Educate physicians, nurses, and administrative staff about their roles and responsibilities in potential disaster events. Work with state and local partners to improve our collective policies and plans for emergency response to health threats.
Paul Biddinger shares insight lessons from Emergency Preparedness as part of a collection of videos used by managers around the world in the broader business community to improve their leadership skills.
CDM and hospital emergency management program members meet regularly with the leadership of many hospital departments and divisions including trauma surgery, nursing, the hospital safety office, and others. Fellows are based at one institution, but receive training experiences and education at all of the participating institutions. In addition, residents are encouraged to complete an eight-hour Occupational Safety and Health Administration (OSHA) Operations-level Hazardous Materials training developed and sponsored by the CDM to allow them to safely wear appropriate Personal Protective Equipment (PPE) in a hazardous materials event.
Medical students from Harvard Medical School, and also those visiting from other medical schools, are included in the HAEMR disaster curriculum lectures. Members of the Center for Disaster Medicine have been invited to speak at local, national, and international events on topics of emergency preparedness and response.
The MGH Hazmat Team has won a special citation from the Mayor’s Office of the City of Boston, and is one of the most active hospital-based programs in the state. Ita€™s something we all hope never to have to deal with, but being prepared for emergency situations is vital.
A crate or carrier for each of your pets, that is large enough to hold their food and water dishes, with enough room for them to still stand, turn around and lie down in.A  It can be a good idea to label the crate with your contact information, your peta€™s information, and your veta€™s contact information. Plastic bags for waste disposal, along with newspapers, paper towels, and bleach for cleanup and sanitizing.
Copies of all your peta€™s veterinarian documents, including proof of ownership and microchip numbers, pictures of yourself with your pets, vaccination and medical records, and contact information for your vet. An instructions page outlining feeding routines, administering any medications, medical issues, behavioural issues, and any other information specific to your pets.
Make sure all your pets are wearing identification tags that are up to date, and consider having them microchipped and registered, to give you the best chance of being reunited with your pets, should you be separated during an emergency.
Consider developing an emergency contact list- in the event that you are away from home when an emergency occurs, a trusted neighbor, nearby family member or friend should have a key to your home, know your pets well, and know where to find their emergency kit. You know best the types of extreme weather and emergency situations you are likely to experience in your area, and the best ways to prepare.
Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP-SCPA) to increase regional surge capacity and emergency preparedness for healthcare facilities.
In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies. The purpose of this article is to describe an approach to improve surge capacity, in this case for hospital and ED treatment areas. Figure 1The South Central region of Pennsylvania consists of 8 counties (Adams, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Perry, and York), 17 acute care hospitals, emergency medical services (EMS), and county-based emergency management. The Partnership leveraged the structure of the South Central Pennsylvania Regional Counter-Terrorism Task Force (SCTF), EMAs, and the Emergency Health System Federation (EHSF, regional EMS agency) as important and established entities with an identical geography to that of the HCFP-SCPA with which to formulate planning efforts.
Also in place before the development of the Partnership was the federal Emergency System for Advance Registration of Volunteer Health Professionals Program (ESAR-VHP). After the grant was awarded, personnel from the SCTF, the largest 7 EMS companies, and 11 hospitals within the region were provided the opportunity to participate in specific roles including planning, collaboration, development, and training activities. Four primary teams were formed within the Partnership to establish modes, mechanisms, procedures, and evaluation techniques to fulfill the goals created for the grant. Through early Partnership discussions, a consensus was reached that surge capacity would be defined as “the number of adequately staffed beds that can be provided in addition to the normal demand within 2 hours of an incident,” which includes accounting for both inpatient and ED treatment beds. Specific, measurable, achievable, realistic, and time-framed (SMART) objectives were created from the 6 grant objectives. Inclusive and frequent communication was evaluated as essential for the Partnership to act as 1 cohesive unit. The Partnership conducted regularly scheduled discussions between regional healthcare facilities on shared needs to enhance surge capacity. These alerts were tested, improved, and practiced by using the Comprehensive Hazard and Vulnerability Analysis (HVA), the HSEEP, the pandemic influenza exercise (PanSurge07) assessment, and the PanFlu assessment. To gather effectiveness and outcomes data, brief Web-based surveys and polls, as well as larger hospital and regional exercises, were performed to quantify various outcomes and clarify roles and responsibilities. A SERV-PA administrator at each of the HCFP-SCPA hospital facilities was designated and trained. The NIMS training requirements were simplified to become more appropriate for the hospital-based participants, and training was made more accessible to all Partnership hospitals, with an online certification process. After several months of information gathering and discussion, the Partnership evaluation and integration team identified 6 gaps in the overall progress and focused on remediating these specific gaps.
