The Big One
“It’s a simple concept,” says Dr. Garrett, “but unless responders practice it, it is difficult to utilize in a real emergency.”
Every hospital should have a HEICS or similar structure set up and the key emergency response roles pre-identified by job title, he says. And while knowledge of weapons of mass destruction (WMD) and incident command is improving, says Stephen V. Cantrill, MD, FACEP, associate director, Department of Emergency Medicine at Denver Health Medical Center, “Some hospitals have taken it seriously; others wish the whole thing would go away.”
More than likely, in the event of a disaster, the HEICS organizational tree is outlined all the way to the top commander in your hospital’s plan. Your role, in general, may have already been determined in this plan, but the conventional wisdom in your hospital (as in most) may be: You’ll learn your roles and responsibilities when the time comes. In fact, depending on your setting, the hospitalist may hold the most senior position in-house overnight or on the weekend—especially if there is not an emergency department at the hospital.
“The thing is, at first people are going to look to the most senior clinician to be in charge during a crisis,” says Dr. Garrett. Perhaps the smaller the hospital, the more you need to know what to do and what is expected of you to fit into the larger picture in the community. “And even if it is a smaller hospital the system and the needs are the same.”
What Types of Care?
Although many types of events can be handled the same way, some involve additional concerns. “With WMD or a contagious disease outbreak, there is the added issue of ‘What’s the risk to me as a provider in the hospital?’” says Dr. Garrett. “And if it’s a community or statewide or national event, ‘What’s the risk to my family?’ Then you’re dealing with issues that aren’t business as usual.”
The hospitalist and the administration will then have to think about other complex issues such as how many people are not going to come to work. Added to that, with a smaller staff, you may need to ask, “What will the scope of my practice be if I’m called to the front of the hospital to help do triage? Roles and responsibilities can change very quickly,” he says.
“Hospitalists are invaluable resources in an institution and in fact [in disaster events] they will be pressed into service because of their location,” says Dr. Cantrill, who with colleagues has trained 15,000 healthcare providers throughout Colorado as one of 17 centers to receive a three-year grant from the Health Resources Services Administration (HRSA) to conduct WMD training. “Especially in the private sector when it hits the fan, the hospitalist is going to be one of the first people to be called.”
