emergency preparedness


What The Boston Marathon Response Can Teach Us About Ebola: 5 Lessons

By Leonard Marcus, Ph.D, Barry Dorn, M.D., Richard Serino and Eric J. McNulty, M.A.

The massive and growing Ebola outbreak in West Africa is tragic both in the suffering and deaths among the affected population and in the difficulty of mounting a sufficient response. The number of cases is rising exponentially. We have had the first death in the U.S., the first case of someone contracting the disease in this country and the first case of transmission in Europe. Over the weekend, a man who had recently traveled to Liberia was taken to Beth Israel Deaconess Medical Center to be evaluated for possible Ebola.

Fear and anxiety are rising.

This has the potential to be the defining public health crisis of the 21st century. Boston has stepped up by sending doctors and other health care professionals with extensive experience and expertise. There is, however, something more that Boston has to share: the leadership lessons from the Boston Marathon bombing response.

(Ebola in Guinea/European Commission HG ECHO/flickr)

(Ebola in Guinea/European Commission HG ECHO/flickr)

After the Marathon, we saw federal, state and local agencies, as well as organizations in the private and non-profit sectors, came together as an integrated enterprise that can serve as a model for the Ebola response. While the two events are quite different, the principles for leadership effectiveness are actually similar.

There are five key interrelated lessons from Boston that can be useful as the world confronts Ebola:

Build A United Effort

An effective Ebola response requires linking and leveraging many organizations into a collaborative, cooperative enterprise, much like we saw in Boston after the bombing. Continue reading

‘The EbolaCoaster’: Boston Prepares Intensively For What-Ifs

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

By Richard Knox

Ebola in Boston? It’s not as far-fetched as you might think.

If the disease does pop up here, it will be a big deal — but probably not as nightmarish as you might imagine.

First of all, virtually no public health or infectious disease specialists think an imported case of Ebola could touch off an outbreak.

That’s because the virus is not spread through the air (except perhaps by certain medical procedures which generate sprays of virus-containing droplets). People can catch it only if they’re exposed to bodily fluids of obviously sick Ebola victims.

No airport screening program could detect such silent infections.

Moreover, U.S. medical personnel have the training and equipment to prevent its spread, and public health experts know how to identify and isolate contagious patients and track down close contacts who might have been exposed.

Still, against the increasingly dire backdrop of West Africa’s epidemic, Boston’s 20 hospitals, two dozen community health centers, public health officials and others have been preparing since August for the possibility that Ebola could appear here.

“My husband calls it the Ebolacoaster,” says Dr. Sharon Wright, director of infection control at the Beth Israel Deaconess Medical Center, speaking of the intense back-to-back “what-if” planning sessions.

The risk of an imported case of Ebola, Wright says in an interview, “is probably more than I would have thought a few weeks ago.”

A Silent Infection

Boston’s not alone. Health centers across the country are sorting out Ebola preparedness plans at a feverish pace. “Ebola doesn’t pose a health risk to the U.S. public, but we’re taking precautions at home,” Dr.Thomas Frieden, director of the Centers for Disease Control and Prevention, told reporters on a conference call Tuesday.

One complication specific to the Ebola virus is that it can take up to three weeks after someone is infected before symptoms appear. Continue reading

‘Run. Hide. Fight.’ Our Townspeople Prepare For Mass Attacks

From the public libraries to Town Hall, from the chamber of commerce to the schools to the elderly housing complexes, Brookline police officers Casey Hatchett and Peter Muise have been making the rounds lately.

I don’t mean regular patrol rounds, here in our leafy Boston suburb.  I mean they’ve been responding to invitations to come and teach residents — hundreds of residents — what to do if they find themselves facing an “active shooter” perpetrating a mass attack.

Sandy Hook is nearly 150 miles from Brookline, but over the past year, the legacy of that town’s trauma has become ever more visibly woven into the fabric of our town’s life.

I first noticed an offering for our town’s medical reserve corps: a workshop called “Protecting Yourself from an Active Shooter: Surviving the Unthinkable.” It included the “Run. Hide. Fight.” method laid out in the viral video above.

Brookline police officers run a community training session on responding to an 'active shooter' attack. (Courtesy C. Hatchett)

Brookline police officers run a community training session on responding to an ‘active shooter’ attack. (Courtesy C. Hatchett)

“If you are ever to find yourself in the middle of an active shooter event,” the ominous voice-over intones, “your survival may depend on whether or not you have a plan. The plan doesn’t have to be complicated. There are three things you could do that make a difference. Run. Hide Fight.”