Outcomes of the Partnership were targeted to be realistic, measurable, time-conscientious, and repeatable so as to be available for implementation by other hospital expanses looking to develop partnerships. Training, policies, and procedures for working with volunteers during a surge were developed or adopted.
During the initial HAN alert system exercise, 76% of the hospitals confirmed receipt of HAN alerts and 45% of the personnel within the hospital received the alert. At baseline, an average of 38% of healthcare facilities responded to scheduled weekly alerts on the FRED and 800-MHz systems.
Surge capacity was analyzed by a contemporaneous phone survey of cooperating hospitals of the region.
During initial review, it was clear that many improvements to the emergency response system were needed in the region. During the granting period, we observed and demonstrated the importance of testing emergency response, not only as a single healthcare entity but also as a regional healthcare system. The members of the partnership were asked to disclose information to the HCFP-SCPA, and much of the data were reliant on this self-reporting. The Partnership successfully increased preparedness and surge capacity through a coalition of regional healthcare facilities and emergency response agencies. We would like to thank the members of the Healthcare Facilities Partnership of South Central Pennsylvania and their representatives: Hanover Hospital (Joshua Hale), Gettysburg Hospital (Ron Sterchak), Chambersburg Hospital (Vickie Negley), Waynesboro Hospital (Dan Farner), The New Carlisle Regional Medical Center (Georgeann Laughman), Holy Spirit Hospital (Jason Brown), Pinnacle Health (Christie Muza), Penn State Milton S.
9. US Department of Health and Human Services Assistant Secretary for Preparedness and Response.
Paul Biddinger, the CDM is closely integrated with the hospital emergency preparedness program and is supported by participation from clinicians on the MGH Department of Emergency Medicine faculty as well as MGH ED nursing and MGH ED administration. CDP designs and conducts regular training events and exercises within MGH to develop, disseminate and test emergency plans. Gregory Ciottone of the Beth Israel Deaconess Medical Center, participating in the structure and design decisions of the overall program and opportunities for fellows. The two year program includes didactic lectures, seminars, readings, goal-related research in a specific area of DM and EM, and fieldwork resulting in a thesis.
Residents are also given multiple opportunities each year to participate in exercises to further advance their training in disaster response.
In addition, medical students at MGH are invited to participate in the MGH disaster exercise program.
To date, CDM members have led more than 50 local and regional training events and have been invited to speak more than 70 times on emergency preparedness and response.
Biddinger has completed work on various CDC-funded projects to conduct both research and trainings on topics of emergency preparedness. Biddinger has served as an advisor on planning for standards of care in disaster situations, and currently serves as a consultant on health emergency preparedness.

Depending on the area you live in, and the types of severe weather and disaster situations that may arise, most people are prepared for the emergency situations they might face. Wet, canned food is also good to have, as wet food helps to provide some moisture for your pet, and will make them less thirsty. A large dog needs about a gallon of water a day, smaller animals less so, but make sure to have a generous supply for everyone. Speak with your vet about further emergency preparation resources specific to your location. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. The coalition focused on 6 objectives: (1) increase awareness of capabilities and assets, (2) develop and pilot test advanced planning and exercising of plans in the region, (3) augment written medical mutual aid agreements, (4) develop and strengthen partnership relationships, (5) ensure National Incident Management System compliance, and (6) develop and test a plan for effective utilization of volunteer healthcare professionals. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents. Furthermore, national-level exercises such as “Dark Winter” and the Homeland Security Exercise and Evaluation Program (HSEEP) have repeatedly exposed areas where the need for improvement in response is clear.3–7 For political leaders, health officials, hospital leaders, and emergency management officials, upholding public confidence in their respective institutions before, during, and after a catastrophic event is crucial. The timely availability of these treatment areas is crucial for all seriously ill and injured patients, and for the public’s health, when a mass casualty incident (MCI) occurs. The region is composed of both rural and micro and metro urban areas, and has a hospital capacity and capability that ordinarily serves the needs of these communities (Figure 1). The SCTF’s mission is to deliver a comprehensive and sustainable regional “all-hazards” emergency preparedness program that addresses planning, prevention, response, and recovery for events in South Central Pennsylvania that exceed local capabilities. It consists of more than 200 quick response services, basic life support services, and advanced life support services. The ESAR-VHP (a product of HHS in response to volunteer-related complications on September 11, 2001) is a registration program of healthcare professionals who will potentially volunteer their efforts in the event of a mass casualty event. The project contracted with additional key partners to provide both technical assistance and outcomes measurements. These teams were (1) education and development, (2) technology and simulation, (3) evaluation and integration, and (4) surge enhancement. The Healthcare Facilities Partnership of South Central Pennsylvania is composed of personnel from 17 hospitals, emergency medical service (EMS), and emergency management agencies (EMA) in the region.
