Planning, training, organization help ensure successful responses

Host Amber Smith: Upstate Medical University in Syracuse New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. When disaster strikes, a community's hospital is an important part of the emergency response for that community, along with police, fire, and ambulance service and local government. To help us understand how Upstate University Hospital is prepared, I'm talking with Chris Dunham. He's the director of emergency management at Upstate. Welcome back to "The Informed Patient," Mr. Dunham.

Chris Dunham: Oh, thanks for having me, Amber.

Host Amber Smith: Now Upstate has a director of emergency management. Do all hospitals of any size have someone who oversees disaster preparedness?

Chris Dunham: Yeah. It's actually mandated through a lot of our regulatory functions. Most smaller hospitals have sort of a dual role. In other words, the disaster management is applied to somebody who is doing other duties. Upstate's very fortunate. We have not only myself, but one other person who this is our full-time job.

Host Amber Smith: Well, we've seen hospitals in the US that have been hit by tornadoes, hurricanes, blizzards, all relatively recently. We've seen them flood. So we know they're not invincible to natural disasters. What do hospitals like Upstate have to do to ensure that they're prepared for anything?

Chris Dunham: A lot of it, from my perspective, comes back to training. We spend a lot of times creating these plans and procedures of what to do when certain things happen. We spend years, sometimes, working on these plans, and ultimately, they're very, I think, well-written. But if the frontline staff does not know what to do or how to apply the plan, realistically the plan doesn't work.

One thing about Upstate is, we're always growing, expanding, changing. The plans consistently update along with them. It is a yearly process where we go through everything every year to kind of go, "OK, what's changed? What's a best practice that we need to include?" Even new technology in the hospital will sometimes change our plan.

Host Amber Smith: So do you and your staff determine the types of things that the institution needs to prepare for? Or is it that the preparation's the same no matter what it is?

Chris Dunham: That's actually kind of a twofold thing. So we have an emergency preparedness committee, and there's about 40 different people on it from various walks of life at Upstate or experience, both clinical and non-clinical. So it is not merely just me and my staff deciding what's important. We actually pull together everybody and do what's called a hazard vulnerability analysis. So it is a prescripted kind of spreadsheet that hospitals use across the country, and we plug different events in, and it's based off of not only what we've prepared for in the past.

It takes into account what we've had happen to us recently and also too, certain geography plays into it. So in other words, if we were in the West Coast, earthquakes would certainly be higher than it is right now. Where, if we were in Florida, it'd be hurricanes. Now, we do get hurricanes up here, but usually we're on the tail end of things, and it's more heavy rain, storms, things like that. Our HVA (hazard vulnerability analysis) has a lot more emphasis on, let's say, snowstorms and blizzards than, let's say, somebody in Florida.

Our relative distance to a major airport, public like places like the Dome, places like the Amp at St. Joe's out on Onondaga Lake. Realistically, we go through this every year because obviously it changes. It takes also into consideration vulnerable populations, so folks who are medically dependent at home, either on oxygen or some sort of electricity powered device. That's stuff we need to take care of or think how do we provide.

Host Amber Smith: What can you tell us about the Storm Ready University designation?

Chris Dunham: Upstate was the fourth in the New York State area to receive this designation. Realistically, it's a partnership and a certification through the National weather Service. They come out and audit all of our plans, our weather preparedness, and how we would react to storms. What's really great about it is, it's designed for universities -- which obviously SUNY Upstate is one -- but you also see counties that are starting to get that sort of designation as well. As a result of that, we have a really good relationship with the National Weather Service in Binghamton, where we participate in conference calls and things like that.

So the winter storm we had just before Christmas, we actually ramped up and were part of the conference calls from the National Weather Service, where we knew really before the local news did what was going on, how it was going to play out, what they thought would happen, and we can plan accordingly -- and more importantly, communicate to other decision makers at Upstate.

Host Amber Smith: Now you organize and participate in drills throughout the year, so that staff practice for the real thing. Can you tell us about some of those?

Chris Dunham: Sure. We actually have a couple different layers of that. So we have some layers of what I like to call surprise drills for frontline staff where myself or my staff will show up in a department and say, "Hey, congratulations, this just happened. What are we doing?" Those are done a few times throughout the year.

