Own the Emergency

It is 8:30 on a Monday morning. You're a member of the management team at an urban hospital—a Level 1 Trauma Center—and it is your day to be the administrator-on-duty (AOD). You are in charge of the campus.

Like many urban Level 1 Trauma Centers, your hospital has several thousand employees on site, between 600 and 800 occupied beds, hundreds of visitors and dozens of vendors moving around the campus each day. Today, you are in effect operating as the mayor of a small town.

Shortly after your shift begins you receive a call from the police department. A major explosion has occurred in your city's main rail hub, and the police suspect terrorist involvement. They tell you to expect anywhere from 500 to 1,500 patients with burns and blunt force or blast-related injuries.

Are you ready to manage this crisis? In the past, your shifts as AOD have only required you to make relatively minor decisions. Have you ever prepared yourself for this level of critical decision making?

Although this scenario falls toward the high end of a disaster matrix, it is possible in today's world.

I was working on September 11, 2001, at the North Shore-Long Island Jewish Health System's (NSLIJHS) Level 1 Trauma Center in the New York City area. The original notification from municipal agencies was that we should expect to receive a surge of 5,000 to 10,000 patients with varying injuries. The NSLIJHS had taken steps prior to 9/11 to enhance its emergency preparedness plans and had begun training its employees in CBRNE (chemical, biological, radiological, nuclear, and explosive) emergencies. But nothing could have prepared anyone for the events of that day. I'm sad to report that we received few survivors at the hospital after the tragedy.

The senior leadership of our organization seized upon this event as an opportunity to better prepare itself for emergencies of any type.

The NSLIJHS is a non-profit organization that provides healthcare in New York City and Long Island . It comprises 15 hospitals, 37,000 employees and numerous ancillary care facilities. As the corporate director of security, I am charged with overseeing security and emergency management at all facilities, and I have a dedicated staff that is responsible for investigations, executive protection, training and emergency management. Five staff members are currently dedicated full-time to emergency management duties.

Let's get back to our hypothetical administrator-on-duty. The AOD function is usually a rotating position that may be filled by nurse managers and mid-level hospital administrators. In the normal course of business, these staff members have many daily responsibilities that range from patient care to finance. In those daily duties, most decisions are made by consensus in committees or workgroups. Consensus building, while important, does not help prepare leaders for the type of critical decision making they'll face in an emergency. In fact, our emergency management staff had observed that during actual emergencies and drills, critical time was being wasted because the AODs, now the incident commanders, were still using the workgroup format to make decisions.

So how can we teach AODs to make effective, critical decisions, as the city's fire chief or police chief would? At the NSLIJHS, I worked with the vice president of emergency services, Brian O'Neill, to develop a training course to meet this need.

The Incident Commander Development Course includes scenario-based exercises led by me, O'Neill and several other instructors from the emergency management staff. Senior-level buy-in was critical to the plan's success. We offered our very first class to the upper level of our corporation. The CEO, COO, Chief of Staff and other senior leaders have all embraced the Incident Command System, and this sends a strong signal to all managers in our organization that these skills must be learned, practiced and used.

The course reviews the Hospital Emergency Incident Command System (HEICS) and the types of emergencies that occur both internally and externally—natural, technological and human disasters or crises. The course also identifies the resources available to managers, who to notify, and how to lead staff during a crisis.

By teaching 70% solutions, the importance of media relations, incident action planning, activating the emergency operations plan, and the logistics and management of an emergency operations center, we have instilled in our managers the importance of “owning” the emergency so patient care standards and and business continuity can be maintained, and damages and loss can be minimized. From minor water leaks, utility and weather emergencies to terrorist events, fires, hostage situations and hurricanes, the corporate security and emergency management staff continue to provide the tools and training to prepare our managers for the challenges emergency managers face daily.

James A. Romagnoli is corporate director of security & emergency management for the North Shore-Long Island Jewish Health System. He can be reached at JRomagno@nshs.edu.

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