Hospital staffers pace up and down the hall, whispering urgently about some kind of outbreak. A woman dressed in scrubs and a red emergency vest enters the control room to talk to someone about the barrage of patients crowding the emergency room.
No, this isn’t a cliffhanger scene out of the popular medical dramedy Grey’s Anatomy. It’s real, and it’s happening right here in Santa Maria.
Well, sort of. As the saying goes, this is only a test.
On June 17, Marian Medical Center participated in a pandemic influenza exercise overseen by the Santa Barbara County Public Health Department. The four other county hospitals were involved, too, as were outpatient clinics, the Santa Barbara County Sheriff’s Department and Office of Emergency Services, Vandenberg Air Force Base, and University of California Santa Barbara.
The countywide exercise marked the first time the public health department, sheriff’s department, and local hospitals simultaneously participated in a coordinated disaster drill.
The county ran the exercise in order to familiarize all emergency service agencies with the Incident Command System, a standardized emergency response system established by the Federal Emergency Management Agency.
The nationally used system came into being shortly after the terrorist attacks on Sept. 11, and is meant to facilitate coordination and communication among national, state, and county emergency responders.
Gary Goeringer, Marian Medical Center’s vice president of planning, explained that the system standardizes emergency responses and communication from the top down.
“It transfers some responsibilities from the feds to local agencies so we’re all speaking the same language during a medical emergency,” he said.
According to the system, each agency responds to simulated reports of a pandemic influenza outbreak as if it were actually happening. Using materials provided by the county, “incident commanders” are asked to assemble their staff members into specialized groups and assign them tasks and responsibilities.
Throughout the four-hour exercise, leaders from every agency were expected to make hourly updates to the mock command center based at the public health department in Santa Barbara.
In order to maintain constant contact, county staff can use any and all forms of communication, including e-mail, cell phones, landlines, and Internet databases.
In Santa Barbara County, the Public Health Department hired training consultants and evaluators from Life Process, an emergency response company based in Santa Cruz, to monitor the success of the drill.
“This level of drill—lots of people don’t step up and do it,” drill coordinator Lisa Angell told the Sun while she oversaw the exercise at Marian Medical Center. “It shows how much the county cares about the community and realizes the responsibility it has for its safety.”
For this exercise, the public health department chose to respond to a flu pandemic because, as deputy director Michele Mickiewicz said, “it’s a likely public health scenario.”
“We’ve done earthquakes before, but this one is more far reaching,” she noted.
The county’s Web site explained that a flu pandemic is an outbreak of a new, highly contagious virus. No one would have immunity, so it would spread quickly around the world.
There have been three influenza pandemics in this century: the devastating Spanish influenza outbreak in 1918, and smaller outbreaks in 1957 and 1968. More recently, the avian flu stirred up fear of a possible pandemic.
Mickiewicz said that, while it’s not the county’s intention to frighten people, it still wants the public to be prepared.
“Approximately 36,000 people die each year of flu in the United States,” she said. “And with pandemics, it’s not a question of if, but a question of when.”
That’s why—even though it’s fake—county and hospital officials take the exercise so seriously.
In the hot zone
At Marian Medical Center, on the day of the exercise, the atmosphere was intense.
Beginning at 8 a.m., hospital officials rounded up the nearly 50 staff members undergoing training to explain the nature of the mock medical emergency: Large numbers of people exhibiting flu-like symptoms—high fever, cough, and sore throat—have been reported throughout the county.
The staff learned about the pandemic approximately 16 hours into its duration, and trained as if they were replacing other staff members going off of their shifts.
An hour and a half later, there were already 30 severely ill people in the hospital, and several people had died due to the outbreak. The hospital went into lockdown and no visitors were admitted, expect in emergency cases.
Hospital administration sent a memo to all employees, physicians, medical staff, and health care providers, requesting the cancellation of all elective surgeries. Staff members were asked to wear gowns, gloves, and masks; wash their hands frequently; ensure that patients use the proper respiratory devices; drink plenty of fluids, and get plenty of rest.