Also, we have a pretty significant training program for our mid-level managers who are our primary incident commanders. They're called our administrators on call. They are required to actually show up to about four or so what I call tabletop exercises. So we'll gather, be it virtually or in person, and I'll put a problem on the whiteboard. And we'll just kind of noodle through how we respond to something like that. Something, as an example, we can simulate or talk through losing water in the hospital, or losing electricity for a significant amount of time, or, hey, we have a blizzard coming. What are we, what are some things we want to talk about?

That has been hugely successful, especially with our newer folks, to really get them used to all the resources and plans that we already have in place so they don't feel like, in the moment, they're recreating the wheel. And it helps them.

And also too, we do full scale exercises. This past fall we did a full scale decontamination exercise at our community campus for a hazardous materials response, where we had to actually wash patients, do some triage, and also integrate with the community as well.

Host Amber Smith: Now University Hospital is part of the Upstate Medical University campus. So in addition to the clinical care, there's also research and academics. Are the people involved in those sections of Upstate involved in disaster planning too?

Chris Dunham: Yeah, absolutely. There's actually a large research component. The academic side of things, especially with, let's say, our student population, is very involved. An example of this that really worked very well for us was the Covid response, because it was obviously organization-wide, and we were able to integrate the academic, the student life, and also the research side of things, which was impacted. And it was coordinated under one umbrella via the "incident command" process.

Host Amber Smith: I'm going to talk to you a little bit more about that. Let me remind listeners, this is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, and I'm talking with Chris Dunham, the director of emergency management at Upstate.

In Central, New York in winter, we always have the potential for a major snow event that impacts travel, electricity, whatever. What does the hospital do to be ready for this? You already mentioned the National Weather Service that you're connected with, so you're paying close attention to the weather reports, but what else goes on?

Chris Dunham: If we see that, if we get a weather report or we get an inclination that it will be a more-than-average winter storm in the Central New York area, because we're also kind of used to winter weather, certainly every time three inches of snow hits the ground, we don't do this. But if it we're talking 12 to 18 (inches) in a 24-hour period, that's significant for us. So what we do is we try to warn our workforce. In other words, to have them be prepared themselves. Also we try to ramp up not only have enough supplies on hand, stuff like food, extra food, extra pharmaceuticals and extra supplies for for our normal workload. We would have that stuff on hand before the storm hits because we don't want the storm to hit and then run out. That's the worst case scenario.

Also, the hospital can, in a large part, run on generators, and we have a number of those throughout the facility, and we make sure all the tanks are topped off and they can run for the maximum amount of time. We also staff up our grounds folks to do plowing and snow blowing and things like that.

One of the important things too is to remember about SUNY Upstate is, is we cannot put a "closed" sign on the front door. We always must remain open. So that is really sort of the basic tenant of every preparedness piece we do. We either need to figure out how we can keep what we have open or alternate or move stuff or be flexible in terms of how we approach a winter storm. But we've been through a couple pretty significant weather events even in my tenure. I've been at Upstate almost 12 years. And we kind of turn into a Hotel Upstate for our staff. Certainly, if folks can't get home, they stay with us. We set up cots in sleeping areas and provide food for our staff and make sure they're okay. Also too, we make sure we have enough staff for the duration of the storm is impact. Because the assumption is, is staff that need to come in won't be able to come in, and staff that's already there might not be able to get home -- so trying to provide a safe environment for not only staff but patients as well.

Host Amber Smith: What have you heard from your colleagues in Buffalo about the impact of the recent blizzard? I think the airport was shut down for five days. What was the impact on hospitals there?

Chris Dunham: Significant. The anecdotal stuff that I've heard is, it was pretty much "shelter in place," as a term. They did have enough supplies. Obviously the state activated its own incident command processes and helped the hospitals out in terms of snow removal and things like that. But that is probably a once in a hundred year event, thankfully.

Really, once the storm hits you can't do anything. You should have already done everything you needed to, to kind of hunker down. The problem is, is usually with a hospital, critical people come to you somehow and you've got to kind of work through that. I'm just thankful it wasn't Syracuse. I mean, that snowfall was amazing. Absolutely amazing.

Host Amber Smith: What do you do to prepare for an emergency, like a plane crash where there are many victims coming all at once?

Chris Dunham: We actually train for this pretty extensively. So we train for not only the plane crashes or the bus crashes. We call them mass casualty events. So these mass casualty events, we not only have special resources we can push down to our emergency departments, but also we practice mass notification of our staff to do a quick recall of physicians, nurses, other critical patient care folks. We do this realistically at least twice a year, because our hospital's the Level 1 trauma center. We're pretty much going to get one if one happens. And we've had some, in recent memory that have gone pretty well, where we've had, upwards of 20 patients coming to us at once from one particular incident.