Two specific tools were implemented to enhance contact during meetings and to immediately collaborate on data and information: a desktop-sharing tool and a toll-free number. Emphasis was based on frequent development, reduced dependency on face-to-face meetings, and growth of mutual understanding of hospital-based procedures. These systems were the Facility Resource Emergency Database (FRED) system, an 800-MHz radio system, and the Health Alert Network (HAN) system.
The Partnership also established triggers for activating those systems and created an “ideal communication” flow chart for the South Central Pennsylvania region. On the secured access portion of the portal, members of the Partnership are able to share information about the surge capability of their particular hospital. To develop a library of low-cost repeatable training exercises, 3 computer simulations were created: a pandemic influenza outbreak (gradual and persistent surge simulation), mass casualty blast incident (sudden surge simulation), and a hospital evacuation scenario (“reverse” surge simulation). All participating healthcare facilities reviewed, enhanced, and agreed upon updated MMAAs that now included the availability of volunteers (SERV-PA). The administrators were given responsibility and oversight for volunteer alerts and organization of volunteers during an actual event. The gaps were identified as requirement for (1) increased capacity through staffing and alternative care sites, (2) improved efficiency through preparedness standardization, (3) decompression of hospitals by working with alternative care sites, (4) development of command and control and NIMS compliance, (5) development of improved transportation planning, and (6) enhanced surge capacity through broader participation. Progress was evaluated by the completion of the 59 SMART objectives (Table) and tested through implementation of 17 brief regional exercises.
The 3 computer-based simulations were created and used throughout the region as an education tool. Seventeen regional data gathering and assessment exercises were conducted during the time period of the grant.
Fifteen of 17 hospitals appointed SERV-PA managers and all were sufficiently trained by the end of the granting period. This should lead to a greater ability for hospitals to meaningfully participate in disaster response. In all, 50% of hospitals were responding to the 800-MHz alert system, and 62% of hospitals were using the FRED alert system (31% used both systems). This was performed by using the Health Alert Network and Web portal communications as an alerting activity, followed by a teleconference documenting capacity for surge at 0700 and 1500 hours at each facility. Many systems that were expected to respond to MCI and other surge emergencies, such as NIMS, MMAAs, and ESAR-VHP, were in existence but not functioning optimally.
In particular, it is important for key jurisdictions within a healthcare region to practice communication in order for a flow of information to go from the initial dispatch to all of the key jurisdictions that need to respond, including hospitals. Although the South Central Pennsylvania region has many communities, hospital facilities, and demographics that are similar to other regions, no 2 points across the country are the same. Furthermore, we rely on the partners to uphold preparedness and surge quality after the end of the grant period.
At baseline, the healthcare facilities in our region of Pennsylvania had the ability to accommodate 10 critically ill patients. Hershey Medical Center (Scott Freeden), Good Samaritan Health System (Kim Crosson), Heart of Lancaster Regional Medical Center (Scott Marks), Ephrata Community Hospital (Gloria Jean Maser Fluck), Lancaster Regional Medical Center (Walter Roth), Lancaster General Hospital (Jeffery Manning), York Memorial Hospital (Lisa Ziegler), and York Hospital (Kevin Arthur). Homeland security exercise and evaluation program, volume I: HSEEP overview and exercise program management. This Section (comprised of faculty from most of the Harvard teaching hospitals’ Departments of Emergency Medicine) has collectively developed a fellowship in Disaster Medicine (DM).
Upon completion of this fellowship, fellows are skilled in all aspects of the disaster cycle and have the ability to assume a leadership role on the local, regional, federal, or international level in the area of Disaster Medicine and Emergency Management. Even if you think you are only leaving for a short time, you dona€™t want unforeseen or extenuating circumstances to prevent you from getting home to get your pet to safety, or put your pets in greater danger. Carefully consider and take the necessary steps to make sure your whole family is well- prepared for whatever life may throw at you. However, these factors may not be optimally functioning to generate an effective and efficient surge response. This can be done by increasing preparedness for public health emergencies, largely those that require the ability to treat a large influx of patients (surge capacity).
