For all of its hospitals CHS develops and maintains Emergency Operations Plans (EOP) designed to guide an effective and efficient framework for managing emergency events and exercises.
Objectives of the CHS EOP
- Prevent or minimize the impact that a disaster or emergency situation may have on the healthcare facility, system and community (mitigation).
- Identify resources and procedures that are essential to disaster response and recovery at the facility, corporate, and community levels, and facilitate their utilization and implementation (preparedness).
- Through regular training, prepare staff to respond effectively to and manage disasters and emergency situations that affect the environment of care at the facility level, and integrate with the community in a broader response.
- Facilitate the reestablishment of normal business operations after a disaster or emergency situation (recovery).
CHS works closely with each community in which it has a hospital to integrate plans and resources to facilitate an All Hazards approach to community preparedness.
CHS has adopted the National Incident Management System (NIMS) as its incident management framework. Hospitals use the closely related Hospital Incident Command System (HICS).
Hospitals Preparedness in Mecklenburg County
All Mecklenburg County based Carolinas Medical Center facilities are included in the Charlotte-Mecklenburg Hospital Protection Plan, which provides a framework for developing a coordinated relationship between local government and hospitals within the County during disasters or emergencies. To that end CHS and CMC facilities have representation on a wide variety of community emergency planning groups, including: Charlotte-Mecklenburg All Hazards Advisory Committee, Joint Health Operations Center, Charlotte-Mecklenburg Mass Fatality Planning Committee, Charlotte-Mecklenburg Special Needs Shelter Committee, Charlotte-Mecklenburg Pandemic Influenza Planning Committee and Charlotte-Mecklenburg Strategic National Stockpile Committee. Mecklenburg-based CHS facilities are also actively involved in the Metrolina Trauma Advisory Council (MTAC) Disaster Preparedness Committee (DPC).
Metrolina Trauma Advisory Council — Disaster Preparedness Committee
Carolinas Medical Center is the managing authority for the Metrolina Trauma Advisory Council’s Disaster Preparedness Committee. MTAC facilitates preparedness and response activities for a 13 county region that includes 21 hospitals, 10 EMS agencies, and 13 Public Health Agencies. These activities are funded by a federal Assistant Secretary Preparedness and Response (ASPR) grant worth over $1 million. The MTAC staff manage regional disaster grant projects for partner agencies, coordinate a regional medical disaster response plan, encourage partnership development throughout the region, collaborate on regional disaster exercises, and provide disaster education to medical providers.
In addition, MTAC provides resources to partners in the event of a disaster. MTAC has a disaster response roll because it houses one of the State Medical Assistance Teams (SMAT).
Hazard Vulnerability Analysis
Each CHS facility conducts an annual hazard vulnerability analysis (HVA) to identify areas of vulnerability related to injury, potential hazards, physical damage, and environmental impact. The HVA is used to develop facility specific emergency response plans for the identified hazards. The HVA assists each facility in identifying events that could affect the demand for services and/or the facility’s ability to provide those services, based on the probability and consequences of each potential event.
Each facility’s HVA is reviewed with its respective community emergency preparedness agency response partners on an annual basis to confirm prioritization of events and to determine which specific emergency plans are necessary. These agencies include the Emergency Management Office, Police Department, Fire Department, Public Health Department and EMS System.
Hospital Based Emergency Response
To coordinate hospital, corporate, and community resources during an emergency response, each CHS facility has developed procedures for establishing a Hospital Command Center (HCC). CHS has adopted a NIMS compliant Corporate Command Center to provide direction and control to all affected CHS facilities in an emergency or disaster event. This scalable command structure is based on an “all hazards” approach. Its primary purpose is to provide administrative coordination and support for all hospital and system resources allocated to the response effort and to establish effective communication and coordination with internal and external response partners to facilitate the maintenance of hospital operations.
If warranted by the specific emergency event, the affected CHS hospital(s) will activate the EOP and establish an HCC. The individual who activates the system will serve as the initial Incident Commander until command can be transferred either to the Administrator on Call or someone more qualified. The Incident Commander, based upon the specific circumstances of the event, will activate any and all appropriate Command and General Staff positions. An Incident Commander is always identified for every actual or potential event with other ICS positions activated based on the situation.