Officials assessed the availability of supplies—food, water, and pharmaceuticals—while an inpatient hotline and press hotlines were established, as well as an emergency triage station outside of the hospital’s emergency facilities.
Marian Medical Center West and other local community clinics were set up as alternative triage sites, and staffers looked into establishing sites outside of the facility, such as Allan Hancock College and Pioneer Valley High School.
At 10 a.m., group leaders reconvened for a briefing. (They were introduced to a “real-world reporter” documenting the exercise for an upcoming article in the Sun.)
At the briefing, group leaders gave progress reports to Incident Commander Kerin Mase and their fellow staff members.
The hospital was in constant contact with the county public health department, which reported that an alternative treatment site had been set up at the Santa Barbara County Fairpark, which was scheduled to open at 5 p.m.
Members from all four specialty groups—finance, safety, operations, and planning—commented on their progress, as well as any problems that popped up along the way. Topics of conversation included establishing transportation for sick hospital staff members being sent home, the gathering of more supplies from outside vendors, the distribution of anti-virals and other medicine, and providing information to the community both in English and Spanish.
Staff members then dispersed to their separate rooms.
“The medically fragile are being taken into account, as with any emergency situation, although it’s especially important with the flu because the young and old are already susceptible,” drill coordinator Angell told the Sun during the break.
At 11 a.m., officials brought all of the staff members into a mock control room to conduct what’s known as a “hot wash.”
Unlike visions of a foamy scrub-down the term elicits, a hot wash is actually a critique or debriefing. Groups discussed both the positive and negative aspects of the drill—what went wrong and what went right.
For the most part, everyone said that the drill went extremely well. Multiple staff members commented on the level of respect and willingness in everyone who participated.
“It’s like your job on steroids,” Angell told the staff.
Each group leader made recommendations on what would help their group do a better job in the future. Staffers were pleased to find that most of these recommendations are considerably small in scope.
The final consensus seemed to be summed up in a declaration made by Angell: “I’ve been to many, many of these drills and I would gladly come back to Marian.”
Still, Angell was quick to point out the important role of the public in an emergency situation.
“In this kind of scenario, it’s all about whether the public listens and does what the officials tell them to do,” she said. “It’ll sink or swim depending on whether the public listens to the public health department, especially when it comes to flu pandemic.”
Shortly after staffers were dismissed, Vice President of Planning Goeringer and Incident Commander Mase, who’s actually vice president of patient care services and head nurse, reflected on their staffs’ efforts.
“This was a very large-scale event that had a lot of participation throughout the county,” Goeringer said. “We have an excellent management team and staff. I’m confident, if we have an emergency response situation, that we can provide extremely good care and support to the community.”
Mase agreed: “I’ve worked in a lot of places, and I think the teamwork and collaboration is more evident here than any other place I’ve worked.”
This praise doesn’t come lightly from Mase, who was present during an outbreak of the Hanta virus at the University of New Mexico in 1993.
But overall, providing top-notch care during difficult times is a no-brainer for Mase.
“The community depends on us. We all have to work together. It’s critical,” she said.
The bigger picture
On the countywide level, Deputy Director Mickiewicz was equally pleased with the results of the exercise.
“It went very well,” she said. “Activation of all of the countywide health care providers went smoothly.”
Still, she’s the first to admit that, in this kind of situation, there’s always room for improvement.
“We’re going to work on tightening up the system in the future,” she said. “Something like this, in fact, would happen over months and months, so we have to keep training.”
While county agencies continue to train, Mickiewicz said that the best way for the public to prepare is by visiting the public health department’s Web site, www.sbcphd.org/advisory/flu, to learn more about the flu and medical resources available in the county.
“There are constant challenges in these kinds of situations, and public education is key,” she said.
Contact Staff Writer Amy Asman at aasman@santamariasun.com.
This article appears in Jun 26 – Jul 3, 2008.
