Since the fall of the Twin Towers in 2001, the federal government has pursued a goal of readiness for the U.S. populace and healthcare partners during emergency. This preparedness goal, emphasized when Hurricane Katrina struck leaving hospitals and nursing homes stranded, led to increasing requirements for Healthcare Partners from the Center for Medicare and Medicaid Services (CMS). Following mandates to improve Emergency Operations Plans and then trial plans, on Oct. 18, Pondera Medical Center (PMC) took a step to not only test the surge capacity of the hospital, but to meet the CMS requirements which included participation with community partners in a full scale exercise.
The scenario agreed upon by the Exercise Planning Committee included numerous children who were accidentally contaminated by the pesticide Paraquat. The child actors included Kindel and Jason DeVries; Addy, Carsen and Corben Sullivan; Breauna Erickson; Scott Coffelt; and Kolton Long. In this larger than life event, the children accidentally turn on a sprayer that has been left unattended by a commercial chemical applicator, Joel Farkell. They become soaked in the blue, foul-smelling liquid. With the onset of eye irritation and coughing, Kindel, who is babysitting, alerts the 911 system and activates the exercise.
Having received the emergency call, dispatcher Jamie Young from the Pondera County Sheriff’s Office notified the City Police, the Ambulance and also the Fire Department. Alerted to the possibility of multiple child victims who may need decontamination, PMC activated their Emergency Operations Plan including Incident Command and Decontamination functionalities. Some children were decontaminated at the site, while others required “decon” at PMC. Because the hospital often faces multiple and varied situations in their Emergency Room, the scenario also included the presentation of a patient with severe chest pain (Darrell Stafford), a Long Term Care Resident who needed immediate attention (Betty O’Tremba and “nurse” JoAnne Cobb) community members requesting information (Wayne and Laurie Anderson, and Matt, Kristin and Harmony Schlottmann) and an ATV rollover with one victim and attendant (played by members of the Army Civil Support Team). Additionally, Barb Endler presented to take pictures for the paper and a television crew (played by actors from the Civil Support Team) pressured Incident Commander Laura Erickson for answers and was finally dealt with by CEO Bill O’Leary. As patients and visitors alike attempted to enter the hospital, they were met with security, lockdowns and decontamination procedures designed to mimic a real life emergency. Director of Emergency Preparedness, Cynthia Grubb, who helped with incident design stated, “I know it sounds over the top, but we needed to stress our system and understand what procedures would be needed to care for a sudden surge of patients. A full-scale exercise gives us data we could not obtain any other way. From this, we know what our staff would do and what our training focus should be moving forward.”
Also a key component in the event was Disaster and Emergency Services (DES). Exercise requirements for both agencies were met with this scenario. LeAnn Hermance, DES Director who also fills the role of Pondera County’s 911 coordinator stated, “We replayed the 911 audios and felt like the communications piece went well, but there is always room for improvement.” One of those improvement pieces is which channel emergency responders communicate on. When multiple agencies are involved, the traffic on the system can be significant making it hard to understand and potentially troubling for real time emergencies.
Following the exercise, the group met for a debriefing or as referred to in Emergency Preparedness lingo, a hot wash. Utilizing video footage from an aerial drone, courtesy of Joel Farkell, observers and participants were able to share their experiences and hear what other players were experiencing during the event. From this discussion and compilation of data, an After Action Report and Improvement Plan are developed. Objectives from the improvement plan are then pursued via the Local Emergency Planning Committee at the County and the Emergency Planning Committee at the hospital. These findings will be reflected in training and policy development and then included in the next exercise event to gauge improvement.
Multiple agencies including City Police, Pondera County Sheriff’s Department, Fire, and Ambulance participated and as a result can better understand concepts of interagency communication, incident command and surge capacity. Additionally, Toole, Glacier and Teton Counties as well as Marias Medical Center participated by serving as evaluators for the incident. Helpful to the success of the day was the presence of Montana’s Civil Support Team and Major Pat Alduenda. Alduenda, who serves as the facility’s EMS Medical Director came to Conrad with his team the day before the exercise where they completed their own operational testing, an intentional hazmat release in the Prairie View School. If readers noticed the multiple trucks parked at Conrad Baptist Church on Oct. 17, the explanation is the presence of the 83rd Army Civil Support Team based at Fort Harrison in Helena. “We are a state resource who focuses on incident support, including identification and containment of hazardous materials. We are available for deployment if needed across the state and in certain cases out of state within US borders. We do exercise training monthly and were not only able to complete our monthly requirement, but also able to assist Pondera Medical Center and Pondera County with their exercise.”
Grubb stated, “This was a broad effort which required extensive team play by our capable providers and staff, but also one the entire community will benefit from as all the partners are better prepared. We would like to extend appreciation to DES for their amazing support, the Conrad School District for the use of their building as well as all the participants and look forward to working together again. While we hope to never experience a disaster, we also know many things are possible and there is some assurance in that we live within a community that works together to improve and to plan.”