Only a Matter of Time?
"Hopefully, you will never need it. Likely, you will"
With this grim commentary on the possibility of future terrorist attacks in the United States, Dr. Pinchas Halpern, Chairman of Emergency Medicine at Tel Aviv Sourasky Medical Center opened a conference at Jacobi Medical Center entitled Emergency Preparedness for Mass Casualty Incidents - The Israeli Experience. Presented by Ivry Associates, international consultants in terrorism preparedness, the Jacobi conference offered an intense, reality-based education in medical center preparedness and response to Mass Casualty Incidents (MCIs), focusing heavily on the medical management of multi-victim terrorist attacks.
Attended by emergency physicians, surgeons, nurses, administrators, infectious disease consultants, hospital engineers, hospital police, and EMS, FDNY and NYPD personnel, the two-day agenda included a realistic drill in which Jacobi's Emergency Department (ED) responded to an orchestrated MCI. The MCI was the result of a hypothetical incident occurring on Shore Road near City Island, in which a large tractor trailer carrying organic phosphate, a dangerously toxic insecticide, overturned and exploded.
Following the explosion, EMS first responders brought in numerous biologically- contaminated and injured patients - replete with realistic moulage - to the Jacobi ED for emergency care. With the Clinical Engineering Department's camera crew trailing in its wake, the Jacobi team quickly swung into action to manage the event. The next day, a film of the drill was shared at the conference, where best practices were reviewed and potential improvements discussed.
"We learned a lot during this drill," said Kathy Williams, Associate Director of the North Bronx Healthcare Network (NBHN) Emergency Medicine Department and Chairperson of the NBHN Emergency Preparedness Committee. "For example, we need to think about how to secure evidence from the scene. Shrapnel harvested from a victim's leg wound must be secured as evidence, because in a situation like this, you know that the FBI will quickly be on site to retrieve it."
Other highlights from the conference included table top exercises focusing on decision making during an MCI, and emphasizing management and flow of contaminated patients. It also included a presentation on contingencies for dirty bomb incidents and other types of radiation exposure. In addition, there was extensive footage and examination of the Israeli response to some recent incidents in Tel Aviv, including the 2001 bombing of the Dolphinarium Beach Disco, which killed 18 and injured 115 young victims.
The Ivry conference, organized by Ms. Williams with support from Janice Halloran, Administrator of the Jacobi Emergency Medicine Department, was unique in establishing a new precedent for Emergency Preparedness educational programming. Rather than shoulder the entire burden of cost for such a program, Ms. Williams sought support from the NYC Health & Hospitals Corporation (HHC) to create an HHC-wide event. As a result, each of the HHC's 11 facilities participated, with the cost evenly shared. More than 150 attendees representing each of the participating facilities were in attendance, learning invaluable lessons from the Israeli team to bring back to their respective institutions. In addition, interested administrators and clinicians from Mass General ( Boston), Kaiser Permanente ( Texas) and The Einstein Healthcare Network ( Philadelphia) attended, and plan to arrange similar conferences with Ivry at their own facilities in the spring. Several members of the Bronx Emergency Preparedness Coalition (a consortium of providers created in the aftermath of 9/11) also attended.
"The Israelis have - through necessity - become experts at planning for and managing MCIs," observed Ms. Williams. "and their preparedness message was well-received. The next day, I received numerous emails from enthusiastic conference participants."
"While we have much to learn from their experience," Ms. Williams concluded, "the Israeli team was impressed with the Emergency Preparedness Program which we have in place already. They felt we are way out in front of most hospitals. Our success in this regard was made possible thanks to the support the Emergency Preparedness Program has received from NBHN senior leadership. Our readiness for an event is due to their foresight in recognizing that unfortunately, it is only a matter of time."