In emergencies, hospital preparedness goes beyond planning

With roughly 144 patients injured from the Boston Marathon bombings--and 62 victims still at Boston hospitals, including 12 people in critical condition--hospital disaster planning has been put to the test.

While hospital emergency departments are required to have and evaluate their mass-casualty plans, the horrible events in Boston this week not only reinforced the importance of testing plans for all types and sizes of emergencies, but also the fact that sometimes hospitals will need more than just a plan.

As one hospital director told me, an emergency response plan is no good unless hospital workers can execute it.

"A plan sitting in a folder on a desk is not going to be very helpful unless the providers in the emergency department know about that plan and know how to implement the plan," Selim Suner, M.D, the director of disaster medicine and emergency preparedness in the Department of Emergency Medicine at Rhode Island Hospital, told FierceHealthcare.

But according to Atul Gawande of Brigham and Women's Hospital, a rehearsed plan wasn't the only factor in Boston-area hospitals being prepared to handle the wave of bomb victims. It also came down to providers' medical instincts and ingrained desire to help people. Before a ritualized plan could even kick in, groups of physicians, nurses, X-ray staff and transport staff had responded to the emergency, knew exactly what to do--and did it.

In addition to preparations from emergency response drills, many providers in Boston had to depend on techniques their military counterparts learned from treating combat wounds.

Far from Boston, a trauma surgeon at Indiana University Health Methodist Hospital echoed Gawande's sentiments. "This is why we stay up nights. This is why we miss birthdays. This is why we miss Christmases--to be here ready, not only to protect ourselves and our family, but to care for our city members," Jamie Coleman told WISH-TV.

Such provider instincts are kicking into full gear in Texas, where hospitals were treating 180 people injured from a massive plant explosion Wednesday night, with at least 16 patients in critical condition and three in serious condition. About 10 hours after the West Fertilizer explosion leveled nearby homes and businesses, Hillcrest Baptist Medical Center already had seen more than 100 patients.

Hospital officials praised the rapid response of more than 250 physicians and workers who arrived at Hillcrest Baptist to care for those injured in the explosion, as well as the public for stepping up its support.

"The people of our community and Central Texas have once again demonstrated our ability to face unexpected challenges and to respond with resilience and strength," Hillcrest Baptist CEO Glenn Robinson said today in a statement.

As with all disasters, like Hurricane Sandy last fall or the tornado that wiped out Joplin, Mo., in 2011, there are lessons to be learned. This week, hospitals in Texas and Boston showed that when disaster strikes, we need more than a response plan; we need people willing and ready to help. - Alicia (@FierceHealth)

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