What happens when another day on the job is not just another day? While no two days are ever exactly the same for an HTM professional, what do you do when life throws you a curve ball? What do you do when you are removed from your comfort zone; when a disaster or tragedy strikes and you need to step up and handle the unexpected? There are those who have gone before you. Their story is one of resolve, learning on the fly, resourcefulness and courage.
Working on a device may come with its own level of stress when the problem is not apparent or there is an urgent need for the device, but that is all in a day’s work for HTM professionals everywhere. Add to that stress the dangers of a tornado, hurricane or terrorist attack, and you have the makings for a very bad day.
The emotions of a typical day on the job might include frustration, accomplishment, joy or slight anxiety. But, what happens when those emotions include fear, uncertainty or even terror? This is important information we hope you will never need. Making it through the disaster often brings with it major challenges. It also brings lessons learned.
The nation saw the wasteland left by an EF-5 tornado in Moore, Okla., in May of 2013. The travails of the Norman Regional Health System’s clinical engineering department were covered in a TechNation profile in April of last year. The Moore Medical Center, part of Norman Regional, was heavily damaged by the twister. In the days and months after the disaster, the department’s manager, Rich Dubord, extracted some wisdom from the experience.
“The first order of business should be the safety of the HCT (Health Care Technology) staff and their families, as well as your own. Have daily huddles with HCT staff to communicate individual/family needs. Once you have established a ‘baseline,’ follow your facility’s disaster plan,” he says.
“Communicate status with frequent updates to your facility leadership team. Develop a ‘team atmosphere’ within your department and those whom you serve. Stay focused on the task at hand, and have faith that you and your team will overcome,” Dubord suggests. One of the department’s biomeds was actually in the Moore Medical Center when the tornado hit. The same biomed’s home had extensive damage, as did the homes of two other members of the department. Apart from the advice about dealing with the emotional toll of disaster, Dubord also learned first-hand about the other big challenge; damaged and displaced equipment. With first-hand knowledge, he lays out a rational blueprint. “Assess the damage; develop a ‘triage’ plan,” he says. “If your HCT department is overwhelmed, do not hesitate to reach out for assistance. In a disaster situation, people are always willing to help, especially fellow BMETs.”
“Having an accurate inventory by department is extremely important in the aftermath of a disaster. Take lots of pictures of the damaged equipment, note location and damage. If possible or necessary, move equipment to a secure area such as a warehouse that is well ventilated, with AC/heat [and] utilities” – Rich Dubord
“Having an accurate inventory by department is extremely important in the aftermath of a disaster. Take lots of pictures of the damaged equipment, note location and damage. If possible or necessary, move equipment to a secure area such as a warehouse that is well ventilated, with AC/heat [and] utilities,” he says.
“Develop a plan to go through all of the equipment. Sort it into categories such as ‘salvage,’ ‘repairable’ and ‘return to service.’ The use of tags with colored dots, representing each of the categories, such as red for salvage, yellow for repairable [and] green for return to service, is very useful,” he adds.
Dubord also suggests developing a relationship and partnering with your facilities insurance adjuster. “Set up a simple ‘disaster’ filing system to capture the results of the work performed — disinfecting, testing, electrical safety — on each piece of equipment. Work with your facility’s Materials Management department to obtain replacement cost quotes for equipment,” he says. The experience brought about an even greater emphasis on safety and awareness says Dubord. It has also produced some shared goals for everyone affected.
“The employees and community have bonded together in support of building the new hospital and everyone is excited,” Dubord shares. “Local support for the 270 hospital employees that were directly impacted has been overwhelming.” “A temporary ED has been built to support the needs of the community. Construction has begun on a new permanent facility with a scheduled opening in mid-2016,” he continues. “Everyone is excited and looking forward to the rebuilding and a new beginning.”
One of the worst disasters of the past century was the devastation left by Hurricane Katrina after it hit the Gulf States. Most of the focus was on New Orleans, in the aftermath of the hurricane, but there was another city that took a more direct hit – Gulfport, Miss. While the nation saw the devastation to Memorial Hospital in New Orleans, there was another Memorial Hospital affected that day and there were biomeds on duty who experienced the power of the monster hurricane.
The biomedical engineering department at Memorial Hospital in Gulfport learned that there was nowhere in the vastness of the hospital that would muffle the sound of Katrina.
