Saint Vincent Catholic Medical Centers of New York Response to the attack on the World Trade Center New York City September 11, 2001

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Saint Vincent Catholic Medical Centers of New
York Response to the attack on the World Trade
Centerand Report on Preparednessfor Future
Events
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Saint Vincent Catholic Medical Centers of New York

• 7 Acute Care Hospitals in 4 Boroughs of NYC
• Large Behavioral Health Network including a
  Specialty Hospital in Westchester County
• 4 Nursing Homes and 3 Home Care Agencies
• The Academic Medical Center of New York Medical
  College
• 1.5 billion in revenue
• St. Vincents Manhattan is the closest Trauma
  Center to WTC

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Disaster Planning

• Internal disaster drills twice each year.
• City-wide drills led by OEM.
• Close relationship with GNYHA which coordinates
  region-wide hospital efforts.
• Experience with other disasters including the
  bombing of the World Trade Center.
• Communications issues
• Supply Delivery
• City-wide traffic
• City-wide Inter-hospital communications.

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September 11, 2001846 a.m.
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The SVCMC Scenario

• CEO David Campbell holding a meeting with his
  Hospital Presidents in the Board Room of St.
  Vincents, Manhattan.
• Group hears airplane fly overhead and a loud
  thump.
• E.R. Director informs the group that EMS has
  declared a major disaster.
• Disaster plans activated in all 7 hospitals.
• 14 St. Vincents Paramedics and hundreds of other
  first responders are dispatched immediately.

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The First Hour

• St. Vincents Manhattan under the direction of
  President Jane Connorton, activates its Incident
  Command Center, opens six auxiliary emergency
  rooms, moves all ER patients upstairs, orders
  extra supplies, sets up triage teams, stretchers,
  and wheelchairs on Seventh Ave and goes into full
  Trauma Center major disaster mode.
• First Patients arrive by subway, taxi and
  passenger car.
• Patients begin to arrive by ambulance, some with
  8 -10 patients.
• Second plane hits South Tower.

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The Second Hour

• More patients arrive at Manhattan trauma center,
  others begin to be transported by boat to St.
  Vincents Staten Island, and still others arrive
  at Brooklyn and Queens facilities by taxi, bus,
  and on foot.
• Off -duty employees, physicians and nurses begin
  to arrive
• South Tower collapses. An SVCMC ambulance is
  destroyed, 2 others damaged. Paramedics missing
  for a period of time.

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The Second Hour (cont.)

• Patients continue to stream into the Manhattan
  Trauma Center and SVCMCs other emergency rooms.
• Extra supplies begin to arrive.
• North Tower collapses.
• Media begins to arrive at St. Vincents
  Manhattan, regular briefings begin.

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In the Center of the Biggest Media Event of the
Century

• Carefully designed disaster media plan put into
  effect.
• All hands on deckeveryone to their station.
• Keep the media in one place by providing what
  they need
• Constant information
• Good visuals
• Frequent new interviews
• Easy access to visiting dignitaries
• Food, coffee, sun block, bathrooms, tents,
  electricity, phone lines
• One voice.

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In the Center of the Biggest Media Event of the
Century (cont.)

• Coordination with city, state and federal
  spokespersons.
• Coordination with other health providers.
• Keeping the medias interest.
• Keeping the healthcare story on us.
• Providing experts in various fields.
• Honesty and integrity.
• Patient and family privacy.

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The Third Hour

• Patients continue to arrive by foot, bus, boat,
  ambulance, and passenger car.
• St. Vincents, Manhattan receives more than 450
  patients in the first two hours.
• St. Vincents, Staten Island more than 200.
• Water pressure drops to dangerous levels at
  St. Vincents Manhattan.
• Thenthe sirens stop and the patients stop
  arriving.

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Where is the Second Wave?

• Physicians, nurses, administrators all waited for
  the second wave.
• Only a modest number of additional survivors
  continued to arrive.
• Neighbors and other New Yorkers began to surround
  the hospital.
• All New Yorkers needed to do something.

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The Afternoon

• NYC OEM Command Center collapsed with the WTC.
  GNYHA expands its command center.
• Part of Disaster Plan includes setting up a
  Family Center.
• Thousands of families and friends arrived at the
  hospital or called in an effort to locate their
  loved one.
• Small Family Center became overwhelmed.
• New School University offers space.

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The Days that Followed

• More than 6500 families visit the SVCMC Family
  Center in the first days.
• GNYHA coordinates sharing of patient information
  region wide.
• Grief and trauma counseling are expanded.
• More than 10,000 calls received at our emergency
  phone center.
• Volunteers, food, clothing and blood donors
  continue to flood the hospital.

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The Subsequent Weeks

• Firefighters, police officers, and rescue workers
  continue to arrive from Ground Zero with
  injuries including eye abrasions, fractures, and
  breathing difficulties.
• The Anthrax scares begin.
• As Anthrax is confirmed in media offices and post
  offices, patients arrive by the hundreds seeking
  testing.
• City-wide coordination of efforts by NYC Dept. of
  Health and GNYHA.

