Emergencies, such as a crisis on a holiday when a hospital is lightly staffed, a mass casualty event and a dangerous flu outbreak all present major challenges for a medical center, which must continue to provide high quality care when patient numbers surge and resources are limited. Health professionals from Washington University in St. Louis (WUSTL), BJC HealthCare and Barnes-Jewish Hospital (BJH) are confronting such challenges with a collaborative effort to achieve sustainable readiness.

Attending physicians at BJC hospitals are Washington University School of Medicine (WUSM) employees, while the hospitals’ residents are Barnes-Jewish and Saint Louis Children’s Hospital (SLCH) employees who are provided oversight by WUSM attending physicians. With the staff, patient care and facilities of the medical campus so closely intertwined, it is necessary to align and coordinate all aspects of emergency preparedness. Representatives from BJH, WUSM and SLCH attend all emergency preparedness meetings within each institution. WUSTL and BJC have also formed strong partnerships with medical center neighbors, including St. Louis College of Health Careers, Goldfarb School of Nursing and St. Louis College of Pharmacy. 

BJC, WUSM Share and Co-Brand Policies

Policies related to emergency preparedness are often co-branded by both BJC and WUSM since they will be utilized by employees assigned to both institutions. WUSM plays an integral part of BJC policy development because the physicians involved are providing clinical guidance and direction during emergencies.  One example of this is the plan on emerging and pandemic respiratory illness, which is used by all BJC hospitals and WUSM.

WUSM and BJC have worked together on the establishment of incident command training and leveraged resources when responding to incident command centers. Notifications of emergencies are initiated to key emergency preparedness contacts at all institutions, and roles of response and support have been identified. The use of similar communication platforms has enabled robust communication between the hospitals and the school. This facilitates activation of emergency information so it can be rapidly deployed. We have even established a unified command center where all entities can work to manage the incident together.

WUSTL and BJC have partnered to develop similar communications platforms for daily and emergency uses.  Since 2008, we have contracted with the same mass communications company, Everbridge, to send communications to personal devices (SMS text messages, E-mails and voice calls). We also include a few key individuals in each other’s emergency alerts so that we are aware of the crisis and can make a determination if it may affect us or if it requires our support. If a mass casualty incident were to occur, this system would recall necessary clinical personnel. We are currently working with Alertus to integrate on-campus communications solutions (desktop pop-ups, indoor public address, cable TV override, digital signage, etc.).

On a larger scale, we are utilizing a program called eSponder, which is a Web based incident management system. eSponder is a communication medium that is used at a regional level (eight counties in the St. Louis metro area) to share situational awareness among our various facilities, first responders, public health and emergency management. BJC HealthCare has initiated this tool, which can be viewed by WUSM. WUSM emergency management has access to post information as an active member of the BJC HealthCare ICS team. WUSM is advised of drills and incidents, and is a key stakeholder to the the hospitals’ ICS. 

Patient Surge Response Is Seamless

Coordination of surge within hospitals is a critical process since we are sharing staff and facilities, and this is reflected in the emergency operations plans. Patients may see a resident employed by BJH or an attending physician from WUSM, receive treatment from a WUSM department and then go immediately to a BJH department for testing. This process should be seamless to the patient just as emergency response should be seamless between our employees regardless of their affiliation.

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BJH has Memorandums of Understanding (MOUs) with both WUSTL and the St. Louis College of Pharmacy to use large spaces such as gymnasiums as patient surge areas in the event of a mass casualty/mass illness. These MOUs are often tested when we conduct drills to ensure that communications paths work, access to the buildings are still current and that the spaces can be set up as functional areas.

BJC HealthCare and BJH have emergency caches to be used in the event of patient surge. These products, as well as those in regional caches, will benefit all institutions when used by physicians and clinical staff to enhance the patient care capability during emergencies. BJH also has an agreement to utilize the WUSM cadaver space in the event of the need to respond to a surge of decedents during a mass fatality incident.

STARRS Manages Funding, Emergency Response

One of the driving forces for emergency response coordination in the region is the St. Louis Area Regional Response System (STARRS). Conceived in 2003, STARRS is a nonprofit organization responsible for managing funding for homeland security and emergency response projects in the greater St. Louis region. The scope includes natural disasters as well as chemical, biological and nuclear threats. The initiative involves two states (Missouri and Illinois) eight counties, 171 governments with fire protection services, 55 hospitals, 90 police agencies and numerous EMS agencies to coordinate disaster planning and response funding. Projects associated with STARRS serve a combined population of 2.4 million spread over approximately 4,600 square miles.

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Many regions have emergency operations centers and supporting software, but STARRS is the first to wrap rapid response collaboration capability around emergency operations that allow coordinated planning and response across multiple jurisdictions. A number of unique programs and plans related to surge capacity have been initiated through the grant funding received through STARRS.

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