Integrating Physician Response Into an Academic Medical Center Emergency Operations Response Plan

Abstract

Acoordinated physician response during a disaster is challenging in an academic medical center environment because of the size of the institution and variety of specialty services provided. As a result of internal and external drill debriefings, it became evident that there was an acute need to better organize physician response efforts at our institution. Previously, physicians were directed to respond to one physician coordination center located in the adult emergency department. This strategy led to chaos in an already congested area. We found that having the medical services coordinator role initially reporting to the operations officer led to minimizing the medical faculty’s roles and responsibilities in the event of emergency operations plan activation. In addition, our pediatric capabilities expanded to include a new freestanding children’s hospital, which, although it is in close proximity to the adult hospital, separated the adult and pediatric services. This physical separation of the facilities added new complexities to the overall emergency operations plan. As a result, Vanderbilt Medical Center (VMC) embarked on a project to develop a physician response sub-plan that coordinated the response of more than 1100 faculty members in the event of a health emergency. The goal in formulating the sub-plan was to outline responsibilities of medical faculty, house staff, and fellows in response to a health emergency. For the purpose of plan development, a mass casualty incident was defined to include health emergencies such as widespread influenza, severe weather, National Disaster Medical System activations, acts of terrorism, fires, hazardous material incidents, nuclear accidents, aircraft accidents, and earthquakes. Realizing that a coordinated approach to incident management is of utmost importance to ensure a safe and orderly response during an emergency incident, VMC adopted the Incident Command System (ICS) model for handling emergencies. The ICS system originated in Southern California in 1972 and is organized under the acronym, “FIrefighting REsources of Southern California Organized for Potential Emergencies (FIRESCOPE).” By legislative action, the FIRESCOPE Board of Directors and the Office of Emergency Services Fire and Rescue Service Advisory Committee were consolidated into a working partnership on September 10, 1986. The FIRESCOPE model was one of the first of its kind calling for the use of an established chain of command led by an incident commander. The FIRESCOPE Incident Management System was adapted and tested for hospital use in California in 1992. The hospital-adapted version of this system is called the Hospital Incident Command System (HICS). HICS is an incident management system based on the ICS that assists hospitals in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. Figure 1 shows the basic structure of the model, which is consistent with ICS and the National Incident Management System (NIMS) principles. Use of HICS strengthens hospital disaster preparedness activities in conjunction with community response agencies and allows hospitals to understand and assist in implementing the 17 elements of the hospital-based NIMS guidelines. This management structure has been used in managing a variety of incidents ranging from 9/11 to large crowd gatherings such as football games and concerts. The beauty of the system is that it allows for an appropriate Pam Hoffner is Emergency Preparedness Coordinator/Adjunct Faculty, Vanderbilt University Medical Center and Vanderbilt School of Nursing, Nashville, TN.