Addressing Challenges in Communications and Triage
Sep 7, 2006
With the nation's busiest burn center and the metropolitan area's largest hospital Emergency Medical Services (EMS) fleet, NewYork-Presbyterian Hospital rescued and treated many survivors of the Sept. 11, 2001, attack on the World Trade Center. A new study published by NewYork-Presbyterian Hospital/Weill Cornell Medical Center in the September issue of the Journal of Burn Care and Research looks at the Hospital's disaster preparations – especially as they address the challenges of communication and patient triage that occurred on that day.
The attack killed four NewYork-Presbyterian EMS employees and destroyed seven NewYork-Presbyterian EMS ambulances and two service vehicles.
The study reports difficulties with communications systems on Sept. 11, including the failure of EMS workers' portable two-way radios and the inability to track the location of EMS vehicles. There were also insufficient systems to facilitate triage of burn victims to specialized burn care facilities. Only 26 percent of burn patients were triaged to a burn center, even though there were an adequate number of beds available.
"In response to the challenges we faced on 9/11, NewYork-Presbyterian has enhanced its disaster response capabilities in areas including the acquisition of new equipment, and increased training and participation in disaster response exercises," says Dr. Roger W. Yurt, the study's lead author, director of the William Randolph Hearst Burn Center at NewYork-Presbyterian/Weill Cornell and the Johnson & Johnson Distinguished Professor of Surgery at Weill Cornell Medical College. "Recent data has shown that triage to burn centers has improved, with more than 75 percent of burn patients in New York City triaged to a burn center; however it remains unseen whether effective triage can be sustained during a disaster."
The study was supported by a grant from the New York Firefighters' Burn Center Foundation.
NewYork-Presbyterian's disaster preparations fall under two main categories – equipment upgrades and bolstered training and planning.
As far back as 1999, NewYork-Presbyterian Emergency Medical Service (NYP-EMS) recognized the importance of radio communications by deploying a mobile communications vehicle equipped with radios capable of operating on multiple frequencies. This vehicle was deployed on Sept. 11, 2001, and functioned as the primary coordination point for regional volunteer fire and rescue services staging at a local stadium outside of Manhattan in the 24 hours after the attack. In 2005, NYP-EMS acquired a state-of-the art mobile communications vehicle equipped with portable radio equipment, radio scanners, and computers with broadband cellular access.
"Within three weeks of delivery, the new vehicle accompanied a contingent of emergency physicians and EMS personnel responding to assist victims of Hurricane Katrina on the Gulf Coast of Mississippi, where it served as a command post for ground operations," says John Delaney, the study's co-author and director of NYP-EMS. There are plans to upgrade the vehicle with a high-speed satellite system for broadband access in areas without cellular coverage, and additional mobile radios capable of communicating with additional public safety frequencies.
Since 2001, all NYP-EMS vehicles have been equipped with global positioning technology (GPS) in order to track the exact location of the fleet. Additionally, decontamination facilities have been constructed outside of the main ambulance entrances of the Hospital's two major emergency departments. A mobile decontamination vehicle has also been added to the fleet.
In recognition of its advanced communications capabilities, the City's Office of Emergency Management (OEM) has designed NYP-EMS as the coordinating center for mutual-aid ambulance notification system.
Bolstered Training and Planning
Since Sept. 11, NewYork-Presbyterian has increased its commitment to training its EMS and emergency department workers, and participating in training exercises and planning in collaboration with local, regional, state and federal agencies and organizations.
As of 2006, hazardous-materials (HAZ-MAT) training has been provided to NYP-EMS and NewYork-Presbyterian Emergency Department personnel. Since 2001, weapons of mass destruction (WMD) training has been available to NYP-EMS workers as a requirement for all hospital-based ambulance personnel who participate in the City's FDNY 911 dispatch system. Many NYP-EMS personnel – including the NYP Hazardous Materials Medical Decontamination Team ("Decon") – have achieved "Hazardous-Materials Operations" and "Hazardous-Materials Technician" capabilities.
The Hospital actively participates in regional exercises such as those directed by U.S. Department of Homeland Security and the Office of Emergency Management. The Hospital's written emergency preparedness Management Plan has been continually updated to reflect lessons learned from exercises, participation in symposia and training offered by state and local sources within the public and private sectors, and actual events.
NewYork-Presbyterian Healthcare System is the recipient of a grant from the U.S. Department of Homeland Security to create a three-day plan to respond to a mass disaster (chemical, biological or nuclear attack or accident). The plan, to be completed in coordination with the New York City Department of Health, will include triage to local and area hospitals and training of EMS workers. It is estimated that such a disaster could result in as many as 400 burn patients.
NewYork-Presbyterian's Response to Sept. 11
On Sept. 11, 2001, NYP-EMS personnel were among the first to respond to the World Trade Center site. Later that day and in days following, Hospital staff, including members of NewYork-Presbyterian/Weill Cornell's Department of Ophthalmology and Department of Psychiatry, volunteered at ground zero by attending to rescue workers.
NewYork-Presbyterian's Emergency Departments treated 175 patients, including 22 burn patients at NewYork-Presbyterian/Weill Cornell's Hearst Burn Center. The NewYork-Presbyterian Healthcare System treated 600 victims in the first 48 hours following the disaster.
The Hospital also helped by providing a phone bank for relatives of victims seeking to locate their loved ones, by organizing blood drives and by providing grief counseling.
Since before 2001, NewYork-Presbyterian/Weill Cornell's Department of Public Health and Department of Emergency Medicine have been active in disaster preparedness. With funding from the Centers for Disease Control and Prevention (CDC), and the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services, Weill Cornell as pioneered the use of computer models to plan the public health response to large-scale bioterrorist attacks. In addition to research on antibiotic and vaccine dispensing, they have studied hospital capacity to treat mass casualties for a bioterrorist event and have engaged in extensive educational activities for medical students, residents and practicing physicians.
For more information, patients may call 866-NYP-NEWS.
NewYork-Presbyterian Emergency Medical Service
The New York-Presbyterian Emergency Medical Service (NYP-EMS), established in 1978, is owned and operated by the Hospital and has been described as the largest hospital-based EMS service within the New York metropolitan region, employing more than 400 Emergency Medical Technicians (EMTs), paramedics and support personnel, and operating 65 vehicles (including 39 ambulances and 26 support vehicles). The NYP-EMS has been certified by New York State to operate within the five boroughs of New York City (NYC) and three neighboring counties, and covers a geographic response area in excess of 1,850 square miles. For 2005, NYP-EMS received more than 83,000 calls for service, transported more than 53,000 patients and trained more than 7,000 providers in Basic and Advanced Life Support. Furthermore, NYP-EMS provides approximately 11 percent of the Hospital-based, Fire Department of the City of New York (FDNY) 911 system EMS responders.
NewYork-Presbyterian Hospital – based in New York City – is the nation's largest not-for-profit, non-sectarian hospital, with 2,344 beds. It provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth on U.S.News & World Report's guide to "America's Best Hospitals," has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital has academic affiliations with two of the nation's leading medical colleges: Joan and Sanford I. Weill Medical College of Cornell University and Columbia University College of Physicians and Surgeons.
The NewYork-Presbyterian Healthcare System – which includes acute-care and community hospitals, long-term care facilities, ambulatory sites and specialty institutes – is committed to providing high-quality, cost-effective and conveniently accessible care to communities throughout the tri-state metropolitan region. The System serves one in four patients in the New York metropolitan area.