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Emergency gear

Swedish Medical Center has spent tens if not hundreds of thousands of dollars on equipment to protect employees and decontaminate victims of a chemical attack, Klaas said. Although the hospital has never experienced such a disaster, it has conducted simulation drills using a busload of Army soldiers playing victims.

"You have to make sure you have the proper surveillance and triage of victims when they go through your doors to make sure they don't contaminate your staff and the building," Klaas said. "[You also have to make sure you] have the proper ability to diagnose and treat victims once they come into your building."

Among the lessons learned through the drills, Klaas said, is the importance of having clear lines delineating the various "hot zones" where highly contaminated, mildly contaminated and clean victims are kept. Victims who are clean, for instance, need to be kept separate from other victims to prevent them from being recontaminated.

Another lesson learned was how difficult it is to communicate while wearing protective gear, in large part because the respirators medical personnel have to wear make noise.

"We had to go back to the drawing board to figure out a hands-free means of communicating, so we didn't have to walk over and yell at the next person or write something down," Klaas said.

Protective gear now includes hands-free radios. The hospital also discovered that people using the protective gear need to be spelled after an hour or two, meaning it's important to make sure the hospital has enough people on hand to take over when they need to rest.

Health care professionals also learned that it's important to decontaminate victims using tepid water, Klaas said, because cold water can cause hypothermia or lead some victims to cut short their shower before they're completely decontaminated. Water that is too warm can dilate blood vessels and speed the flow of contagia through the body.

Klaas said the drill forced them to look at the logistics of the showering process, patient identification, marking of valuables and the flow of patients. They also had to consider how willing victims would be to shower naked as compared to the soldiers, who showered in shorts and T-shirts.

Like other hospitals, Swedish Medical Center has received funds from the federal government to help it pay for special equipment needed to decontaminate victims and protect health care workers. Its decontamination tent cost $15,000 and respirators, 15 of which had to be purchased at each of its three campuses, cost $1,000 each.

Washington state is working to make sure the equipment used statewide is the same, Klaas said, so that workers from other parts of the state brought in during a disaster will know how to use the equipment. She said once the immediate problems subside, hospitals must go through substantial financial recovery and reimbursement, as well as a debriefing and an emotional recovery process.

"It would be horrible to lose a good worker because they're so shaken they won't be able to help you in the future," she said.

All systems go

Swedish Medical Center uses the Hospital Emergency Incident Command System (HEICS), which originated in California, to guide its actions during an emergency, Klass said. The system and the drills that are mandated either by state law or the Joint Commission on Accreditation of Healthcare Organizations has made its response to disasters much more effective, she said.

"We haven't had the horrendous chaos we would have experienced five to 10 years ago," Klaas said. "We have the structure and support in place to get us through it."

Maribeth Woitas, RN, director of emergency services at North Memorial Medical Center in Robbinsdale, Minn., said her suburban Minneapolis hospital also employs the HEICS program.