Finding organization in the chaos of mass violence Marjorie Bessel, MD, chief clinical officer, Banner Health April 14, 2018

ABC News On April 15, 2013, two bombs went off near the finish line of the Boston Marathon, killing three spectators and wounding more than 260 other people. Your experiences with your brother and father. What I told my father is counterintuitive – it goes against our nature and what I am learning is that when it comes to emergency response is that many times we will have to act against our first instincts. Faced with any kind of chaotic situation, our first instinct may be to help all when that is simply not possible; to expend all available resources to save an individual life; to stay with our patient no matter what. Today, I am going to talk about how my organization Banner Health prepares for this kind of chaos and the very difficult decisions that come with it.

My introduction to Emergency Management As chief medical officer for one hospital, considered the scarcity of ventilators Americans don’t tolerate scarcity How does one triage resources time in a crisis? Prepare to make those decisions on a large scale Title of the talk is finding organization – we believe organization is something that is created ahead of time; preparation is key Can not be specifically prepared for every emergency but will have developed infrastructure to help us solve many different types of urgent problems Learned that early on when I started as a chief medical officer at Banner Baywood Question of ventilator supply representative of all questions that will be asked during all emergency type situations – question of triaging people, labor, resources When faced with a situation where you can’t save everybody, save as many as you can

About Banner Health Step back and explain some of the unique challenges facing Banner We are health care system in six states providing different levels of care Challenges: Communication, coordination and standardization over the span of six states. Different locations: urban, suburban, rural Different levels of care, from neonatal ICUs to hospice care Training of 50,000 employees on emergency procedures

Hospital Incident Command Center (HICs) Team trained to respond to an incident at a hospital Concept used globally Involves people from various departments in the hospital Used for all hospital-based emergencies Share an example of HICS that you ran as Baywood CMO?

Emergency Operations Center (EOC) Systemwide version of HICs Stood up for large-scale events that can involve more than one hospital Looks at the Big Picture Supports mitigation, preparedness, response, and recovery efforts

Case study: Measles in Arizona Biggest outbreak in 2016 Infected patient visited two Emergency departments HICs: onsite patient workflows triage EOC: centralized liaison with state and county Case illustrates that “the crisis comes to us’’ in most cases

Case study: Solar eclipse 2017 Banner hospitals in Wyoming and Nebraska in eclipse’s path Wyoming’s population expected to double Challenges: Lack of staff or physicians; credentialing cumbersome Potential lack of medications including anti-venom Only one major highway in area International tourists may need interpreters Risk of cell towers being overwhelmed Response: Centralized supply, staffing and preparation

Review hazards with community partners and responders Step 1: Develop the plan Review hazards with community partners and responders Develop, review and revise emergency plans with internal and community partners Use plans as a basis for training To deal with an chaos that may come to us, we prepare through planning, training, practicing and refining.

Employee training critical to support understanding of the plans Step 2: Train to the plan Employee training critical to support understanding of the plans Training offered to employees: active shooter response workplace violence prevention mass casualty incident response evacuation Banner involved in training at different levels: Different hospital departments will train for specific situations Hospitals go through training for different codes

Drills/exercises test plans for strengths, weaknesses Step 3: Test the plan Drills/exercises test plans for strengths, weaknesses Develops confidence in staff Banner participates in internal and community exercises Banner participates in drills at different levels of

Continuous process improvement After drill/exercise, revise plans if needed Share best practices and lessons learned with community partners and responders Drill/exercise again

Communication is key Preparation is key Debriefing is key Lessons learned Communication is key Preparation is key Debriefing is key NPR.org

Questions? Http://bannerhealth.mediaroom.com/ahcj When faced with a situation where you can’t save everybody, save as many as you can Questions? Http://bannerhealth.mediaroom.com/ahcj