Crisis Management

When I wrote about the plane crash in the last post, I was thinking of my experience, a single responder with a specific skill set and role. But as we talk and think about mass casualties, I begin to recognize more and more the challenge for and remarkable response by the higher level administration, both at SFO and at Stanford. From a hospital standpoint, a situation of this magnitude puts into play so many different things. We have to communicate with the disaster site to assist them with deciding who goes where. Any single hospital could get quickly overwhelmed, but by sending patients to nine different Bay Area hospitals, we did not inundate any one hospital's resources. Upon activating a code triage, the emergency department has to be cleared out and additional space set up. If dozens of critically ill patients arrive, we cannot have the ED filled with nonurgent cases. I talked a little about how additional physicians responded including multiple trauma and perioperative teams, but we also have to call in extra nurses, technicians, and other staff. If a patient needs to be transported to the OR or ICU, we have to have people on standby just for that job. We have to open up ICU and hospital beds, no easy feat when hospitals run near full capacity. And we have to handle a dozen other tasks: talking to media, predicting needs for the next 24-48 hours, identifying names of the victims, maintaining infrastructure. I know the hospital does a lot of simulation exercises to prepare for such situations, and the fact that this went so smoothly is a testament to the systems and preparation set in place.