71 Had the Time Square Bomb Exploded: What Would Your Emergency Department Have Done?

Abstract

Study objectivesOn May 1, 2010, at 6 PM, there was an attempt to detonate a car bomb in Time Square, New York City (NYC). Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.The purpose of this paper is to raise awareness among emergency physicians to the possibility of a mass casualty event (MCE) requiring emergency department (ED) response to a large number of injured children in coordination with the pediatric critical care (PCC) units, offer a replicable model for disaster planning and drills, and provide insight from full scale exercises conducted at 7 hospitals in NYC. A MCE may result in an overwhelming number of critically injured children that exceeds available capacity of PCC units. The NYC Department of Health and Mental Hygiene (DOHMH) created a Pediatric Disaster Coalition (PDC), comprised of experts in emergency preparedness, emergency medicine, PCC, surgery, and city agencies. Currently, 21 NYC hospitals participate in the coalition. A survey conducted by NYC PDC in 2011 determined that on average, only 22% of PCC beds in NYC are available at any given time. EDs act as a gateway to the hospital and are charged with triage, stabilization and disposition. A disaster involving a large number of children may require activation of PCC surge plans to allow for disposition from the ED to the PCC unit. During a pediatric MCE emergency physicians may need to provide care for acute patients unrelated to event, triage and stabilize a large number of acutely injured children from the MCE pending disposition to surgery and PCC unit.MethodsSeven hospitals completed PCC surge plans and tested them via a full scale exercise (FSE). A PDC representative participated in meetings at each hospital. Some of the hospitals used the Time Square event as the drill model. All hospitals used actors to simulate the victims. Three of the hospitals enlisted children from nearby schools as actors. They were given a card describing their injuries, moulaged, and briefed on how they should present at triage. The exercises included ED triage, patient evaluation, radiology, consultations and eventual admission to surgery, hospital wards and PCC unit.ResultsAfter-action conferences were completed at each site to determine lessons learned. The outcomes of the exercises were utilized to revise and operationalize the PCC surge plans. The process of planning for pediatric-specific disasters and conducting FSE helped participating hospitals identify their needs and improve in the areas such as ED activation and notification, local incident command, patient tracking, identification of additional ED surge capacity space, clearing ED upon notification, staffing and staffing notification, supervised overflow areas from ED for non-admitted children, family mental health center, one-way patient flow, ED incident command, supplies, pharmacy, employee needs and one-page protocols for unusual events.ConclusionsHospital plans for MCE should address unique pediatric needs. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans. It is important for emergency physicians to recognize their role in responding for MCE involving children in conjunction with PCC unit and other hospital areas. ED involvement in the creation of pediatric specific surge plans, and testing plans together with the PCC unit via FSE, may help improve hospital disaster plans. Study objectivesOn May 1, 2010, at 6 PM, there was an attempt to detonate a car bomb in Time Square, New York City (NYC). Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.The purpose of this paper is to raise awareness among emergency physicians to the possibility of a mass casualty event (MCE) requiring emergency department (ED) response to a large number of injured children in coordination with the pediatric critical care (PCC) units, offer a replicable model for disaster planning and drills, and provide insight from full scale exercises conducted at 7 hospitals in NYC. A MCE may result in an overwhelming number of critically injured children that exceeds available capacity of PCC units. The NYC Department of Health and Mental Hygiene (DOHMH) created a Pediatric Disaster Coalition (PDC), comprised of experts in emergency preparedness, emergency medicine, PCC, surgery, and city agencies. Currently, 21 NYC hospitals participate in the coalition. A survey conducted by NYC PDC in 2011 determined that on average, only 22% of PCC beds in NYC are available at any given time. EDs act as a gateway to the hospital and are charged with triage, stabilization and disposition. A disaster involving a large number of children may require activation of PCC surge plans to allow for disposition from the ED to the PCC unit. During a pediatric MCE emergency physicians may need to provide care for acute patients unrelated to event, triage and stabilize a large number of acutely injured children from the MCE pending disposition to surgery and PCC unit. On May 1, 2010, at 6 PM, there was an attempt to detonate a car bomb in Time Square, New York City (NYC). Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.The purpose of this paper is to raise awareness among emergency physicians to the possibility of a mass casualty event (MCE) requiring emergency department (ED) response to a large number of injured children in coordination with the pediatric critical care (PCC) units, offer a replicable model for disaster planning and drills, and provide insight from full scale exercises conducted at 7 hospitals in NYC. A MCE may result in an overwhelming number of critically injured children that exceeds available capacity of PCC units. The NYC Department of Health and Mental Hygiene (DOHMH) created a Pediatric Disaster Coalition (PDC), comprised of experts in emergency preparedness, emergency medicine, PCC, surgery, and city agencies. Currently, 21 NYC hospitals participate in the coalition. A survey conducted by NYC PDC in 2011 determined that on average, only 22% of PCC beds in NYC are available at any given time. EDs act as a gateway to the hospital and are charged with triage, stabilization and disposition. A disaster involving a large number of children may require activation of PCC surge plans to allow for disposition from the ED to the PCC unit. During a pediatric MCE emergency physicians may need to provide care for acute patients unrelated to event, triage and stabilize a large number of acutely injured children from the MCE pending disposition to surgery and PCC unit. MethodsSeven hospitals completed PCC surge plans and tested them via a full scale exercise (FSE). A PDC representative participated in meetings at each hospital. Some of the hospitals used the Time Square event as the drill model. All hospitals used actors to simulate the victims. Three of the hospitals enlisted children from nearby schools as actors. They were given a card describing their injuries, moulaged, and briefed on how they should present at triage. The exercises included ED triage, patient evaluation, radiology, consultations and eventual admission to surgery, hospital wards and PCC unit. Seven hospitals completed PCC surge plans and tested them via a full scale exercise (FSE). A PDC representative participated in meetings at each hospital. Some of the hospitals used the Time Square event as the drill model. All hospitals used actors to simulate the victims. Three of the hospitals enlisted children from nearby schools as actors. They were given a card describing their injuries, moulaged, and briefed on how they should present at triage. The exercises included ED triage, patient evaluation, radiology, consultations and eventual admission to surgery, hospital wards and PCC unit. ResultsAfter-action conferences were completed at each site to determine lessons learned. The outcomes of the exercises were utilized to revise and operationalize the PCC surge plans. The process of planning for pediatric-specific disasters and conducting FSE helped participating hospitals identify their needs and improve in the areas such as ED activation and notification, local incident command, patient tracking, identification of additional ED surge capacity space, clearing ED upon notification, staffing and staffing notification, supervised overflow areas from ED for non-admitted children, family mental health center, one-way patient flow, ED incident command, supplies, pharmacy, employee needs and one-page protocols for unusual events. After-action conferences were completed at each site to determine lessons learned. The outcomes of the exercises were utilized to revise and operationalize the PCC surge plans. The process of planning for pediatric-specific disasters and conducting FSE helped participating hospitals identify their needs and improve in the areas such as ED activation and notification, local incident command, patient tracking, identification of additional ED surge capacity space, clearing ED upon notification, staffing and staffing notification, supervised overflow areas from ED for non-admitted children, family mental health center, one-way patient flow, ED incident command, supplies, pharmacy, employee needs and one-page protocols for unusual events. ConclusionsHospital plans for MCE should address unique pediatric needs. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans. It is important for emergency physicians to recognize their role in responding for MCE involving children in conjunction with PCC unit and other hospital areas. ED involvement in the creation of pediatric specific surge plans, and testing plans together with the PCC unit via FSE, may help improve hospital disaster plans. Hospital plans for MCE should address unique pediatric needs. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans. It is important for emergency physicians to recognize their role in responding for MCE involving children in conjunction with PCC unit and other hospital areas. ED involvement in the creation of pediatric specific surge plans, and testing plans together with the PCC unit via FSE, may help improve hospital disaster plans.