“The water never really made it to us. The old roofs with the tar and the gravel, we had those, and of course the gravel became projectiles, so, we had to evacuate patients from those rooms — with windows — and make sure they were safe,” said Dale Latimer, a CBET at the time. Latimer’s home was destroyed by Katrina and he had to live in his office at the hospital for a month. He slept on a cot. “Our primary responsibilities are medical systems, but in this instance, we ended up doing a lot of different things, wherever we were needed,” Latimer said. “We were running around moving patients out of the rooms into the hallways. It was quite a fiasco for quite a number of hours for everyone.”
Working in a location that can be threatened by hurricanes provides an additional list of protocols that not all HTM professionals have to think about. Jim Walmsley, another CBET in the department, explained the realities of working as a biomed in one of those locations. “During the hurricane season, we have biomeds that are assigned to the hurricane team. If our hospital comes in the cone, where they are predicting that the hurricane is going to hit, then our administration makes the decision when we are going to lock down,” he said.
Walmsley said that once the hospital is locked down, the biomeds, who are on that schedule, check in with the command post so they can be available to do anything that is needed.
“If it’s helping the engineers secure windows or moving the biomed equipment away from the glass or maybe a patient needs special care with a piece of equipment, we’re here to do that,” he said. “We have to usher mops and brooms and buckets, we do what has to be done in the middle of a contingency and we work as a team. You’re locked down, so you’re finding a place to sleep right here in the hospital. You bring some clean clothes with you. You can shower and it may become kind of cramped.”
One hospital biomed department in Charleston, S.C., added back-up batteries to all ventilators and life support equipment after Hurricane Hugo. Improvements to the switching system and emergency system grid also resulted from the giant hurricane after the emergency generators were flooded. Power to the Children’s Hospital was quickly furnished by the adjacent main hospital, but the experience pointed to areas for improvement. For biomeds who might work on the Gulf Coast or the Atlantic Coast, or to a lesser degree, on the Pacific Coast, the advice from fellow biomeds who have faced a hurricane can be instructive. Along with what Walmsley and Latimer suggest, another colleague speaks from first-hand knowledge.
“Be prepared in advance. There is no such thing as being too prepared,” says Robin Bailey, CBET, radiation/imaging specialist at Memorial Hospital Gulfport. “You prepare your family ahead of time because it may come that you’re stuck at work for days or longer with no communication with them.”
“The only communication I had was text (message), and it was delayed for hours. The cell service was overwhelmed and no back up batteries. You can’t be obsessed with your family and concentrate on your job. Bring extra food and water with you because things can run short quick,” Bailey says. “I have been in quite a few hurricanes and lately I have been researching the net on survival techniques.” Bailey also suggests carrying a “bug out bag” in your vehicle. The bag could be a backpack with food, water, a knife and other essentials.
“I have spent weeks without electricity and water after a storm. You get creative and prep more every time,” Bailey says. Bailey points out the changes that can result from experiencing a disastrous situation. Some practical things are learned to prepare for future events. He also bore witness to one of Latimer’s observations. “We have had rock on the roof for years. That is the way roofers installed and repaired it. After the last hurricane, someone finally got the great idea of removing them. The rocks became like machine guns flying around and breaking hundreds of windows (and) letting in the wind and rain, not to mention scaring the staff and guests,” Bailey says.
“Buildings are being built higher above any chance of water intrusion,” Bailey says. “The power to the hospital is always being improved. We have always kept a box of call bells to temporarily take the place of a down nurse call system. The old manual bell is a good backup when the power drops out. Extra extension cords, flashlights, batteries and anything along those lines are good to keep handy.”
The bombings at the Boston Marathon put the city on high alert, and one of the healthcare providers to step up to the plate was the Boston Medical Center. The facility and its staff were prepared and so was the clinical engineering department.
The hospital’s preparation came from practicing for emergency events. The department gained insights useful to their HTM counterparts from the frightening experience.
“I strongly encourage others to take part in their organization’s Emergency Preparedness team,” says Jim Piepenbrink, director of the Clinical Engineering Department at the Boston Medical Center. “HTM professionals have critical thinking capabilities that are essential when dealing with disasters and quite often we have a very good understanding of how the organization is laid out and how different departments operate.”
“My team serves two roles on our Emergency Preparedness Team – Planning Chief and Logistics Team member. Each of these roles enables us to leverage the knowledge we have about the organization, as well as the technologies used to support patient care, and we can assist in ensuring that we can handle a surge of patients as well as identifying the duration of a disaster and what the impact of the event will require in terms of support, both short term and long term,” Piepenbrink explains.
