Sierra Mountain Hospital was well known for its stellar reputation for nursing and medical excellence, great leadership, and fantastic work environment. The new chief operating officer and her team had done wonders in totally transforming the organizational culture over the past 5 years and dramatically improving the patient, operational, and financial outcomes for the hospital. The executive team had recruited and hired top medical and surgical specialists and talented nursing leaders to create centers of excellence that were second to none for tertiary-level community hospitals. Sierra Mountain Hospital sat at the base of the Sierra National Forest and was surrounded by beautiful, well-established pine and sequoia trees. The hospital had recently been recognized in the national press as one of the top 50 hospitals in the nation for excellence in patient outcomes and patient, physician, and employee satisfaction.
Sierra Mountain Hospital had the usual policies and procedures and annual competency reviews for various crisis situations, particularly disaster planning. The procedures outlined roles and responsibilities of the command post leaders and participants and sites for the safe location of patients for any type of disaster. Every employee in the organization was required to review the disaster policies and procedures annually and to demonstrate their knowledge and competence in carrying out their specific individual roles and team roles in case of a disaster.
In extreme weather conditions with winds recorded at 90 miles per hour, an electrical transformer was blown over and started a fire in dry timber conditions. With the high winds, the fire spread rapidly to the surrounding areas, and embers were blown about as if they were laser darts. As the fire encroached on homes in the community, local fire brigades were dispatched to evacuate residents who were in the fire’s expected path. Within hours the state National Guard and other fire brigades were en route to provide assistance in containing the rapidly spreading fire. Per protocol, the leadership of Sierra Mountain Hospital assumed their roles in the command post to assess resources needed, identify patients who could be discharged or immediately moved, identify patients who would need assistance, and determine the level of danger from the fire situation. The nurse director was in radio contact with the police and fire departments and was informed that she would be contacted should patient evacuation be necessary, but it was not expected.
As the command post leader began calling in staff, she realized that the expected number of staff from the callback might not meet expectations because many were actively involved in protecting their own homes and families. Some of the staff indicated that they would come in only if they could bring their young children and pets because they were afraid to leave them behind with other family members who were engaged in trying to protect their homes. The command post leader, knowing that she would need additional help to relieve staff who needed to return to their homes, told the callback staff that they could bring their children and animals to the hospital in this crisis situation. Immediately, the command post leader contacted the facility director and asked for a space to be designated for the care of young children and a space for animals. This situation was certainly one that no one had anticipated when practicing various disaster scenarios.
Within a few hours the nurse director called the police and fire captains for more information about the encroaching fire. It was obvious that they had become so involved in their work that they did not inform the nurse director that the fire was spreading rapidly and in the direction of Sierra Mountain Hospital. It’s never an easy decision to make the call for evacuation of all patients, but the nurse director felt that it was in the best interest of the patients and her staff. Evacuation procedures were clearly outlined in the disaster protocol, so the nurse director implemented those procedures and called for the immediate removal of all mobile patients to a safe area in the community’s high school on the other end of town. She asked the police department for assistance to use school buses to transport the more mobile patients. Higher acuity patients would be transferred by any available ambulance, and the nurse director mobilized all of her leaders to set up temporary critical care units in the school’s gymnasium for the more critical patients who would be transferred with as much equipment and supplies as possible. She made calls to neighboring community hospitals to send ambulances and staff to help. The hospital had several trucks that were used to transport medical supplies and equipment, and these were mobilized to transport the sicker patients in their beds and with their equipment.
The next day authorities determined that it was safe for patients to be returned to Sierra Mountain Hospital, so the staff began the process of moving patients back. After the disaster was over, the nurse director, the command post leader, and others reviewed the situation and how the various unit and department disaster teams performed using the policies, procedures, and practiced roles. Although they were pleased that none of the patients were compromised in the process of protecting them and transferring them to a safe location, the team realized that there were several issues that needed to be addressed to prepare for future disasters. A list of potential changes was identified for implementation. The nurse director and others realized that staff who were called in were reluctant to leave their children and pets. Therefore, it was decided that the hospital would purchase a number of portable pet crates of various sizes and temporary fencing for the containment of animals on the grounds and in large storage areas. Cots and bedding would also be purchased for use when staff needed to bring their children to the hospital during disasters. The role of child caretakers was created and staff were identified for this purpose. Because of the knowledge gained from the review of the fire disaster, Sierra Mountain Hospital led efforts in the community to identify various safe locations for patients and storage areas for cots and other supplies should patients need to be evacuated again in the future.
1.Using the DCTM as a framework, how would you assess Sierra Mountain Hospital’s disaster preparedness?
2.From your own knowledge and experience, what other steps could the leadership of Sierra Mountain Hospital have taken to prepare for this or any other disaster?
3.Describe your perceptions of the review process after the disaster was over in planning for changes that would prepare them for future disaster response.
4.Describe how disaster response teams fit the description of a complex, adaptive, self-regulating system as described in this chapter.
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