Disaster preparedness, emergency response plans, and rescue training – in the past decade these phrases have become painfully real as disasters of epic proportions unfold throughout the world. Whether we see it coming or it takes us by surprise, whether it is natural or manmade, we cannot predict how much damage a disaster will cause or how much injury and mortality will be sustained. Hackensack University Medical Center (HUMC), located in Hackensack, N.J., has taken disaster response to an extraordinary level.
One of the top hospitals in the nation, HUMC recognizes the need to have a comprehensive disaster response plan. Since 2006, HUMC received $15 million in government and private funding to create an innovative program based on a modular concept that allows emergency response efforts to be scaled up or down as needed. HUMC designed and built two mobile acute care hospitals, known as MACH1 and MACH2, as well as a biologic incident response vehicle (BIRV) and a mobile support vehicle (MSV).
Flexibility and agility
Each MACH is a 43-foot box truck with expandable sides that is fully equipped to convert to a seven-bed intensive care unit, and it can be used as an emergency room overflow facility. The MACH Program can be deployed rapidly in the event of any natural or manmade disaster or catastrophe.
The BIRV is equipped with biological weapon detection and surveillance systems. The MSV has satellite capability and is designed for communications and logistics staff.
Design and construction is in the process for a mobile operating room that will have the ability to interlock and attach to the MACH1, allowing life-saving and stabilizing surgical procedures to be performed while the patient is at the disaster site.
“Not only is the MACH a disaster asset for our local community and the state of New Jersey, HUMC also is listed in the Federal Registry of Federal Assets,” said Joseph Feldman, MD, FACEP, chairman of emergency services at HUMC. “So at the pleasure of the governor of the state of New Jersey and the request of another governor of another state, the MACH Program can be deployed to not only another state but internationally.”
Deployment of the disaster team can occur within two hours of notification and be active within the tri-state area (New Jersey, New York, and Connecticut). If the MACH1 is requested anywhere else in the nation or internationally, it can be flown in a C5 or C117 aircraft.
Cross-training is essential
Each MACH is equipped with medical gases, portable defibrillators, telemedicine capability, portable digital X-ray machines, portable field laboratories, two portable transport ventilators, an arterial blood gas analyzer, and an onboard pharmacy. Recommended minimum required personnel for each of the MACH response vehicles consists of two HUMC emergency room physicians, three registered nurses, a registered respiratory therapist, a certified X-ray technician, two certified paramedics, two support staff members who assist in clerical duties and responsibilities, and a MACH vehicle operator.
As volunteers of the HUMC disaster response team on the MACH, cross-training is essential in order to operate as a cohesive health care team. Out of this team emerges a new skill set for RTs that requires training beyond the job description but within the scope of practice.
“Having respiratory therapists on the MACH disaster response team is a valuable asset,” Dr. Feldman said. “The respiratory therapists provide a specialty of care and are part of the multidisciplinary team at HUMC.”
Each RT volunteering to be part of the HUMC disaster response team must complete the MACH medical and support staff training program. As a part of the setup crew, RTs require the knowledge and training to safely position and level the MACH vehicle to make it operational. RTs also are trained on how to deploy and stabilize the MACH’s slide-outs and how to set up equipment.
For example, RTs must know how to operate the portable oxygen generators (POGs) that are used on the MACH to provide medical air to operate the anesthesia equipment and the ventilators. They also provide direct oxygen to patients and serve as a cylinder filling station for portable oxygen.
“Each POG can be operated independently or in combination to provide an unlimited oxygen flow 24/7,” said Joseph Grabianowski, mobile asset coordinator and MACH scale-up and scale-down trainer of HUMC. “The POGs can be deployed quickly and start producing oxygen for continuous use in any disaster without delay.”
Team members’ core characteristics
HUMC RTs trained to participate on the MACH disaster response team require an active respiratory care practitioner license for New Jersey, a valid basic life support certification, and advanced cardiac life support certification. Each RT has a minimum of two years of intensive care and emergency trauma experience, as well as being intubation certified. They must be able to wear a respirator and be fit tested.
RTs on the disaster response team complete a course through the Emergency Management Institute called “Introduction to the Incident Command System” (ICS 100) that provides the foundation for higher level ICS training. It describes the history, features, principles, and organizational structure of the ICS. It also explains the relationship between ICS and the National Incident Management System (NIMS). NIMS provides a consistent nationwide template to enable all government, private-sector, and nongovernmental organizations to work together during domestic incidents. Responders from different jurisdictions, organizations, and disciplines can combine services while responding to natural disasters and emergencies, including acts of terrorism.
Each RT is prepared to participate during a disaster at a moment’s notice. “Helping people in dire need during a devastating time is the natural instinct of a health care provider,” said Jason Steinfeld, RRT, a respiratory therapist at HUMC for nine years. “Knowing that my wife and family are in a safe environment and support me as a member of the MACH disaster response team enables me to contribute my knowledge and experience to provide the necessary care victims will require from our team.”
Deployment of the MACH can last up to two weeks. It can be set up directly outside the disaster hot zone. Bravery, humanity, courage, dedication, teamwork, and adaptability are the core characteristics required by all members of the disaster response team.
“This is just another example of the diversity of care the respiratory therapists are able to perform,” said Bruce Gelotte, administrative director of the HUMC respiratory care department. “The quality of training, standard of care, and level of professionalism that the respiratory therapists of HUMC provide directly transfers to their vital role as a member of the disaster response team.”
1. FEMA, 2011, IS-100.b – Introduction to Incident Command System, ICS-100, Retrieved March 6, 2011, from http://training.fema.gov/emiweb/is/is100b.asp
2. FEMA, 2011, IS-700 National Incident Management System (NIMS), An Introduction, Retrieved March 6, 2011, from http://training.fema.gov/emiweb/is/is700.asp
Colleen S. McGowan, BSHA, RRT, is supervisor of the respiratory care department at Hackensack University Medical Center, Hackensack, N.J.