Within this region, a total of 17 acute care hospitals became members of the Partnership, which was supported by a federal grant from September 1, 2007, to August 8, 2009, inclusive of 2 no-cost extensions to the initial award. The SCTF, supported primarily by grants from the Department of Homeland Security, is organized into approximately 10 functional groups and committees.
ESAR-VHP expedites the volunteer’s verification of identity, licenses, credentials, and accreditations.
Each of the 59 SMART objectives created by the Partnership included a description of how to measure or document the objective, and the person or persons who took the lead to implement each, and provided a deadline for completion. The desktop–sharing program (Webinar, Web-based seminar) was fully interactive, which allowed all attendees to present, respond to, and discuss information in real time. FRED is an Internet-based system that alerts facilities in the event of a crisis or situation that may warrant a coordinated response. These flat-screen, computer-based simulations incorporated the HVA, PanSurge07, and PanFlu assessment results for at-risk medical populations.
The HCFP-SCPA carried out a week-long recruiting event to encourage volunteers to register at each regional facility.
Along with this, the Partnership launched a Web-based portal with a public and secure access to facilitate communication between partners and with the public. Incident scene operations may require emergency operations center (EOC) support for MCIs of significant magnitude. After each was performed, the partnership evaluated and reviewed the results to identify limitations in the region as a whole and within each Partnership facility.

More than 500 SERV-PA volunteers had been added within the region since the start of the project. At baseline in 2007, it was determined that total regional surge capacity for critical adult patients was 10 or less and for critical pediatric patients, 2 or less.
It was clear to the Partnership that without significant practice and troubleshooting, the path of communication did not move rapidly from the initial dispatch to all of the event catchment hospitals. Simulation training with the regional facilities is a priority and is crucial to sustain regional disaster preparedness. Each region has individual requirements, restrictions, and resources, which may differ from ours.
Although we believe that our partners are dedicated to emergency preparedness and increasing surge capacity, the incident of fraudulence is possible. At the conclusion of the study, the Partnership has practiced a regional response to a large surge event and has found an increase in capacity that exceeds 100 patients. We would also like to thank Osteopathic Hospital, The Lebanon Veterans Affairs Medical Center, The University Physicians Group-Fishburn, the University Physicians Group-Middletown, and The South Central Pennsylvania Regional Counter-Terrorism Task Force.
The CDM designs and conducts between three and six full-scale exercises each year dealing with mass casualty, chemical hazards, and radiological hazards. The DM fellowship program is designed to provide qualified emergency physicians the opportunity to develop an expertise in the related fields of Disaster Medicine (DM) and Emergency Management (EM). After graduation, fellows can assume a leadership position and be active in research and academics, eventually becoming an internationally noted expert. He has also completed work on four separate AHRQ-funded research projects on disaster preparedness, and one Department of Health and Human Services (HHS)-funded research event in 2009. Pets are important family members, and it is essential to have an emergency kit prepared for all your animal companions with the basics that would be needed, should you ever have occasion to use it. It consists of representatives from 16 hospitals, the Office of Public Health Preparedness, 8 county EMAs, and other critical entities required for public health and safety for a population of about 2 million people.
The EHSF also works to improve preparedness and recruitment and provides regional resources that can be deployed in the event of a required response. In the state of Pennsylvania, ESAR-VHP is known as The State Emergency Registry of Volunteers in Pennsylvania (SERV-PA).
Teams met regularly to discuss current developments and to further the goals as set forth by the HCFP as a whole. It provides information about the emergency and enables facilities to report about available resources. The portal also kept a central repository for information regarding availability of equipment, similar to that of the National Hospital Available Beds for Emergencies and Disasters System developed by the Agency for Healthcare Research and Quality. The SERV-PA program was advertised on the Partnership Web site and at several of the hospitals in the region to further encourage volunteer enrollment. A regional “ideal communication flow chart” (Figure 3) was created and trigger points for surge response were identified and agreed upon to further strengthen communication. The EMAs are then responsible for producing a Pennsylvania Emergency Incident Reporting System (PEIRS) report. This compares favorably with the 600 volunteers that were available statewide at the beginning of the Partnership.
