Hospital Disaster
Response in a Rural
Setting
Presented by Barbara Ringhouse, RN MSN
Assistant Administrator at Island Hospital
In Anacortes, Washington
Anacortes, Washington
 Far west end of Skagit
County
 Population - 16,000+
 Located on Fidalgo
Island - connected to
mainland and to
Whidbey Island by
bridges
Medical Response Capabilities in
Anacortes
 Three city-operated Fire
Stations staffed with
paramedic/firefighters
or EMT/firefighters.
 Three volunteer fire
districts with 5 volunteer
fire stations.
 Hospital-owned
ambulance used for
non-stat transfers.
Medical Facility in Anacortes
Island Hospital
 43 bed acute care hospital
 10 bed Emergency
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Department
Level III Trauma Center
Board Certified ED
physicians
TNCC/ENPC trained
Emergency Nurses
Trauma Surgeons on staff
4 Surgical Suites
Fully staffed ICU
Hospitalists on staff
Patient base - approx.40,000
Average daily census – 28
Annual ED visits – 14,000
Disaster Response Capability of
Island Hospital
 ICS trained Incident
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Command Staff
ICS/Disaster Trained
Emergency Department Staff
16 person Team Delta
Dedicated Hospital
Decontamination Team
Onsite Hospital Helicopter
pad with additional off-site
landing zones
Bi-annual disaster exercises
with community and regional
partners
Risks/Vulnerabilities for Anacortes
 Earthquakes
 Tsunami
 Winter storms
 Wind Storms
 Mass Casualty Incidents
Potential sites for Mass Casualty
Incidents
Anacortes, Washington…A quiet,
pleasant USA small town
Until………….
 April 2, 2010 at approximately 12:30 am an explosion awakened
the sleepy Anacortes community.
 The explosion happened at one of the local refineries just across
the bay from Anacortes in one of the naphtha production units.
 Many minutes passed before the sirens started blowing.
 The only person able to sound that alarm was one of the victims!
Normal Staffing for night shift at
Island Hospital
 Board Certified ED physician
 ON CALL:
 Two ED Registered nurses
 Trauma Surgeon,
 One Admissions clerk
 Night shift coordinator
 3-4 Acute Care Registered
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nurses
2 Acute Care CAN
2-3 ICU Registered nurses
1 security guard
Assorted housekeepers
1 radiology tech
 Anesthesiologist,
 CT tech,
 OR nursing staff,
 On-call Admin. person
Hospital Response to this event….
What worked well.
 Code External Triage
 Communications with
called overhead
 Incident Command
opened by Night
Nursing Coordinator
 ED prepared for burn
patients immediately
 Hospital Emergency
Preparedness
Coordinator called in
Field EMS triage officer
consistent.
 Early notification of the
severity of injuries.
 Airlift notified early so
arrived almost
simultaneously with first
patient.
 Burn Center notified
early in the event.
Timing couldn’t have been better
 Called in more ED nurses
 Medics completed work at
prior to patients arrival.
 ICU and Acute Care nurses
able to come to ED to help
 Only one previous patient in
the ED, awaiting a ride
home.
 No other patients arrived in
the ED that night except
patients from explosion
the scene and came to help.
 Received calls from Skagit
Hospital and Providence
Medical Center – Everett to
offer help in caring for
patients
 Diverted two patients from
the scene to Skagit Valley
Hospital
 Airlift able to divert
helicopters enroute.
Patient Conditions
 Patient #1 - Arrived at 0130
 Patient #2 – Arrived at 0205
 Full thickness burns to 80
 Full thickness burns to 95
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percent of BSA
No history available
No airway on arrival
Surgical airway performed in
ED
Central line, Foley, and burn
dressings applied
Door to Departure time: 50
minutes
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percent of BSA
No history available
No airway and no IV line on
arrival only I/O access (not
working)
Surgical Airway performed in
ED ( Very difficult to obtain)
Central line, Foley, burn
dressings.
Door to Departure time: 70
minutes
The difficult part of response…
 Severe burns not common to our staff.
 Patients had full thickness burns to 80-95
percent of their bodies.
 Patients arrived awake and still talking to
medics and staff.
 It was discovered on arrival of second patient
that the patient was a relative of one of our
house supervisors.
Total response
 22 members of Island Hospital staff took care of two
severely burned patients: Trauma Surgeon,
Anesthesiologist, ED physician, 5 ED nurses, Nursing
Coordinator, Respiratory Therapist, ICU nurse, Acute
care nurse, CNA, unit clerk, admissions clerk,
radiology tech, security guard, and housekeeping
staff (runners)
 Had two Airlift helicopters on site – one in a nearby
landing zone set up by police department.
 Two full Airlift crews worked along side the ED staff.
 One of the medic units stayed and helped in the
hospital.
Is this how we would always
respond?
 Our response would be the
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same regardless of size of
the incident.
We keep our staff trained.
We exercise our plans.
We review every exercise
and every real event for the
lessons learned.
We work with 10 other
regional facilities on a
monthly basis.
Consistency in the way any
hospital prepares and
responds to disaster is key.
Code External Triage
 Our response would be the same regardless
of size of the incident.
 Consistency in the way a hospital responds to
disaster is key.
 Code External Triage paged overhead
 Incident Command opened – usually starts in
the ED with Nursing Coordinator then moves
to first arriving administrator and into our
secure Incident Command Center.
Incident Command decision
 Level of response needed is
determined with input from
ED physician and staff.
 Calls go out through either
call trees or the hospital’s
Everbridge Alert Network.
 Triage area is set up and
assignments made.
 Communication is
established with the EMS
triage officer at the scene
and maintained until incident
is over.
Island Hospital Level of Response
 Level 1 – Usually affects on the ED and the ED staff
will determine how many personnel are needed from
those already here at work and then notify Incident
Command Center.
 Level 2 – A partial hospital call back system
activation will occur after Incident Command Center
has received reports from each department as to
what the personnel needs are for the individual
departments and orders that activation.
 Level 3 – An entire hospital call back system
activation will occur after the Incident Command
Center determines the disaster is large enough to
warrant all hospital employees to respond. A level 3
activation requires the establishment of a labor pool.
Level 3 response required
 Hospital lockdown initiated if deemed necessary by
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Incident Commander and staff are assigned to attend
all doors.
Incident Command opens labor pool and all staff not
doing direct patient care report to labor pool.
All elective procedures are cancelled.
All inpatients are assessed for possible early
discharge and Hospitalist is notified.
Hospital PIO assignment area and location of press
area is designated.
But what if………………..?
 The actual number of victims from this incident were small but
what if it had been a large number of victims. 50…75..100.
 We have several large community events annually, Tulip
Festival, Art Festival, Jazz Festival, and Oyster Run
 50 to 100 patients would quickly drain any facilities resources.
 This is the time that regional planning pays off.
Region 1 Hospital Bed Control
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Region 1 Bed Control would
be contacted by the Incident
Command and Island
Hospital response would be
expanded to reach out to all
other Region 1 facilities.
 Further information
regarding Island Hospital
Disaster Response is
available through:
 Linda Seger, RN CEN
Island Hospital Emergency
Preparedness Coordinator
360-299-4226 or
lseger@islandhospital.org