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Training prepares Blue Mountain Hospital providers, staff for real disaster...Medically Speaking-Volume One, Number Six 12/12/13

Training prepares Blue Mountain Hospital providers, staff for real disaster

It’s been said, ‘if ye are prepared, ye shall not fear’ but it can also be said, ‘those who practice shall be prepared’ and that is vital during a medical emergency.

For providers and staff at Blue Mountain Hospital, some timely preparation last month made a huge difference in their ability to handle a major medical incident the following week. When students, teachers and staff at Montezuma Creek Elementary School became victims of carbon monoxide poisoning on November 18, more than thirty patients were transported by ambulance to Blue Mountain Hospital for treatment. By the end of the day, 28 patients were treated in the emergency room, another 12 were evaluated in the ER’s waiting room and sent home, and four more were diverted to San Juan Hospital in Monticello.

BMH’s Emergency Manager, Cari Spillman, was also the Operations Manager for this incident. She said the staff began hearing radio traffic from Montezuma Creek early that Monday morning and began discussing what they would do if they got patients. They had just finished debriefing from a major disaster training held the previous Friday. During that training, eight patients were treated in the ER, after being exposed to a mock sulfuric acid leak, resulting from a collision between a truck and an SUV. Spillman said providers and staff evaluated the training, took those things that could be improved upon and tweaked them to make them work more efficiently. She said that experience played a huge role in helping prepare for the real CO emergency on Monday.

“More and more people came in and talked about the incident in Montezuma Creek. We had no idea how big this thing might be, so we started making plans,” Spillman said. “We went ahead and pulled the command cart out and we were getting ready for 15 patients. To me that was a high guess. I thought no more than six or seven because this doesn’t happen here, and the most we’ve seen from car accidents was eight. So I thought 15 was a pretty high estimate.”

Spillman said the Operating Room crew asked what they could do. She told them they would need oxygen because it was apparent the incident involved some kind of gas.

“The OR crew was absolutely fantastic. They didn’t have to have any guidance. They just went to work and set up every bed with IV stuff and every bed with oxygen. And we were ready for 15 patients with oxygen and beds, before we ever received notification we were getting patients,” she said.

“The preparedness was ncredible. Once we started getting real reports of what was going on, and we realized we were getting quite a few patients; we activated the Emergency Operations Plan. This is basically to as sign an incident commander, start making phone calls, and get some more people in here. Before we had patients we had probably 18-20 nurses standing by waiting,” Spillman added. “We had a charge nurse and she had her assignments, and she was making assignments. Incident command was set up and we all had radios and we were ready to go. That part of it was just phenomenal. I think a large part of it was that we had just practiced it on Friday. It went really well.”

The first two patients from Montezuma Creek Elementary, one adult and one child, came into the BMH emergency room at around 10:30 a.m. After the first two were treated, Spillman said the process began going very smoothly. Every patient who came through the ER doors got a number, a clipboard and a nurse, meaning each patient received one-on-one nursing care up through the entire incident. Patient tracking was very efficient and when parents came to the hospital, wanting to see their children, their children were easily located.

“We had lot of worried parents. But we had that list of patients made when they were coming in, and where they were, so when parents got here we were very quickly able to take them to their kids and try to give updates. I think, for this being the hospital’s first disaster, we did a really good job,” Spillman said.

Of the 28 patients seen in the ER that day, 27 were children and one was an adult. All were very, very sick, after being exposed to CO levels of 312 ppm in the school, according to Spillman. She said normal amounts of CO in a typical home are around 9 to 15 ppm. A level of 35 ppm is dangerous to an adult. So, even after being in the fresh air outside the school, having oxygen at the scene, and in the ambulance, or driving in a car with the windows down, during the 45 minute ride to Blue Mountain Hospital, all the patients were still very ill when they got to the hospital.

“We saw nearly 40 patients in all that day, including those we evaluated in the waiting room,” Spillman said. “Any time we run emergency drills we’ve tested for 20 patients, thinking we’ll never see that many. So when we actually saw 28 in the emergency room, we were successful at it. Now we’ve got the confidence to handle a lot more than we thought we could and we actually did it quite well.

“If we had 30 trauma patients, that had to have procedures done and things like that, that would be a totally different game. But where these people just needed 90 minutes of oxygen we can do that. ”

Spillman added. Spillman had a lot of good things to say about the nurses, providers and staff who helped that day. She said the MVP of the operation had to be RN Jodene Fisher, who was the Charge Nurse.

“Everyone pitched in and did an excellent job,” she said, “but you would have thought Jodene had been through eight or ten of these disasters, the way she took charge and made assignments. She was just calm and collected and did a fantastic job. I was very impressed,” Spillman said.

Spillman also praised the efforts of the OR crew, calling them one of the best, well-oiled teams in the hospital, even on a day-to-day basis. “All the providers were just fantastic,” Spillman continued. “They just stepped in and made some tough decisions about whether to divert or to keep people here. Dr. Josh Nielson talked to the media when no one else really wanted to. They all just stepped it up.”

Spillman spoke highly of Incident Commander Jeremy Lyman, whose calm demeanor helped him make decisions ‘on the fly’. Burdette Shumway and Kasidy Lyman were Safety & Security Managers, Deanna Stevens was the clerk, handling registration and billing. BMH Director of Clinical Services, Kent Turek helped coordinate nursing operations during the incident. Spillman said all did an excellent job, as did everyone involved in helping with the incident.

Spillman wanted to thank San Juan Hospital, in Monticello for responding to a request for additional oxygen regulators, during the incident. San Juan Hospital sent five regulators, which were not actually used. That was greatly appreciated. Late in the day, four patients were diverted to San Juan Hospital. As Spillman explains, “Truth of the matter is we were full. We were beyond full, and yes we could handle them, but are they going to get the best care? The decision was made to divert three children and an EMT that had a broken leg to San Juan Hospital because there’s an orthopedist in Monticello and we would have had to transfer him anyway. They’re already in \an ambulance so we said, let’s just send them up there. So we diverted those four patients.”

In evaluating the way this incident was handled, Spillman said the one thing she’d like to improve, in the future, is the communication between those at the scene and Blue Mountain Hospital. A full hour-and-a-half passed, before hospital staff knew whether last month’s incident involved carbon monoxide or not. They kept hearing rumors but they didn’t know for sure.

But, from an emergency management standpoint, and for Blue Mountain Hospital’s first disaster, it was just fantastic, Spillman said. She said she couldn’t have asked for it to go any better, honestly.

“The patients got great care, everybody was calm, and it was ordered chaos. It went exactly how it should have gone. I was absolutely thrilled with the response we got from calling people in, to the providers, to EMS working with us, you just couldn’t ask for things to go any better. There were no fatalities. We really couldn’t ask for a better situation,” she said.

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