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

2. 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.

3. 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

4. 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

5. 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?

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

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

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

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