Officers Hatchett and Muise include the video in their training sessions, but they also speak more broadly about the town preparations for emergencies and the growing prevalence of mass attacks in American life — well over 300 of them since the 1960s.

It’s not that Newtown changed police practices, the Brookline officers say — but it changed people’s attitudes.

“For us, it’s something we’ve trained for, and been thinking about a lot, and doing planning and training around for many years,” Hatchett said. “But I think it increased maybe our community’s appetite for discussing options.”

Several years ago, Muise said, there was some resistance when Brookline introduced school drills to practice what would happen in a lockdown. Now, people not only accept them, they’re eager for more.

“That was very hard to try and sell to people at first,” he said. “But once we did, then it was okay, and then it was people coming up to us saying, ‘That’s some good stuff. What do we need to do next?’ And that’s where we’re at now. What’s the next level? And ‘options’ is what we have.”

By “options,” Hatchett and Muise mean the “Run. Hide. Fight.’ doctrine that’s increasingly espoused by law enforcement.

To date, the discussion has always been around locking down, hiding and locking down,” Hatchett said. “And now, what we’re trying to do, when we meet with people in the community, is to just have them consider that there are options — that locking down isn’t always the safest option for them. That if you can get out, and there’s a door 20 feet away from you and you can get to safety, that you should take that door. And get yourself and others to safety. And if you can’t, and you can’t hide effectively without being found by the subject, you have to consider fighting.” Continue reading

Medical Staff Preps For Code Silver, Or Active Shooter In The Hospital

Earlier this afternoon, police shot and wounded a man armed with a handgun in the Children’s Hospital of Wisconsin, triggering “a lockdown at the hospital,” reports The Chicago Tribune.

Sadly, the incident sounds all too familiar.

Think Newtown. Aurora. Johns Hopkins Hospital. Mass. Eye and Ear Infirmary.

Horrific shooting rampages in public places — even hospitals — are, insanely, becoming more and more common in American life.

So, many Boston hospitals, including biggies like Mass. General, Boston Medical Center, Beth Israel Deaconess Medical Center and Brigham & Women’s, are strongly urging (and in some cases requiring) employees to be prepared for a “Code Silver,” as some are calling it, or, in lay terms, an “active shooter” in the hospital.

Last week, about 1,200 Brigham doctors, nurses and other staff viewed the hospital’s new “Active Shooter Preparedness Training” video, which offers a step-by-step guide on how to handle a hospital shooter.

Ultimately, about 16,000 Brigham employees will see the 10-minute video, created with help from the Boston police department, Boston EMS, and other area hospitals. The shooter video will be part of the hospital’s annual training requirement, said a Brigham spokesman.

Screen shot 2013-11-12 at 9.47.02 AM

One Brigham doctor who saw the video last week said: “It was weird to see our lobby turned into a reenactment of terror,” and added that while the video may or may not help in real life,  “hopefully I won’t have to find out.”

“Shots fired in the hospital — the last sound you’d expect to hear,”  the video narrator says. “An active shooter situation used to be a phrase only used by law enforcement but as these are occuring more frequently, it is something that people in all types of organizations, including hospitals and health care facilities must learn about and prepare for.”

Actually, at the Brigham, this type of emergency is specifically not called a  “Code Silver.” (Everyone knows “Code Blue” from medical dramas, when a patient requires emergency resuscitation or immediate medical attention.) The term “Code Silver” was considered, said Brigham spokesman Tom Langford, but was ultimately tabled.

He explained in an email:

Other hospitals may use code silver, but we specifically chose not to. Here’s why: If there ever were an active shooter and a code was broadcast, only the staff would know what the code means. In an active shooter situation, it is extremely important that patients and visitors also know what’s going on so that they can evacuate the area as quickly as possible. Using a code could put patients and visitors at risk. So we would use a plain English announcement. Something like “There is a life-threatening situation in (location), please move away from the area as quickly as possible.”

Colors vary. MGH, which earlier developed its own shooter training video, deems this kind of emergency “Code Silver-Active Shooter” and BMC calls it a “Code Green.” And, according to the Mass. Hospital Association: “All Massachusetts hospitals are adopting and performing ‘Code Silver’ drills of some type, including some ‘shelter in place’ drills as a result of the Marathon bombing aftermath.”