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Around Johns Hopkins: Getting Ahead of Emergencies at Johns Hopkins Bayview

Johns Hopkins Bayview Medical Center’s emergency
management and safety coordinator, Todd Dousa,
participates in the “Operation Unplugged” exercise
to test the health system’s resilience during a

network and internet outage.

In a time of crisis, a hospital’s emergency management team typically leads the response. Outside a crisis, the team is preparing for emergency events by holding exercises and training. In upcoming issues of Hopkins on Alert, CEPAR will highlight an emergency manager and/or team at member organizations within the Johns Hopkins enterprise.

This issue, CEPAR spotlights Johns Hopkins Bayview Medical Center’s emergency management team. Todd Dousa, emergency management and safety coordinator, works with the leadership of Rachel DeMunda, director of environmental health and safety, to oversee emergency preparedness efforts in conjunction with departments throughout the facility, the health system and university faculty and staff on campus and other campus affiliates.

Dousa’s 27-year career started in emergency medical services, and included a deployment to support the survivors in Jefferson Parish, Louisiana, in the wake of Hurricane Katrina. He has been with Johns Hopkins Bayview since 2014.

Dousa recently responded to questions from CEPAR.

Q: What is your role in emergency management?

A: My main focus is ensuring the safety of our staff, patients and visitors as well as maintaining the continuity of care for our patients. This comes through various preparatory efforts, staff education, equipment purchases and training, and drills, as well as analysis of real-world events such as mass shootings and cyberattacks. This requires adaptability and the ability to understand the priorities of each area and practice and its function, and to ensure that everyone has critical needs met in case of an emergency event.

Q: How did you become interested in emergency management?

A: When I was growing up, my father was a volunteer in the local fire company, and I helped him study for his paramedic test in the mid-1980s. By age 11, I knew all the medications and treatments that paramedics in Maryland could give at the time. I joined the volunteer fire service in 1991. Over the years, I became a firefighter/paramedic/rescue technician/hazardous materials technician, and always had a special interest in emergency medical services and hospital emergency departments. In 1993, I was on my first mass casualty call involving a bus accident, which inspired me to get more involved in emergency response. In 1997, I started teaching emergency response and terrorism response for a government contractor, which is where I really started getting into hospital emergency management. 

Q: What are some of the unique emergency preparedness challenges Johns Hopkins Bayview faces? How are you working to overcome these challenges?  

A: The size of our 130-acre campus combined with different patient populations, business owners and tenants can be challenging. In addition, we are one of the five adult trauma centers in the Baltimore region and the only burn center in the state of Maryland, meaning we care for some of the sickest and most injured patients. Our location is also unique. We are acutely wedged in between two major highways and two major railways, which pose their own risk. 

Fortunately, Johns Hopkins Bayview has one of the most advanced and redundant electrical generator systems in the country, which helps mitigate power outages that occur more frequently than I’d personally prefer. Ultimately, staff education is where a lot of my focus goes to help alleviate rumors during emergencies, which can doom a response. Clean, accurate information transfer is critical in emergency situations, and training staff is critically important. Training staff on preparedness efforts we already have in place also helps to reassure staff regarding our resilience. This shows during response to events too.

Q: How do you plan emergency preparedness drills at Johns Hopkins Bayview?  

A: Our drills are based on the highest risks that our emergency management team sees as potentially impacting regular operations at Johns Hopkins Bayview. Loss of electronic resources, such as medical records, imaging, etc., was a significant risk that we were able to help prepare for by drilling the scenario. My team makes the scenarios as realistic as possible so that staff can experience the challenges that each presents.

Q: What is one of the more recent exercises you have planned?
A: In the last large-scale exercise, “Operation Unplugged,” we simulated a systemwide network and internet outage. We learned a lot about staff ability to function during IT downtime using paper forms to record clinical processes, since a majority have only been exposed to electronic resources most of his or her career. We also learned about what programs interfaced with others to provide test results, diagnostic information, etc. 

In terms of other drills, we have recently done department-based evacuation training/drills as well as department-based active shooter training/drills. Both of these occur on a regular basis, and staff members appreciate knowing that the medical center is prepared for the unthinkable.

Q: How were you involved in recent local mass casualty events in which patients were transported to Johns Hopkins Bayview?

A: During the mass shooting at a Rite Aid distribution center in Aberdeen, I received the initial notification and shared it with our emergency department, where I remained until patients started arriving. The house supervisor and I then opened our hospital incident command center (HICC), where I served as the incident commander for the event. The HICC coordinated patient care flow, support services in the areas caring for patients, family and visitor management, media and more.

In October, an apartment fire with an explosion in Baltimore City injured several people. Johns Hopkins Bayview received an apartment resident with life-threatening injuries and six firefighters with burns. Again, I alerted the emergency department when I got the notification and assisted in preparations for the patients. While we didn’t set up a formal hospital incident command center, I served as the incident commander for this event as well.

Q: What are some projects you are most proud of?
A: During inclement weather, employees may, on occasion, stay on campus for their safety and are therefore assigned resources to make their time here more comfortable. Refinement of the “Hotel Bayview” process continues to evolve, and it’s nice that we have made the process much more efficient. 

Also, ensuring that departments are prepared for emergencies and have some hands-on resources is extremely important, especially when I can make the implementation process simple and nonintrusive.

But the one thing I can say I am most proud of is the unification of everyone on campus during an emergency event. Since I have been at Johns Hopkins Bayview, ensuring that everyone on campus knows about an emergency and the impact has been a challenge. We have certainly evolved, and all entities communicate and work in harmony to manage through the event with as minimal impact as possible. Considering the size and complexity of the Johns Hopkins Bayview campus and its tenants, that has been a major undertaking on its own, and I am proud of how everyone comes together to provide the best services in any challenging situation.