Ten years ago the staff at Rush University Medical Center watched a news report on a mass casualty accident happening in Chicago. Rush was responsible for handling the influx of trauma patients flowing into the emergency room.
But the event wasn’t real. The videotape playing the newscast was pre-recorded; it was the start of Rush’s standardized staff training on mass casualties. As the years have passed, the Rush medical staff has trained on everything from hazmat suits to radiation safety—especially relevant in the wake of recent tragedies such as the March tsunami and earthquake in Japan.
“We actually had patients come in saying they were afraid they were exposed. So that was an example where we kind of sat back, and we said, well this isn’t going to affect us, but this is a good opportunity to get up to date on radiation injuries and exposure,” said Dr. Dino Rumoro, chairman of the department of emergency medicine.
The refresher course on radiation also motivated the physicians into moving from reactive mode into proactive mode when it comes to considering disasters.
“That’s a lofty goal,” Rumoro said. “We know we’re not there yet. The thing is with the new center opening, we’re going to have to be more like that.”
The McCormick Foundation Center for Advanced Emergency Response will open in January, putting to test the skills and programs Rush physicians have been building for a decade.
When the physicians came up with the concept for an advanced emergency response center, training had to come up with it. The newly formed Department of Homeland Security got the process started by giving Rush a million-dollar grant.
Rush used it to train about 20 medical residents and board-certified emergency physicians in advanced emergency response.
The doctors took several “merit badge” courses in order to assess the worthwhile programs and to be better trained at handling mass casualty incidents. The doctors were also putting together what they believed to be the ideal training program for emergency physicians.
Training included advanced hazmat training courses, advanced disaster life support courses and even international trauma life support courses. The doctors worked with the Chicago Fire Department for first responder training. They also traveled to the Noble Training Center, formerly known as the Noble Army Hospital, in Fort McClellan, Ala., that provides a national training center for medical weapons of mass destruction (WMD) training with the Federal Emergency Management Agency. The doctors went to the Radiation Emergency Assistance Center/Training Site in Tennessee for radiation emergency training, and also traveled to Camp Atterbury in Indiana for bomb training with the military.
After taking courses, Rush doctors created the Rush Advanced Trauma Training Program. The goal is to provide military battlefield medics and first responders with skills to reduce mortality on the battlefield.
In the weeklong program there are three labs–the first has participants working with cadavers to learn skills like airway management and chest tube insertion. In the live tissue laboratory, doctors and servicemen work on skills like suturing and cardiac repair. Finally, the Rush team created a 10,000 square foot area for a combat trauma simulation lab. Participants work on injuries such as a blast lung injury, an impaled abdominal object and even smoke inhalation with burns.
“We put on basically a mass casualty event,” said Dr. Edward Ward in emergency medicine. “So it’s a bomb that goes off and you’ve got soldiers and civilians mixed in together. The soldiers are sent to the area and it’s as close to reality as we could. We find the ones we can save, the ones who have to go now, and the ones who we can’t help at all. And that continues as we find the patients that need to get transported into our simulation lab across the street.”
Rush and the military have developed a relationship through the course training. Ward said the doctors often hear from the military that they don’t get the opportunity to be taught by physicians—something that would be beneficial in a war zone.
“It’s a two-way learning street,” Rumoro said. “They learn how we do it as civilian first responders, and then we also learn from them how they do it as a civil support team.”
Now the doctors hope to take the skills learned and ideally create a Rush manual to be distributed. The doctors are not aware of any other local hospitals with a training program like this, and hope to spread the word.
In the meantime, the doctors prepare and train for the opening of the Center for Advanced Emergency Response.
“Now we have to say to the nurses, ‘do you know how to do triage for radiation injuries?’” Rumoro said. “The initial pushback is going to be ‘I still want to learn how to do triage for chest pain,’ but as a center for advanced emergency response, you have to say, ‘now we take it to the next level.’”
At this point, Rumoro is working on the minute details that make the new hospital specialized. He works with the engineers and architects on the embedded design features in the new center, such as the airflow throughout the center’s layout of three divided pods. Every time a change is made, the operating policy and procedure for who pushes the button and makes the call also has to be altered.
But on July 1, hospital staff will have six months to begin training the staff in the new center.
“So we have approximately six months from July to January to figure out where the buttons are and how to push them,” Ward said. “There’s a lot of unique things to the physical layout of our department that is going to be new to everyone that comes through there.”
The advanced training will happen closer to opening day, Rumoro said.
“Obviously it’s not going to end when the doors open,” Rumoro said. “In my mind, that’s just the beginning. We’re going to work out a lot of kinks with simulated patient encounters, but honestly it’s not until you really hammer the system with real patients that you’ll start to uncover where we forgot something, and we’ll have to adjust on the fly.”
