These events posed a significant challenge to UVAHS, not only to the emergency department but also the operating room and critical care and acute care units. Despite these challenges, the UVAHS emergency department cared for all patients that day, both related and unrelated to the event. The ability of the emergency department to meet this challenge was a direct result of planning and preparation that occurred over the preceding six weeks as well as past years.

The UVAHS Response

With the “scheduled” nature of this MCI, UVAHS and other community partners were able to prepare a coordinated response. The known time and place of this event, however, are in stark contrast to the unanticipated events managed recently by emergency responders in Orlando, Florida; Paris; and Boston.

Gurneys lined up outside of the University of Virginia Medical Center initial casualty collection point (the front entrance to the medical center), ready to receive patients.

First and foremost, situational awareness was a priority. During the planning process, UVAHS personnel were informed of the event and the potential impact on hospital operations, including casualty estimates and likely medical conditions generated, using the most likely and most dangerous scenarios. Graduated security options that included access to the facility were implemented. With these notifications, situational awareness was created weeks in advance and carried through the event.

Furthermore, health care provider emergency notification procedures were reviewed and updated when required. For the emergency department, emergency physician (both faculty and resident physician) call-activation systems were revised and tested using the GroupMe app; ED nursing, hospital-based EMTs, and clinical ancillary departments had similar plans. Trauma surgery, anesthesiology, and the various critical care physicians followed similar emergency notification simulations. In addition to emergency notification procedures, the specific medical care roles and responsibilities were evaluated and revised accordingly for the anticipated patient treatment needs. Lastly, potential longevity of the event and related needs were considered with the creation of at least two shifts of additional care providers (physicians, nurses, EMTs, etc).

UVAHS capacity issues were addressed; this portion of the response plan was also vital to operational preparedness and its eventual success. UVAHS leadership made the decision to limit nonurgent procedures and admissions 48 hours in advance of the event. Nonurgent transfers into the hospital were also limited at that time. With this approach, significant inpatient capacity was increased for acute care, including critical care units. Of course, with increased inpatient capacity, the emergency department was able to decompress, creating greater provider availability and bed space for patient management.