2, 100% of the hospitals confirmed receipt of the alert and 47% of the personal within the hosptials confirmed receipt. At the conclusion of the grant, all hospitals had the 800-MHz radio, wired and monitored continually, and had practiced receiving the FRED alert.
The computer-based simulation added additional interactive and qualitative data and measurements that exceeded previous real-time exercises, such as tabletops.
Similarly, while we feel that improvement in hospital personnel participation is a result of participation in, and actions of, the HCFP-SCPA, the possibility exists that subjects improve or modify an aspect of their behavior that is being experimentally measured in response to the fact that they are being studied.
We would also like to thank Nancy Flint, Carla Perry, Shannon Harrington, and Lee Groff for their help.
The MGH CDM has hosted fellows from the disaster section in its lectures and preparedness exercises, and fellows have met with Dr. Once prepared, store your pet emergency kits wherever the rest of your emergency supplies are kept, so everything for the whole family is together in case of an emergency. The response to this model (Figure 2) for completing the work was received favorably by members of the Partnership and this proved an efficient means of task management for its overall goals. Attendees of Webinar meetings were able to communicate verbally during sessions by calling into a phone conference. The 800-MHz radio is a system implemented by the Pennsylvania Department of Health as a means to alert and communicate in the event of failure of primary communication methods. On the public portion of the Web site, the Partnership created a way to communicate with the region’s communities about preparedness efforts and emergency situations. Following recruitment, the SERV-PA system was tested to determine how many new volunteers were generated. Information on the PEIRS report is passed through the Pennsylvania Emergency Management Agency (PEMA), to the Pennsylvania Department of Health (DOH), to the Emergency Health Services Federation (EHSF), and then to the hospitals who will be receiving the patients.
After exercises, self-reported capacity for the responding hospitals showed an average regional hospital surge capacity of 342 beds over the baseline of 3,192 beds (a 10.7% regional increase with surge capacity). We would like to thank Christopher Hatzi and Dennis Damore of Crisis Simulations International, LLC (CSI). All of the faculty members in the MGH Department of Emergency Medicine are required to participate in a CDM-sponsored activity at least once every three years. Biddinger is also the principal investigator on numerous statewide preparedness projects in Massachusetts funded by the Assistant Secretary of Preparedness and Response (ASPR) via the Massachusetts Department of Public Health. Using the Webinar with phone, meetings could be held and “attended” by all parties, regardless of their location within the 8 counties (approximately 13,303 km2). HAN is a national system developed by the Center for Disease Control that alerts facilities of any health threat using Web- and satellite-based technologies, and then links organizations critical for preparedness and response to said events.
To achieve faster situational awareness for hospitals, the 911 service now directly contacts local hospitals in the event of a significant occurrence for which surge is possible. After these surge capacity exercises, we were able to demonstrate the following increases in hospital beds: 25% increase in adult floor beds, 37% increase in critical care beds, 27% increase in ED beds, and a total regional increase of 24%. These activities were supported in part by a grant from the Department of Health and Human Services, Office of Preparedness and Emergency Operations, Division of National Healthcare Preparedness Programs, grant No. Since 2005, the CDM has published 17 peer-reviewed articles, 12 non-peer reviewed articles, chapters and reports, and presented 24 abstracts at national conferences.
Mass General takes great pride in our responsibility to prepare to serve our diverse communities in times of need. This significantly reduced travel costs and allowed partners to complete their other regular duties with less interruption to their everyday workflow. These local hospitals then contact regional hospitals capable of creating a Facility Resource Emergency Database (FRED) alert that notifies all hospitals in the region.
However, no increase in pediatric capacity could be created regionally without changing the Department of Health regulations on designated use of adult and pediatric beds. In subsequent practice sessions, verifiable alternative care expansion and personnel availability were shown to produce more than 3,600 low-acuity, staffed evaluation and treatment rooms for surge capacity enhancement within the region.
These exercises asked hospital organizations to identify usable, staffed clinical areas that could be directed to care for patients needing education, immunization, and low-acuity visits but not requiring services only available within the affiliated hospital.
These sessions assumed that the ESAR-VHP was used to augment staffing of available beds (ie, movement of providers assured between hospital organizations), that memorandum of understandings between hospital organizations resulted in enhanced coordination between overloaded and other hospital organizations, and that staffed beds for low-acuity patients could provide a load of 4 patients per treatment room per hour.

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