Radiology Departments Taking Proactive Approach To Emergency Preparedness
On the night of July 14, 2016, tourists and locals were celebrating Bastille Day along one of the beachfront promenades in Nice, France, when a terrorist drove a truck through the crowd, leaving hundreds of battered bodies in his wake.
Almost 200 of the injured ended up before radiologist Nicolas Amoretti, MD, at the University Hospital of Nice. Many patients were unconscious, others did not speak French, and some had no identification, forcing hospital staff to write identifiers on the patients’ arms with markers. When the influx of information between the CT scanner and the operating room (OR) overloaded the system, transmissions were delayed by as long as 20 minutes. Radiologists used telephones to communicate with surgeons in the OR while reading from the screen.
Further problems ensued when a second CT scanner was utilized to handle the overflow of patients. “The second CT was on a different floor,” Dr. Amoretti recalled. “The staff bringing in patients didn’t know where it was, so we had to write directions on paper.”
Despite the challenges, doctors performed 18 surgeries that night and no patients were misidentified. Dr. Amoretti and colleagues detail the experience in the May 2018 Radiology study, “Terrorist Attack in Nice, France, in July 2016: Massive Influx of Patients to a Radiology Department.”
A Proactive Approach to Emergency Preparedness
From terrorism incidents and mass shootings to a string of natural disasters, emergency preparedness has never been more important in health care. While no health care facility can fully prepare for the unpredictability of such an incident, having an emergency/crisis plan in place is necessary to mitigate the impact.
Requirements for such plans vary by country. For example, the night of the terrorist attack, the University Hospital of Nice operated under its White Plan, an emergency preparedness procedure based on the broader nationwide framework known as the Orsan Plan.
In the U.S., the Joint Commission requires hospitals to have an Emergency Operations Plan describing how a facility will respond to and recover from all hazardous incidents. However, the Joint Commission does not require hospitals to include specialty departments, such as radiology.
For that reason, imaging may be left out when hospital administrators develop emergency preparedness plans, according to Ronald M. Bilow, MD, an emergency radiology director at UTHealth McGovern Medical School who is affiliated with Memorial Hermann Texas Medical Center, both part of Texas University Medical Center, Houston. Both facilities were in the path of Hurricane Harvey, which tore through Houston in August 2017.
“Most hospitals create plans through the emergency center,” said Dr. Bilow, who has held various leadership roles in the American Society of Emergency Radiology (ASER). “Some might include surgery and anesthesia, but traditionally many have not included radiology departments.”
That is likely to change as hospitals experience more disasters and realize the importance of including various specialties, including imaging. Radiologists are the best-trained to use imaging tools to quickly triage patients and provide surgeons with precise information on life-threatening injuries.