January 8 A Tucson Tragedy and a hospita s response Thursday, September 22 nd 10:30 AM - 11:30 AM Presenters Stephen Brigham, Architect Director of Capita Panning & Projects University Medica Center - Tucson Michee Ziemba, RN MSN Director of Trauma & Emergency Services University Medica Center - Tucson 1. Hear first hand from hospita administrators invoved in one of this years most highy pubicized tragedies. Learning Objectives 2. Learn how a trauma center responded to the cinica and operationa requirements for managing a nationa tragedy. Learning Objectives 1
3. Learn how a hospitas need to be physicay and operationay prepared to accommodate a hospita surge in the event of any interna or externa disaster. Learning Objectives 4. Discover how faciities staff served in centra roes during the event and in subsequent responses to news agencies, governmenta agencies, and community vounteers. Learning Objectives This was tough year due to natura events Earthquakes and vocanoes Weather 2
and too many un-natura acts of vioence Japan Earthquake and Tsunamis Japan Tōhoku coast Japan Tōhoku coast 3
Norway Japan Tōhoku coast Bombing in Oso and massacre on Utøya isand Jopin tornedo St. John s Regiona Medica Center St. John s Regiona Medica Center Jopin, Missouri 4
St. John s Regiona Medica Center and then there was Tucson on January 8, 2011 Jopin, Missouri Where is Tucson? Tucson 5
Who is Arizona s academic medica center Leve I Trauma Center for Southern Arizona 487 icensed beds 526 bed capacity Nationay recognized: is now Recent merger with University Physicians Inc. Integrated corporations and systems 6,000 FTE in Tucson ED / Trauma Center Recenty competed addition Main hospita entrance New heipad New ED / Trauma Ctr. 54 ED rooms 7 Trauma bays 2 adut ICU units 2 adut med/surg units 88 adut beds Chidren s Medica Ctr. 116 peds beds $184 M project 215,000 sf. 6
Trauma Center 1st eve Heipad 7 th eve Hospita main entrance Ambuance entrance Surgery 1 st eve VIP patient room 3rd eve Emergency Dept. 1 st eve Memoria site Secondary entrance Media staging areas U.S. REP. GABRIELLE GIFFORDS TO HOST FIRST CONGRESS ON YOUR CORNER OF THE YEAR ON SATURDAY Arizona Daiy Star - January 8, 2011 10:15 January 8 Notified by centra medica communications that t there had been a shooting with 10 victims and 4 medica heicopters were dispatched Next ca UMC asked to take 7 immediates, 4 DOA on scene Media and aw enforcement begin coming to UMC 7
Muti-Casuaty UMC Arrivas Timeine, Jan. 8, 2011 1030 1100 1130 1200 1230 1300 1330 1400 1430 1500 1530 1600 1630 1700 ~ 2100 Emergency Department Response Patient K Patient I Patient G Patient F (heicopter) Patient J Patient H Emergency Medicine Physicians mobiized and prioritized the care of a patients and caed in additiona physicians. Avaiabe Trauma Surgery Staff in house (4) arrived in the ED as we as surgica resident staff avaiabe. Patient E (heicopter) Patient D (heicopter) Patient C LEGEND Arriva at UMC Patient B Triage started Patient A Patient s transferred in: Attending and resident staff divided themseves among the trauma bays to care for patients. Additiona nursing staff pued from other ED areas to staff the trauma bays and incoming. Patient s arriving from scene: Physician Room Assignments Patient Destination = Surgery Intern = Surgery Upper Leve 2 1 6 of the patients were taken directy from the ED to the OR = EM Intern = EM Junior 3 4 5 patients admitted to the Trauma Surgica ICU = EM Senior = Surgery Attending 5 6 5 patients admitted to the Trauma Intermediate Care Unit = EM Attending 7 1 deceased PICU 8
Immediatey started working on identifying the famiies and the victims Poitica famiy and bood famiy Famiy and friends paced in arge conference room area for initia briefing Individua updates done privatey with each famiy group A done prior to press conference Visitors and Famiy Incident Command Initiay, a mutiagency incident briefing was competed. UMC, Sheriffs, TPD UMC impemented forma incident command structure for emergency operations. This asted through Sunday UMC maintained stand down emergency operations mode through the foowing week with reguar briefings to key stakehoders. Daiy morning briefings prior to press conference and as needed. Incident Command Overview of Activities Incident Commander Visitation/Access to Faciity by patients and famiies Staff Arrivas and Support Pubic Information Officer Safety Officer Privacy Discharges Liaison Officer Medica/Technica Speciaist Media response Dignitaries visiting Operations Section Chief Panning Section Chief Logistics Section Chief Finance/Admin Section Chief Donations and Memoria 9
Pubic Affairs Team The on-ca person assumed responsibiity eary in the situation and then other staff caed in, recognizing the high profie patient and media response Others on ca and stayed overnight to manage media Teams brought in from other departments to support efforts Pubic Affairs Objectives Unified spokespersons for the event: Dr. Rhee Dr. Lemoe Kevin Burns - CEO Michee Ziemba UMC Admin Director for Trauma (as needed) Dr. Randy Friese (as needed) As things setted, other subspeciaty comments as appropriate: Dr. Kathy Hier, Emergency Medicine Pre-hospita EMS representatives Nursing Media Response Daiy press conferences in Kiewit auditorium adjacent to hospita but outside hospita buiding to reduce access to hospita by unauthorized staff Schedued daiy updates and website updates to reduce interruptions and mutipe demands Transparent and avaiabe for interviews to avoid others from specuating and speaking on the event and the need to have specific taking points and messages Embraced the media Limited spokespersons on event: Dr. Rhee and Dr. Lemoe Media Food three times a day Toiets Treated them ike we treat patients, visitors, and community how we want to be treated Media embraced us Famiies first, then the media 10