“Disasters oftentimes are swift and immediate, but the effects can be felt for days if not weeks — maybe longer — and ensuring that we can provide clinicians with technology to do their work is a valuable and essential piece of managing the effects of a disaster and helping return the organization to normal operations,” he says.
Piepenbrink points out that HTM professionals have the ability to work with vendors, as well as colleagues outside the organization, to request additional technology or assistance.
“Additionally, with the proliferation of technology under HTM’s control, we have the best lens into what the capabilities are and how these devices may be mobilized in the event that a temporary area needs to be established,” he says.
With the unusual experience of what happened that day in Boston, the hospital and CE department learned lessons.
“We have a renewed focus on increasing the number of people who will participate in disaster management, especially at the command team level,” Piepenbrink says. “Disasters can last for days and we have worked at ensuring that we have a better bullpen of people we can draw from to ensure that people limit their shift so that they are making effective decisions and not getting burned out.”
“Additionally, we have beefed up our software solution to better capture necessary information so that we have a single lens into the activities during a disaster instead of manual and electronic monitoring of the situation,” he adds.
“We learned quite a bit from a few incidents we have managed and with each one we have a critical after action meeting to discuss what we did well, where we may have struggled and how we can improve on the management of events,” he continues. “These sessions are essential because experience is the best teacher and as we create improvements in the process and the technology we create a more robust program.”
The enormity of some disasters doesn’t end at the door of the hospital. The devastation wrought by an EF-5 tornado that hit Joplin, Mo., on a Sunday in May of 2011 was hard to escape. The towers of the hospital were extensively damaged and six public schools were destroyed.
“The experience is taken home with each individual. Some staff members only deal with the devastation at work. Others lost their homes, family and friends,” says Don Allen, director of Clinical Engineering for Mercy Hospitals in Joplin.
Allen may not have been there on the day of the tornado, but he has lived with many of the consequences during the intervening time period. His team and co-workers have relived that day also.
“The mental and emotional toll is great,” Allen says. “Time and compassion is required when dealing with the co-workers that have experienced personal loss.”
The tornado plowed a path more than 22 miles long. It was three quarters of a mile wide. One hundred and sixty-one lives were lost that day and more than a thousand others were injured. More than 18,000 vehicles were destroyed and 8,000 structures were damaged.
Allen’s employer, one of several Mercy Health System facilities in Missouri, was destroyed by the giant tornado. At the time, the hospital was known as St. John’s Regional Medical Center. A temporary tent hospital was erected days later and a modular hospital opened in August. In 2012, a new hospital was opened with a full-scale emergency department and birthing facility. The facility was engineered to be 30 percent stronger than the original facility. The opening of a new 600,000-square-foot hospital will occur in March.
Allen says preparation is the key to weathering a disaster.
“I see preparation as two items: business and personal,” he says. “The personal preparation is the hardest. It is easy to procrastinate and extremely difficult to anticipate the full toll on you and your staff. Business preparation is much the same. Although very few will experience a total loss, it is important to be prepared. Make sure your database is accurate.” Allen says planning should be outside the box.“One of our biggest challenges has been location. Because the hospital was destroyed, our departments are scattered across all of Joplin. The high-priority patient care areas were accommodated in our temporary hospital, but the ancillary support departments and lower priority clinical departments are not,” he explains.
“Every piece of rental property was snatched up and Clinical Engineering now shares a warehouse with Materials Management, Histology and Microbiology. Logistically, it’s difficult to manage. Joplin isn’t a huge city, but a mile between departments is far greater than a floor or two,” Allen adds.
Along with those other unwilling participants in disasters, those designing the new Mercy facility in Joplin applied lessons learned to be more prepared in the future.
“We have windows that will withstand wind speeds of 90 mph, 140 mph and 250 mph – all location specific based upon acuity of patient – it was a lesson learned from the storm,” Allen says. “We have also built the hospital to withstand an earthquake, relocated the backup electrical generators and have three each boilers, cooling pumps, cooling towers and electrical generators. All lessons from the tornado.”The department has had to deal with the big job of cleanup, three hospital moves and a forth move coming up. Allen says that the real story in the aftermath of the disaster is what has been accomplished through sheer determination.
“How many hospital projects have you seen that have gone from acquiring the land to occupying the space three years later? May 22, 2011, the tornado hit. January 2012 we began moving dirt — without finalized hospital plans. March 22, 2015 we will occupy. That’s a testament to our resilience, cooperation, commitment and our faith,” Allen says.
And that is the lesson learned; preparation is important and the human spirit perseveres.
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