The thing about Upstate is, is we're always busy. We always have a lot of patients, and how we flex up to the incoming patient number is usually an incident command event. It takes a lot of resources and coordination to do so.

Host Amber Smith: You mentioned incident command earlier. And for the past three years with the pandemic that was in place for many weeks or months at a time. Can you explain what it is and how it works?

Chris Dunham: So incident command is merely a process. It was developed in the 1970s as a response to the wildfires out west. So they would have these wildfires that would not pay attention to political or geographic boundaries, and it would go across large areas. What they found is, is there was a lack of coordination and command and control, much less communications in terms of county A would fight the fire one way. County B would fight the fire another way. And they rarely would talk.

So by using the incident command process, there's a couple fundamental tenants. In other words, everybody uses the same terminology for certain things, and there's a heightened awareness to plain language communications, activation, demobilization once it's over. Hospitals actually really started using this after Sept. 11. (Hurricane) Katrina certainly pushed it to the forefront, and we continue to use it. Upstate's been using it, really, pre 9/11. And it is a title and a way we can organize to sort of cut out a lot of the normal business processes, make quick decisions, move resources very quickly. Incident command sort of helps identify problems a little quicker and also provide resources without going through the normal chain of command and things like that. So it's able to respond a lot faster than normal operations.

Host Amber Smith: Have you learned anything about emergency planning on the job that you've brought back to your personal life?

Chris Dunham: Yeah, a lot of fundamental emergency preparedness stuff for me really comes down to, folks should have a plan. They should understand and watch the environment around them, whether it be weather or traffic closures or whatever. You know, you can't be prepared for everything. But communication is key, important to havefolks that you can call in an emergency to either let them know you're okay, or if you need some things.

And also too, have a heightened awareness for what's going on. If your local fire department says, "our residents need to do this," then you should do it. Realistically, folks watch the news or have information come in online. They should definitely follow or pay attention to their local county's emergency preparedness program. They're very good at putting out information, let's say in a winter storm or any sort of emergency. And they're a great source of information.

Host Amber Smith: Along those lines, how would you advise people maybe who are new to Central New York to prepare their homes so that they're ready for a disaster? Are there items that they should keep stocked?

Chris Dunham: I think some canned goods. Certainly, it depends on how far you really want to go. Have about three days worth of food on hand. Make sure all your medications are refilled. You don't want to run out at the middle of a blizzard. You can also make sure you have enough winter clothing. And I say that... you know, we've had a number of folks new to Upstate come from the southern part of the country, and invariably they'll be like, "hey, how bad is the winter here?" And when I explain it to them and kind of give them sort of the average numbers, you know, "oh wow, I need to get a better vehicle, maybe, or at least get a better winter coat."

I mean, you know, as Central New Yorkers, we kind of wear the weather as a badge of pride of like, "oh yeah, I've been through this." And that is okay. But sometimes there are people out there that sort of disregard things of, "well, it's only 12 inches of snow. I can drive to the supermarket," and things like that. And yeah, and that speaks to getting to know your environment, getting to know the people who would be able to tell you, "Hey, now's not a great time to be on the road," or "Hey, you should be hunkered down" kind of thing. So that kind of gets back to the listening to the local emergency managers or the local police or fire or what have

Host Amber Smith: you.

Are you one who advocates having a to-go bag packed?

Chris Dunham: Yeah, I think that's a good thing to have sometimes, depending on where you live. I think that the reasons for using a to-go bag during a mandatory evacuation, I think are pretty, blessedly, low in Central New York. In other words, the reasons that would happen would be pretty unique.

But having a to-go bag in terms of copies of important paperwork or, clothing, things like that, especially if you have children, might be an extra toy or two thrown in the bag to keep them occupied. I think it would be a good thing. people typically struggle with maybe an extra phone charger or things like that.

You can even get the, I say "old," but the transistor radios that are battery powered. They still sell those. Those could be quite useful in an emergency. Things like that. There are to-go bags for sale. You can buy one on any online retailer. It depends on how far you feel comfortable going with that. But having the bare minimums would be important.

Host Amber Smith: Well, this has been very informative, and I thank you for making time for this interview, Mr. Dunham.

Chris Dunham: Oh, thanks for having me.

Host Amber Smith: My guest has been Chris Dunham. He's Upstate's director of emergency management. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.