Carolinas HealthCare conducts regular drills, both table-top and with mock patients. Some are coordinated with other community and/or regional agencies while others are designed simply to test internal readiness and capabilities. A regional exercise was conducted in July 2009 with the premise of a terrorist incident involving mass casualties with chemically contaminated patients. Among the objectives were:
1. Implement incident response communications within the healthcare system.
2. Provide coordination and support for medical care through incident command/emergency operations centers in accordance with NIMS.
3. Provide for decontamination/treatment and isolation of chemically exposed persons by the hospitals.
Carolinas HealthCare System hospitals in several communities in the region took part. CMC, as the Level I Trauma Center, took advantage of the exercise to fully deploy its six decontamination showers for ambulatory patients as well as to suit up those staff members who would come into contact with contaminated patients in a real-life disaster. Volunteer patients were provided with roles and moulage to add to the realism. Patients were transported by Medic ambulances, triaged outside the emergency department, decontaminated as needed, and moved through the emergent care and admissions process.
Care providers were appropriately dressed in protective gear and the exercise was conducted with a high degree of realism.
After action hotwash and other reviews revealed strengths and weaknesses in the system that lead to needed changes.
Of course in many disaster situations, hospitals normally carrying a high census can be quickly overwhelmed by a sudden surge of patients. Charlotte is unique among American cities because of a mobile hospital designed and owned by Carolinas Medical Center (CMC).
Carolinas MED-1 was conceived in 2000 as a mass-casualty transport vehicle, but it soon became clear that in a major incident an on-scene treatment facility would be more useful than a mere patient-hauling asset. With funding from the Department of Homeland Security’s Metropolitan Medical Response System, MED-1 creator Dr. Tom Blackwell and others shaped it into a mobile medical response facility capable of providing everything from basic-level care to surgical interventions.
It consists of two 53-foot tractor trailers, one for patient care and one for support and storage. It is staffed by physicians, nurses and associated personnel from Carolinas Medical Center and paramedics from the Mecklenburg EMS Agency, assisted by federally deputized officers of the Charlotte-Mecklenburg police SWAT team, and other support staff.
The patient-care trailer features three slide-out pods: One provides a two-bed shock-resuscitation and surgical unit, and the others become a 12-bed critical- and emergency-care unit, both with a full complement of monitors, equipment and tools. An attached tent awning system can shelter up to 200 more beds outside for ambulatory or inpatient care.
MED-1 also includes x-ray, ultrasound, and laboratory resources, enough medications for 72 hours, a complete communications infrastructure and its own power source. Upon arrival at the scene caregivers can begin seeing patients in minutes and the unit can be fully deployed in about a half hour.
It was among resources from North Carolina sent to the Waveland/Bay St. Louis, Mississippi area in 2005 under an EMAC request following Hurricane Katrina. By Sept. 4, it was set up and providing care in a parking lot not far from Bay St. Louis’ incapacitated Hancock Medical Center. The N.C. care team continued doing so until Oct. 14.
With the reopening of Hancock Medical Center, Carolinas MED-1 returned to Charlotte after logging 7,500 patient contacts, including heart attacks, broken bones, burns and deep abscesses requiring surgical intervention.
“Thousands of lives were touched, and many lives were saved, by the volunteers who provided care on MED-1,” said Blackwell. “It was a team effort from top to bottom, and I’m grateful that we were in a position to make a difference for the people of Waveland and Bay St. Louis.” North Carolina SMAT units helped provide staffing during he prolonged deployment.
Subsequent deployments include New Orleans to provide surge relief during the first post-Katrina Mardi Gras in 2006, and Columbus, Indiana in 2008 after flooding closed Columbus Regional Hospital for months. Thus Carolinas MED-1 has proven its value and flexibility as both an on-scene asset or one that can augment a damaged hospital while repairs are underway to return it to full service.
Having hospitals ready for receiving and treating disaster victims is, of course, vital. But Carolinas MED-1 has shown the value of having a comprehensive mobile hospital that can go to those patients to provide a full range of treatment modalities and life-saving procedures, or that can stand in for a hospital that is, itself, damaged.