Anatomy of an emergency: How Penn State Hershey prepares for issues like Ebola
Ebola ranked dead last on most hospitals’ lists of “things to worry about” in early 2014. While Penn State Hershey’s infection control committee worked on a policy when the outbreak started in Africa, a patient’s arrival at a Texas hospital with the disease in late September kicked its emergency preparedness team into high gear.
“Most health care providers in the United States recognized that something like Ebola may not just stay in West Africa but could affect us here,” said Dr. Cindy Whitener, professor of medicine and hospital epidemiologist at Penn State Hershey.
Now, the hospital has been named one of 50 planned Ebola treatment centers in the nation.
“What began as a meeting and subcommittee has grown into something huge,” Whitener said.
Whether or not an Ebola patient ever shows up in Hershey, the preparation process has left the hospital more prepared than ever for future health emergencies.
Scott Mickalonis, emergency preparedness program manager at Penn State Hershey, said the hospital completes a hazard vulnerability analysis each year to determine which health, weather and infrastructure issues present the biggest risks. His team stays abreast of trends and news of what is going on elsewhere in the nation and world.
Whether the threat is an outbreak of the flu, emergence of an eradicated disease like smallpox or simply bad weather, the hospital must have a plan to handle it. The official word on how that is done is contained in the hospital’s Emergency Operations Plan, a document that is expanded each time a new threat emerges. Information and protocols for handling an Ebola patient added more than 100 pages to the plan.
Emergency preparedness experts know it’s not enough just to have a plan. It must be tested and tweaked, refining everything from big processes to minor details.
When it comes to Ebola, Mickalonis said, “We have all been learning together how to keep up with the recommendations and send a consistent message to our employees and volunteers on the treatment team.”
For Ebola, one of the first steps is screening.
“We want to be sure we are aware of anyone who enters our facility who could possibly have had an exposure to Ebola,” Whitener said.
The hospital asked faculty and staff to volunteer to be part of a team that would receive specialized training on how to care for an infected patient, should one show up in Hershey.
“Everyone who goes through the drills and training sessions has to feel comfortable doing it,” Whitener said.
Emergency medical providers, patient transport, laboratory and environmental health workers also had to be educated about how to take special precautions.
Did providers understand how to protect themselves while interacting with an infected patient? Did they feel comfortable doing their jobs while wearing personal protective equipment? Were there processes in place for handling blood work, waste — even a potential cadaver?
“You cannot just write a plan and assume it is going to work,” Whitener said. “You have to walk through it and drill it to find the gaps, then rewrite it and drill it again and see what details you need to fill in to get the process to work smoothly.”
That means everything from transporting mock patients by ambulance and putting them in a designated room to going through the steps of getting X-rays and lab work.
“The better prepared we are for this, the better prepared we will be for any highly infectious disease we may see in the future,” Whitener said. “The way the world is today, a disease in the Middle East or Africa can get here in a day, so we need to be ready to face it.”
Preparation comes with a price tag. The hospital needed to purchase supplies such as special stretchers, stethoscopes, audiovisual and laboratory equipment, as well as personal protective equipment for providers who would care for an Ebola patient. Then there is the cost of giving staff intensive education and training opportunities, as well as time off from their regular duties to do it.
“It is very time and resource intensive,” Whitener said.
Michelle Del Pizzo, hospital administrator, said Penn State Hershey has committed three-quarters of a million dollars to Ebola preparedness. Yet if an Ebola patient never comes to Hershey, the time and money will not have been wasted.
“It’s not all throwaway,” she said. “This has really propelled our emergency preparedness to the next level. The work we are doing has so much more value beyond just Ebola. We are building awareness for people around preparedness, and that has been a wonderful experience.”
While the emergency operations plan provides a general framework, emergency preparedness is about having several “levers” in place and at the ready. Different incidents would require different types of response from different “levers.”
“The key is to know which you would or wouldn’t pull based on the situation,” Del Pizzo said.
Mickalonis said the amount of preparation a hospital must do for any emergency directly corresponds to the degree of reaction it would need: “The more you can think a process through ahead of time and prepare your staff, the less reactive you have to be if something actually does happen.”
By Jennifer Vogelsong