Hospital security in the "Pope Zone"
Hospital security in the "Pope Zone"
When Pope Francis visited Philadelphia, several hospitals found themselves operating in a downtown "box"
Sound emergency planning requires safety professionals to adopt an "all-hazards" approach to planning for events in their hospital. But the plans start with a hazard vulnerability assessment, which requires planners to think about all the things that could happen to a facility. For instance, if Justin Bieber or another well-known celebrity were admitted to the hospital, most facilities have a security plan in place to handle the media onslaught that will inevitably descend upon them.
But what happens when the celebrity is so large, and the security so big, that hospitals can't plan for everything in advance?
It happened in Philadelphia in late September, when Pope Francis visited the city as part of his first-ever U.S. visit. With more than 3 million people estimated to visit the city, security was so tight in the downtown Philadelphia area that the Secret Service closed off a three-square-mile area that became known as "the box" to emergency planners. Within that box, only pedestrians were allowed. That meant no vehicular traffic?except for police, fire, and EMS vehicles?would be allowed to access the five hospitals that became "trapped" within that box. Needless to say, the situation forced hospitals in Philadelphia to get creative with their emergency operations plans.
"We had to make sure we could operate for seven days without resupply," says Herbert Cushing, MD, FACP, chief medical officer of Temple University Hospital in Philadelphia. "I'm proud of how everyone stepped up to do the right thing."
The Pope's visit was a carefully planned and orchestrated event, and Secret Service officials had reached out to city emergency planners as far ahead as April to start preparations. But the visit was expected to draw large crowds?many of them sick and elderly faithful followers?who had hoped to attend a huge Mass celebration that was planned. Although hospitals planned for the usual potential disasters such as mass casualty incidents, terrorist attacks, and an onslaught of illnesses such as heart attacks and dehydration that can come with a large elderly population, the sheer size of the event as well as the changing dynamics of the security perimeter required hospitals to constantly rethink their security plans.
"Our approach is [generally] to plan as if we were an island," says Matt Butler, MS, EMT-P, manager of emergency preparedness for Children's Hospital of Philadelphia (CHOP). "If we get to a point where we can't manage it effectively with the resources we have here, the next call is rally the troops, bring resources in to the hospital, and we weren't going to be able to do that."
Hospitals generally rely on what is known as "just in time" delivery of supplies, which ensures that trucks are able to restock hospitals with perishable supplies before they run out. But in this case, with supply trucks unable to get into the area, facilities had to plan to be on their own for up to a week?which required finding space to put all the extra supplies. In addition, in an emergency such as a snowstorm, extra staff can be called in as needed or even stay the night. But with mass transit shut down and all roads and parking garages into the downtown area closed off, facilities were forced to cancel visitations and elective surgeries, and to "hotel" entire shifts of workers at the hospital to make sure they would be able to get to work.
"We were told to plan like this is a major snowstorm, but we had to take this one to extremes," says Bernie Dyer, director of safety and emergency management for the University of Pennsylvania Health System in Philadelphia. Dyer added that in a typical snowstorm, his hospital might have 200 staff sleeping over, but in this case the hospital had to plan for 1,000 employees to be housed and fed?not to mention kept busy during their downtime. "People came in on Friday and stayed the weekend until Monday."
Any disaster or event?no matter how much a hospital plans for it?will cause disruption in daily activities and will lead to lessons learned. Philadelphia hospitals say that despite the temporary hardship caused by millions of people in a relatively small area of their city, the event wound up being a positive experience, one that required coordination with other hospitals and changed their planning practices forever. Officials at those hospitals share their experiences and give some takeaways:
- Start as early as you can. It's been said many times that one can never start planning early enough for upcoming and anticipated events. For the hospitals in Philadelphia, their success with the papal visit was because they began to plan as soon as the Secret Service came through the door.
"It would be easy to say we were going to increase our resources by 50%, but we don't have the room for that," Butler says. "When you have more than a million people coming, it's a whole different planning approach. If 1% require an ED visit, that could push a hospital into a surge event. This was a very unique scenario."
- Know what staff are available. Get your hands on schedules for surgeries early and often, and know what can be postponed. Determine where you will house and feed your staff who stay over. Figure out where the city will set up command centers, and make friends with the cops who will run them. These relationships made it possible for hospitals to be in constant contact with city command posts, who were able to coordinate special exceptions when traffic needed to get to the hospital?such as when patients needed to get in for important appointments, or to allow visitors with critically ill relatives to get in to visit.