Safety Officer Security iaisons Director of Security A security staff required to do extended shifts Immediatey ocked down and secured entrance to UMC (due to vioent event) Faciity visitation by patient famiies Controed access to the faciity Name badges for patient famiies Protection of high profie patient Protection of staff and patients from media Protection of visiting dignitaries Security of the Memoria Worked coaborativey with muti-agency response TPD FBI Sheriff Secret Service NASA Congressiona Poice Staff with dignitaries Victim Witness Agency Needs and Accommodations Need for space for them to work Space cose enough to patient and famiies Dedicated famiy ounge and or conference rooms Need teevision i Need Internet connections, computers Refreshments Visitation/Access Lock down -- Stayed on Lock down for 6 days Night-time visitation at two entrances staffed by UMC and Tucson Poice Dept Vaidation of ID Check in for appointments ID badges issued to famiies Difficut and chaenging but improved Additiona computers and staff required to manage the infux of patients and visitors Management of access for patients/visitors, physicians, staff, and students Much improved within 48 hours 11
Famiy Advocacy Famiy first, then the media updates Support, advocate, and educate for famiies Famiy spokesperson and wishes articuated Chaenges with patient s right to privacy and patient confidentiaity Nationa media and the President can make you drop your guard. Poicies and procedures over rued and brought us back to focus Privacy The chaenge of ensuring patient privacy with transparency to the media 3 empoyees terminated for unauthorized access to the victims medica record Resources to protect t the privacy of the patient t and monitor medica record access of victims Discharges Discharges which normay occur at the main hospita entrance were redirected due to media truck presence and pedestrians out on the awn UMC was fortunate to have the Diamond Chidren s obby to avoid congestion for discharging i patients t Staff Arrivas and Support Staff arrivas were encouraged through badge contro entry ways in faciity to avoid front obby congestion Staff support for CISM debriefings and team discussion 1/9/2011 and continued through the week Staff vounteering coordinating through the staffing office Hospitaity cart for a departments to recognize a staff in the faciity and support them. Continued daiy through January Enhanced eadership rounding on staff 12
Dignitaries Visiting President Obama and First Lady Governor Brewer Congressman Rau Grijava Nancy Peosi Janet Napoitano Senator Kye Senator McCain Dr. Sanjay Gupta Hospita Memoria The memoria began on day 1 and grew every day Community vounteers were constanty on-site Who was going to manage the increased media and community attention? What was going on at the Safeway Store and Giffords office? The Memorias Internationa focus "When something happens ike this in a pubic pace and anyone coud have been a victim, we suddeny reaize we're a vunerabe and we're a connected in a profound way... The Arizona Repubic 13
on a hospita Memoria sites The memoria at the hospita started on day 1 and grew every day Tragedies generate pubic passions, vigis, and media interest Coordination started immediatey with other sites invoved in the event (Safeway and Congresswoman s office) Memoria panning Four panning phases: 1. How to manage active memoria(s) 2. Dismanting / cosing down memoria(s) 3. Permanent memorias 4. Fund-raising / donations 1. Memoria management Assign someone who is not invoved in cinica or daiy operations Work with security staff to genty contro access Coordinate with Incident Command Engage key stakehoders and chidren Coordinate with victims/famiies Acknowedge past disaster victims/famiies Poitics focus on what hospitas do Remember other patients (and staff) in the hospita 14
2. Cosing down memoria(s) Re-connect with staff not directy invoved in the initia event Pan the cose-down ceremony with staff, vigi eaders, and famiies Storage not trash - No dumpsters - moving vans Hospita chapain non-denominationa spiritua eader and messages Engage an archivist if the event is significant 3. Permanent memorias Pre-pan before the event memorias at a hospita? Aow time to make tough decisions Shift the focus from the hospita to the community - oca governments Be carefu of donated services, art, or contractors Beware of indirect marketing efforts Provide reguar updates 4. Fundraising Be prepared to accept and ceebrate sma spontaneous gifts Use community organizations to hep victims and famiies first Hospita fund-raising can not overshadow other disaster needs Coordinate with hospita foundation and other community foundations Donations Received arge donations of food for the victims, staff, aw enforcement, and media Restaurants in the community stepped up to provide food Donations of money to the victims and Trauma Program Coordinated through UMC Foundation Community Food Bank Fowers to oca nursing homes 15
Lessons earned - 1 Organizationa readiness and commitment A hazards emergency preparedness Patient Progression initiative Patient Famiy Service Exceence Initiative Investment in Trauma System participation with EMS and community partners Commitment to be the ony trauma center and meet the needs of Southern Arizona Positive reationships among our organization s coeagues and reationship in the community Lessons Learned - 2 Active participation with community stakehoders Commitment to performance improvement we review past experiences and we keep getting better Commitment to best practice and innovation Dynamicay changing environment Academics: we are expected to be the innovators, eaders, and chaenge ourseves to find a bigger and better way. Lessons Learned - 3 Our team benefited from going through this together Greater cohesiveness among the team More purpose and meaning to our work Emotiona impact--it affected a of us Community response and how much the community and the nation cared for us: Admiration for the work we do You must reay work hard You did a fantastic job You made us proud Lessons Learned - 4 Tucson became caregivers. The whoe community came together to unite and care for each other. We cared for them whie they cared for us. Peope fee ike they know us. The community is proud. The eve of visibiity and awareness for the things we do everyday. (Difficut to get used to) The nation became Arizonans. 16
Together We Thrive: Tucson & America The next steps of community coaboration to move forward from this event 17