Barton sets emergency preparedness as top priority

On June 21, three days before the Angora fire erupted on the South Shore, Barton Memorial Hospital held an exercise for hospital management. The "table-top" exercise involved hospital personnel sitting down to discuss a possible incident and the hospital's response.

This exercise's scenario, coincidentally, revolved around a fire encroaching on the hospital. All hospital management attended one of the two full-day sessions to discuss logistics of the hospital's full-scale evacuation.

Hospitals must perform these types of exercises to maintain accreditation from JCAHO, the Joint Commission on Accreditation of Health Care Organizations.

JCAHO requires, among other things, that hospitals perform at least two functional or full-scale exercises per year.

Functional exercises are more comprehensive than table-tops. The hospital actually simulates the incident, setting up an incident command and places orders for resources.

Full-scale exercises get the boots on the ground. The hospital simulates an incident, but actually orders resources and uses mock victims.

Darcie Carpenter, emergency management coordinator for Barton, came to the hospital in December 2006. Upon arriving at Barton, Carpenter set her sights on emergency preparation and ensuring staff could effectively evacuate the hospital.

She planned to help meet her goals through functional and full-scale exercises in the fall and spring. Carpenter organized the recent table-top exercise.

"I'm either clairvoyant, and I knew (the Angora fire) was coming, or I'm a jinx, according to most of the staff," Carpenter said.

Carpenter came to Barton from the Nevada Public Health Department, where she worked in the Public Health Preparedness Program. Working in Nevada, Carpenter received FEMA and CDC training, and was eventually promoted to the state's tuberculosis manager. Eventually, she heard about the opening at Barton for an emergency management coordinator, applied, and got the job.

Although many hospitals have committees and personnel working part-time on emergency preparedness, Barton is one of the few hospitals of its size with a full-time position dedicated to preparing the hospital for potential disasters.

The table-top exercises were a big factor in allowing Barton to effectively respond to the Angora fire, Carpenter said.

"These (exercises) were instrumental; the timing was just outstanding," said Kathy Cocking, director of hospital operations. "We were trained all morning, and then we did a mock drill in the afternoon, and we were able to put that right to use."

The fire started about 2:30 p.m., June 24. By 3:45 p.m., Barton had set up its incident command.

Several department managers had seen the plume of smoke and came into the hospital. They listened to the scanner, and after realizing the size of the fire and that it was burning out of control, they declared a code triage external. This is the hospital's term for an incident outside the hospital that calls for establishing an incident command.

Hospitals use an incident management system called Hospital Incident Command System (HICS). The system, designed in the late 1980s, is meant to formalize a hospital's response to internal or external emergencies. The system's goal is to decrease confusion and communication breakdowns that can happen during an emergency.

The hospital's first priority was patient safety, making sure the emergency room was properly staffed for burn and smoke injuries. Next, personnel prepared for the hospital's possible evacuation.

"We had a truck ... ready to load supplies at a moment's notice," Carpenter said.

"We had wheelchairs in front of all the patient's rooms; we knew census; we knew who we could move by wheelchair and who had to be moved by ambulance " all those kinds of things."

The rest of the day on Sunday, personnel planned and prepared for potential emergencies. By 10 p.m., they were able to scale down incident command to an incident commander, with all other staff on call, according to Carpenter.

Beginning June 25, Carpenter began attending all briefings at the Emergency Operations Center at the Lake Tahoe Airport. Carpenter served as the liaison between the hospital and outside organizations. Once back from the EOC briefings, Carpenter briefed section chiefs, who passed on the information to others in the hospital.

On June 26, Barton scaled down its EOC at noon, resuming normal operations. The EOC was quickly scaled back up at 2 p.m., after the fire jumped Highway 89.

The hospital evacuated 39 skilled-nursing patients on June 27. For two days personnel had smelled smoke inside the hospital, Carpenter said. Due to the degrading air quality, Barton decided to move skilled-nursing patients out of the hospital " those who would be the most difficult to move if an evacuation became necessary.

The patients were moved to the Carson Valley Residential Care Center by BlueGo buses provided through a memorandum of understanding (MOU) with the City of South Lake Tahoe. The process took 51?2 hours; Barton staff accompanied the patients to provide care, according to Carpenter.

For the next couple of days hospital staff held their breath and waited, Carpenter said.

By June 29, the fire and been largely contained, and so the skilled nursing patients were returned to Barton, and the EOC was scaled down. Carpenter continued to serve as liaison between fire officials and the hospital.

During the Angora fire, Barton treated five people for burn and smoke injuries. Two were firefighters who had deployed their emergency shelters.

Emergency management is one of Barton's top priorities, Carpenter said.

"You look at the health care structure (in South Lake Tahoe) and 90 percent of it is Barton. Because of that, it's huge that we are as prepared as possible," Carpenter said.

In coming months the hospital is going to work on improving communications, and training additional staff to be able to assume leadership positions during emergencies, said Barton Chief Nursing Officer Mary Bitner. Purchasing new communications equipment, improving internal communication to staff via a Barton Web site or hotline and continuing to develop strong relationships with outside agencies are among Barton's emergency preparedness priorities, Carpenter said.