In another attempt to decompress the emergency department rapidly, the admissions process for event- and non-event-related patients was significantly curtailed, allowing patients to quickly move to an inpatient location, again creating ED capacity. This intervention, developed and implemented by the chief medical and nursing officers, was also very effective. With the increased ED and UVAHS capacity, the emergency department was able to accept a large number of patients over a very short period of time, with very efficient through-put to maintain readiness for additional patients.

Several additional patient care areas were created. One area, adjacent to the emergency department, was identified as an admission holding zone. This area normally functions as a preprocedure and recovery area for invasive radiology procedures; it is equipped with critical care monitoring, gas exchange, and suction capabilities. The hospital lobby, a very large open space, was identified as the triage point for the emergency department if the MCI plan was activated.

In addition, the circular vehicular entranceway into the UVAHS lobby allowed for the rapid entry of ambulances and other automobiles with patients. Patients were quickly unloaded and transferred into the triage area, where high-priority cases were immediately taken to the resuscitation areas of the emergency department. Lower-priority cases were managed in the lobby. Appropriate supplies, equipment, and electronic support for this area were identified and tested in advance. This equipment was stored in areas adjacent to the lobby for immediate use when triage operations shifted from the emergency department to the lobby.

The interface with public safety and other health care community partners, including fire-rescue and law enforcement leaders, was another very important area of planning and preparation. Regarding EMS response and care, UVAHA met with them and developed appropriate communication plans as well as a working knowledge of their ability to triage and manage patients at the event. Law enforcement interface was also vital, not only for security considerations in the emergency department and UVAHS but also for forewarning of the potential threats (eg, firearms, toxins, etc). A UVAHS emergency medicine faculty member, medical director of the Charlottesville Fire Department, was present at this forward triage area, allowing for physician-level triage in the field and direct communication to the UVAHS command center.

On Aug. 11, the UVAHS command center was opened and remained open through the late afternoon of Aug. 13. In the command center, an incident commander was identified along with various command and general staff positions (ie, clinical operations, logistics, plans, public information, and communications), each responsible for their specific area of UVAHS function. A member of the emergency medicine faculty, the medical director of UVAHS emergency management, was present and active on the incident commander’s staff. The command center was in communication using telephone, radio, and telemedicine.