Living the Drill: Hospital Finetunes Disaster Response With Continuous Training, Meticulous Planning

At Cleveland Clinic Martin Health, even the weather report is special. “Blue skies”? That’s shorthand for business as usual. “Gray skies”? Activate the teams; there’s an emergency affecting our operations.

Like all Cleveland Clinic facilities, Martin Health (CCMH) – a group of three hospitals on Florida’s east coast, including Martin South, Martin North and Tradition – relies on a robust emergency preparedness plan that covers both internal and external hazards, including bomb threats, active shooter situations, fires, severe weather, utility service disruptions, hazardous materials events and community mass casualty incidents.

However, CCMH’s coastal location creates some unique concerns, explains Christine Tea, MSN, RN, NEA-BC, CENP, CNOR, FACHE, Senior Director of Nursing at Martin North and Surgical Nursing Services across CCMH.

“Hurricanes are a special risk for us, of course, so when we see one in the forecast, we begin preparing a full week ahead while making daily and hourly updates,” she says. “That process really revolves around our staff, who also must be given time to secure their own homes, families and pets before reporting to their shifts.”

In addition, the hospitals are located near the nuclear power plant in St. Lucie County, a major interstate highway (I-95) and the Brightline high-speed passenger rail line — all of which create specific risks for mass casualty events, she adds.

Power of teamwork

Tea shares overlapping emergency response responsibilities with her colleagues Brett Clarke, MHL, RN, NE-BC, Senior Director of Nursing at Cleveland Clinic Martin South and Director of Emergency Services at CCMH, and Lori Matich, MSN, RN, NE-BC, Senior Director of Nursing at Tradition. These “intertwining” roles help ensure consistency while broadening access to staff, equipment and resources, Clarke explains.

Emergency preparedness is a process that begins with planning and practice, notes Tea. “The beauty of having a plan in place is that it prevents chaos,” she says. “We are continually reviewing our resources and adjusting our approach. During a disaster, you may see a heightened energy level among the clinical team, but there’s no panic. Everyone knows what to do and how to do it.”

CCMH has developed six Incident Management Teams (IMTs): one for each of the three hospitals; a single Corporate Command Team that helps coordinate and streamline efforts between facilities; an IMT for the freestanding St. Lucie West Emergency Department; and a final one representing the 19 ambulatory sites within the group. All IMT positions are redundantly staffed — usually three deep — and team members are cross-trained so they can fill multiple roles.

That’s especially important during lockdowns where we anticipate extended activations which span across multiple operational periods (a common occurrence during hurricane activations when it is unsafe to travel on the roadways), explains Christina Proulx, CEM, FPEM, CHEP, Senior Manager for Emergency Management.

“These position redundancies are predetermined across all teams to ensure adequate staffing and continuity of patient care during the emergency — with each having an alpha and bravo shift on-site to offer relief for their counterpart," she says. "This is a duty our caregivers take very seriously; they make plans for their personal lives well in advance, so they are prepared to give 100% of their attention to the emergency at hand.”

Practice, practice, practice

Emergency preparedness at CCMH also includes a Hospital Emergency Response Team, a highly trained, broad-based task force focused on emergency response actions that address all potential hazards. “The team is ready to respond to anything – from setting up decontamination tents to transporting patients to another part of the hospital,” says Clarke.

The teams routinely undergo exercises designed to help them practice what they’ve learned. Held once per month (at minimum), these training sessions allow participants to rotate through a variety of possible scenarios. Each mock emergency typically begins with a “tabletop” discussion.

“It’s critical that we’re all on the same page to ensure safe emergency response actions, particularly in active threat situations that require us to work with external public safety agency partners,” notes Proulx. “For instance, should an active shooter incident ever take place on a CCMH campus and on-site caregivers spring into action to render immediate, life-saving aid to a gunshot victim, law enforcement personnel arriving on scene may perceive the caregiver bent over the victim as the active threat. The primary objective in each of our training scenarios is always life safety — for our both our patients and our caregivers — so we talk through potential issues like that before we put our boots on the ground for any functional or full-scale exercise.”

Proulx emphasizes that the training exercises are designed to feel as realistic as possible, citing a recent active-shooter drill conducted at a primary CCMH family health center (which was closed during exercise operations).

“Our local law enforcement agencies partner with us during these exercises; they play very convincing assailants (shooters) and use blanks in their training weapons to replicate to sound of real gunfire," she says. "The noise can be extremely disorienting inside of a building, and coupled with the aggressive actions of the shooter, caregivers truly feel the seriousness of the scenario. The realism gives our caregivers an opportunity to practice their response actions in real time.”

The hospitals’ mass-casualty and radiological drills frequently include actors with simulated wounds and personnel from a host of relevant local, state and federal agencies, including the Federal Emergency Management Agency, Florida Power and Light, local health departments and the Florida Division of Emergency Management. Exercises are followed by in-depth debriefings in which caregivers are encouraged to evaluate their teams’ response by discussing performed strengths and identifying areas for improvement. Emergency plans and procedures are then updated based on lessons learned, and the cycle begins again.

Ready for anything

Proulx points to the “instrumental” role of the CCMH nursing staff in the healthcare system’s ability to ensure patient safety during an emergency – whether real or simulated.

“One of the things I really love about Cleveland Clinic is that our clinical caregivers participate in every step of emergency preparedness,” she says. “They continually strive to provide the highest level of care, and they are confident and well-prepared for what they do. Personally, I love working in emergency management, and the fact that our nursing teams embrace it, too, is very gratifying.”

Tea adds, “It’s wonderful to be part of an organization that’s willing to put so much time into emergency preparedness. Even if the worst should occur, our caregivers and community members know they can depend on us to be their rock.”

Tea’s confidence in her CCMH teams is not misplaced, a fact that was borne out during a 2021 Code Red: a fire sparked by roofers working outside Martin North. The emergency response team sprang into action, quickly evacuating four of the hospital’s operating rooms as smoke billowed out of an adjacent ceiling.

“Fortunately, three of the surgical procedures could be quickly and calmly finished and closed, and the patients could be moved to the recovery room,” Tea says.

The fourth case, however, proved to be more complicated. Unable to complete the procedure before evacuating, the surgical team calmly packed the patient’s abdomen, covered it with sterile towels and wheeled the patient out of the operating room. The challenge, which required an elevator ride to a surgical suite on a separate floor, was met with calm efficiency, Tea says. The surgeon was able to complete the procedure without further incident, and the patient had a normal recovery.

“The team did an amazing job!” she says. “And as with all such events, we gained knowledge that will help us be better prepared if it ever happens again.

“And I certainly hope it never does!”