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RADIOLOGY AND THE HOSPITAL EMERGENCY PLANNING

Paul J. Bode, M.D.

INTRODUCTION

In recent years there has been a notable change in attitude towards disaster and emergency planning
in the community, the hospital in general and the various departments.
Both the millennium problem and geo-political realities have forced us to have the existing plans
evaluated, updated and exercised.
Rightfully we think the radiology department an important if not pivotal link in normal hospital
routine. This obliges us to participate in the various planning committees and take an active role in
the drafting, implementation and drills of all parts of the emergency and disaster plan. “Plan for the
worst, hope for the best” is a good adagio.

THE HAZARDS

Emergencies may be classified as “minor”, “major” and “mega”.

The nature of the disaster can be local, affecting a limited area, or broader in scope effecting a whole
department, the hospital, an entire community or even an entire nation. It is clear that a power failure
with negative effects on patient care is of another magnitude than fire in the administrative building
(some would welcome that), bio-chemical terrorism or a large-scale natural disaster. Meeting these
disasters, small and large, calls for tailor-made plans, which should be available at all times in
accessible locations and on-line trough the intra-net.

EMERGENCY AND DISASTER PLANNING

Objectives:

In general one can make a distinction between external and internal emergencies.
The main objective in case of an external emergency is:
Handling large numbers of patients while maintaining the standard of care as long as possible. Most
hospitals overestimate their emergency capacity for various reasons. A patient distribution plan over
neighboring hospitals might be life saving.
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In case of an internal accident the first objective is limitation of the damage done and protection of
personnel and properties.
Bear in mind that a combination of internal and external emergencies may occur.

GENERAL ORGANIZATION

The hospital should install a central planning committee with representatives from every department
planning all kind of emergency response based on the existing hospital organization structures.
Every department or unit should scrutinize those plans and make amendments.
The resulting plan should be simple but comprehensive and cover topics from command and control,
logistics, emergency communication systems, patient routing to full-scale evacuation. The use of
checklists is mandatory.
The competence to set the emergency plan in motion has to be set low in the hospital hierarchy. It is
better to call of an action than to loose precious time locating the hospital director.
When ready start exercising on a small scale.

RADIOLOGY DEPARTMENT ORGANIZATION

It is not illogical to assume that the radiology department will be heavily involved in emergency
situations.
Every emergency plan is very dependent on local circumstances, potential threats and possibilities so
it is impossible to give an omni usable blueprint.
However, some general considerations are worth mentioning.
The Radiology department emergency plan must be an extension of the general hospital emergency
plan and key elements must be carbon copies of that plan, especially the departmental command and
control, communication and patient identification set-up.
Highly augmented inflow of patients will necessitate a good triage system under the direction of the
surgical department. Secondary Triage can be refined with radiological assistance by using
(portable) ultrasound.
Triage classification is as follows:
Class 1: ABC instable, urgent need of intervention
Class 2: ABC stable, needs admission
Class 3: ABC stable, outpatient follow-up
Class 4a: DOA (dead on arrival)
Class 4b: Palliative therapy only, moribund.
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While class 1 victims will be rushed to OR radiology will be busy with class 2 &3 victims mostly
using ultrasound, CT and radiography.
Design your department plan accordingly both in the deployment of hardware and manpower.
The best thing to do is make sure that people work at the same place as in normal situations doing
the work they normally do with co-workers they know.
Design meeting points for inflowing personnel and handout check lists.
Control and command structure and communication plan must be military oriented.
Good and triage class separated patient transit route’s trough the hospital is highly advisable.

Notice that in time your workflow will change: in the mobilization phase getting organized is the
main goal even if this means a few minutes delay.
In the early operational phase most of the demands will be in or around the emergency rooms
shifting later to OR, ICU and wards.
Exercises seldom take more than a few hours, the real thing can go on for days so do not exhaust
your human resources.
Most if not all of your personnel will appreciate an after care and evaluation program.