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SVCMC System-wide Numbers

• More than 1400 patients seen in ERs
• 148 Admissions
• 6,900 visits to Family Center
• 16,000 calls to crisis lines
• More than 1200 visits for Anthrax concerns
• 248 Anthrax tests conducted
• More than 20,000 individuals undergoing ongoing
  counseling conducted by SVCMC Behavioral Health
  Service Division.

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The City-wide Numbers

• More than 7,300 patients seen in ERs
• 712 Admissions
• 26,900 visits to Family Center
• 376,000 calls to crisis lines
• More than 2900 visits for Anthrax concerns
• 482 Anthrax tests conducted
• An estimated 500,000 suffering from Post
  Traumatic Stress Disorder
• More than 100,000 individuals undergoing ongoing
  counseling.

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The Financial Consequences

• SVCMC has expended and lost revenue totaling more
  than 25 million.
• City-wide healthcare totals will exceed 500
  million.
• After 12 months of aggressive advocacy efforts,
  HRSA releases 140 million in funding to
  hospitals. SVCMC receives a total 22 million.
• Philanthropic gifts have increased.
• Nuclear, Biological, and Chemical (NBC) terrorism
  preparedness is enhanced.

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Lessons Learned

• Special attention must be given to other
  patients, their families, community members, and
  your employees
• Policy on volunteers and blood donors.
• Policy on sharing of patient information.
• Patient access in emergency area.
• Additional communications needs
• System-wide and city-wide.
• Business Interruption Insurance.
• The challenges of obtaining government funding.
• Accelerate preparedness for next attack.

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Media Lessons Learned

• Having a carefully designed disaster media plan
  paid off.
• Staff burn-out.
• The media really did stay in one place because we
  provided what they needed
• Constant information
• Good visuals
• Frequent new interviews
• Easy access to visiting dignitaries
• Food, coffee, sun block, bathrooms, tents,
  electricity, phone lines
• One voice.

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Media Lessons Learned (cont.)

• Coordination with city, state and federal
  spokespersons was vital and made us look better.
• Coordination with other health providers was key.
• We kept the medias interest and kept the
  healthcare story on us.
• Even in the weeks that followed and now 2 years
  later we are still called upon to provide experts
  in bioterrorism.
• Honesty, integrity, patient and family privacy
  paid big dividends.
• The media hogs.
• You never know when that camera is live.

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All Hazards Preparedness

• Ongoing preparedness for the system, our
  communities, our patients, and our staff.
• System representatives are serving on a regional,
  state and national level
• -GNYHA
• - NYC DOH Healthcare Task Force of the
  Committee on Weapons of Mass Destruction
  
• -HANYS
• - AHA
• -JCAHO
• -US Dept of HHS Preparedness Task Force

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Regional Preparedness

• Working with with regional hospital association
  and city-wide OEM to develop ability to better
  communicate with city agencies and other
  hospitals in a disaster.
• Developing new EMS protocols on transport of
  contaminated patients.
• Developing a redundant communications system
  (800 megahertz radios).
• Developing a data sharing system that enhances
  surveillance and detection, identifies excess
  capacity and needed resources and establishes a
  regional patient locator system.
• Most recently, developed region-wide
  pharmaceutical stockpiles.

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SVCMC System-wide Preparedness

• System-wide Preparedness Committee continues
  developing new protocols for incorporation into
  the seven hospitals and four nursing homes
  disaster plans.
• Focus is on staff training, pharmaceuticals,
  medical supplies, facilities needs, development
  of community disaster response plans and system
  communications to assure efficient sharing of
  resources.
• Estimated cost of SVCMC preparations is 10
  million.

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SVCMC System-wide Preparedness

• Preparedness Committees recommendations are
  currently being implemented and aim at assuring
  patient and staff safety
• -NBC Protocols
• -Pharmaceuticals (Mark I kits, Sodium
  Thiosulfate and Pre-Push Packs.)
• -Training
• -First responder courses
• -Staff Courses (including discussions and
  planning for lock-down scenarios)
• -Community Education
• -Equipment (PPE) and facilities
• -Employee Health (N95 mask- fit testing for
  all employees)
• -Communications

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SVCMC System-wide Preparedness

• Working closely with city, regional, state-wide
  and national preparedness efforts.
• Three SVCMC Emergency Rooms being rebuilt
  including the St. Vincent Manhattan Trauma Center
  which has been renamed the Rudolph Giuliani
  Trauma Center at St. Vincents.
• To be entirely rebuilt and expanded by an
  additional 11,000 square feet.
• Will include new ventilation system, expanded
  decontamination facilities, as well as built in
  surge capacity to quadruple the number of
  patients that can be seen at any one time, and a
  new all hazards mass casualty education center
  for healthcare professionals and community
  members.