, for it put into place early detection programs and helped establish universal precautions (guidelines that protect health care workers from pathogens) and define the extent of the epidemic.
In 1994, the division of emergency medicine became a full-fledged academic department with Kelen, who had headed its residency and research programs, its director. He was 43, the youngest chief at Hopkins.
By the late 1990s, Kelen was assessing bio threats like smallpox and anthrax. “It was really a wonderful spin-off of HIV, because just as with HIV, we were all about detecting emerging diseases earlier, better and faster.”
Then came 9/11. “That just totally propelled us into this other world, the world of response and preparedness theory. It was an area I had really not paid a whole lot of attention to.” Asked to create a task force that would map out Johns Hopkins’ response to future disasters, Kelen soon realized that way more than a simple, summary report was required. And so, in 2002, CEPAR was formed.
Pretty much up until September of last year, the focus in the United States was on terrorist events. “But Katrina taught us that natural disasters are every bit as great a threat,” says Kelen. It also showed that medical centers have a role to play. “Next to the government’s DMAT [disaster medical assistance teams], the large academic medical centers are in the best position to rapidly respond with teams appropriately composed of people who have worked together everyday.”
Of course, the teams from across Hopkins Medicine who went to the Gulf Coast did not actually work together everyday. But, Kelen points out, they were united by a common thread: the Hopkins work ethic. “You do whatever needs to be done. Put just the thinnest incident-command structure to that—a team leader and well-defined roles for everyone—and people just fall into line.”
Johns Hopkins’ proposal was one of 34 applications received by the Department of Homeland Security. When the five DHS reviewers arrived for their site visit, it was evident that Hopkins was not their first choice. “It was as though they were just putting in time,” recalls Kelen. “That was their body language.”
But the CEPAR team, led by Kelen, executive director Jim Scheulen and administrator Dianne Whyne, had done their homework. For three months, they had worked practically around the clock to pull their proposal together. Kelen had personally contacted every potential partner and about 200 potential investigators. He and Scheulen had then visited every partner, in or out of state.
Now, for the two-day site visit, 80 of the 90 participating investigators were on hand. The proceedings were opened by President Bill Brody himself. The CEPAR team began by presenting the consortium’s philosophy, capabilities and specific projects. Just two hours into the program, Kelen could sense a sea change in the reviewers’ attitudes.
Weeks later, on Dec. 5, Homeland Security Director Michael Chertoff arrived at Hopkins Hospital to announce the $15 million Center for the Study of High Consequence Event Preparedness and Response. (The center is also funded with $3.5 million from Johns Hopkins.) It was the fifth university center of excellence anointed by Homeland Security and arguably its most essential. “The others target specific issues. But our center,” says Kelen, “strikes at the heart of what Homeland Security is all about. It is about preparedness and response, and that is truly the glue that holds everything together.”
—Anne Bennett Swingle