Also, be ready to change your plan. Hospitals thought they were fine at first, when the city didn't expect the Pope to make an appearance. Then the Secret Service announced he would celebrate Mass. Then they closed off a large part of the city. Then they doubled the restricted area. Translation? The best plans make room for change?and change is inevitable. You may have enough cots on hand for the staff that will sleep over during a snowstorm, but what happens when that number doubles suddenly? Your plan for a large-scale event may include using the nearby parking garage for staff to park when they come to work, but what do you do when the Secret Service suddenly decides to close off that garage and use it as a command center and staging area for emergency vehicles? Always have at least one alternative plan in place.
"There are things you have to be ready for on the fly," says Dyer. "We doubled security staff to deal with buildings that weren't normally used. There was a large increase in people using bikes to get to work, so we needed a guard in that area. We had patients who had come in on a tour on a charter bus and had no way to get back to papal Mass. We used our security vehicles to help them get back."
- Organize your command structure. Hospitals in the Philadelphia area adopted (and swore by) the Hospital Incident Command System (HICS), designed as a flexible way to maintain organization during a major incident by establishing command and control and basically giving everyone a job to do. Based on the National Emergency Management System created by the government after 9/11, the principles of HICS are designed to apply to small or large groups of people; they designate groups of command structure that can help delegate smaller tasks within a large group. See page 4 for an example of a HICS command structure.
At CHOP, seven different "work groups" were designated, including patient care, staffing, critical resources, communications, a tech support group that helped identify potential trouble areas including an anticipated loss of cellular service, and a homecare group that helped coordinate patient services outside the hospital during the event. The beauty of HICS is that it allows smaller groups to operate and report to a commander instead of giving one person complete control over everything.
- Team up with your friends. Hospitals are realizing they can't operate in a vacuum when it comes to emergency planning. Every local facility is in an emergency together, and each should include mutual aid in its plans?and that means meeting regularly and discussing what things facilities can mutually benefit from. Many hospitals that were caught "in the box" in Philadelphia realized they did not have enough cots available for all the staff members that would be sleeping over, so they borrowed them from less-affected neighbor hospitals in other parts of the city.
- Find space wherever you can. When you've got millions of people surrounding your facility, almost 1,000 staff members sleeping over, and the need to stock your hospital with enough supplies to last a week, you're going to have to find space you never thought you had. That might mean turning a conference room into a supply closet, or using an on-campus museum or a building under renovation as a temporary staff hotel. Not enough bathrooms and showers? Rent a shower trailer.
- Take care of your staff. Yes, it's your staff's job to be on their game and keep alert enough to take care of patients. But you need to remember that in an adverse weather event or other incident that requires staff to sleep over at the hospital, you are taking them away from their lives, families, and everyday activities that would normally refresh them and give them the downtime they need. Unless you help them, they are going to tire of the situation very quickly.
Officials at Philadelphia hospitals knew they were asking a lot of their employees by having two fully-staffed shifts in the building at all times, so they tried to make things as comfortable as possible. At CHOP, employees were treated to a "Welcome Aboard" event on Friday night, and throughout the weekend they were provided with clean linens, catered food, and showers in a shower trailer that was brought in. In addition, conference rooms were outfitted with amenities such as lounges, table games, televisions, and other quiet spaces to give staff a space to decompress in.
"This was our first time doing this," Butler says. "Staff members were on for 12 hours, off for 12 hours, so we figured if they got a good night's sleep, good food, and downtime, that was a good trifecta. They felt like they were supported."
- Bring senior leadership on board. Sadly, a common complaint from safety professionals is that senior leadership does not take enough of an interest in emergency planning and security, and therefore gets surprised when safety lays out the need for big changes. When faced with a large-scale event, leadership must be involved?insist on it!?and kept in the loop. During planning for the Pope's visit, Dyer says the president and executive director of the UPenn Health System was involved in the meetings with the Secret Service to keep up to date.
- Include everyone. While it's important to include the senior leadership in planning meetings, it's also important to include everyone else, especially the people who will be directly implementing the security plans. UPenn formed many committees, some up to 50 people strong, and included employees from the ED as well as food services, security, and maintenance to allow them to be part of the process.
"Everyone has a reason to be there," Dyer says. "We pumped out information to employees and helped keep them updated on changing information. "