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Around Johns Hopkins: Preparing for Emergencies at Suburban Hospital

Cindy Notobartolo (left), Suburban Hospital's
administrative director of emergency
department/trauma, safety and security
services, and Donna Sasenick, Suburban
Hospital's manager of safety and emergency

A hospital’s emergency management team is the team you call in a crisis. When there is not an issue, the team is preparing for one by holding exercises and trainings. 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 Suburban Hospital in Bethesda, Maryland, where Cindy Notobartolo, administrative director of emergency department/trauma, safety and security services, and Donna Sasenick, manager of safety and emergency management, have been leading the emergency management team together for more than a decade. Both come from emergency medicine nursing backgrounds. Notobartolo has been with Suburban for 24 years, and Sasenick has been with Suburban for 15 years. They wear numerous hats through their roles, but response and planning for emergencies are daily aspects of their jobs.

Notobartolo and Sasenick recently responded to questions from CEPAR.

Q: What are some of the unique emergency preparedness challenges Suburban Hospital faces, particularly when compared with other hospitals in the Johns Hopkins Health System? How are you working to overcome these challenges?

A: The top current challenge for Suburban Hospital is connecting a newly constructed 300,000-square-foot building extension to the existing hospital infrastructure and utilities. The excavation for this new building is taking place in and around the hospital’s main plant operations hub. After previously conducting a hazard vulnerability analysis, our emergency management team determined that utility failures and disruptions are the No. 1 risk to our hospital. In mid-August 2018, flooding from the excavation site disrupted electrical service, resulting in the hospital relying on backup generator power for two consecutive nights. During this time, lighting, air conditioning and fire systems in the hospital were supported, and our hospital’s Incident Command Structure was activated. Other previous incidents relating to the construction involved the cutting of a gas line, water shutdowns, floods and IT disruptions. We help minimize the impact of such emergencies on patients by writing additional and expanded response plans, communicating to all impacted managers and staff members, purchasing supplies such as lanterns and portable wash sinks, and providing just-in-time training for staff.   

Q: How do you plan emergency preparedness drills at Suburban?

A: We look at risk and, in novel ways, bring the concept to staff at all levels. In December 2017, a team of Montgomery County Police, Security and Emergency Management staff provided active assailant training in each department at the hospital for both day and night shifts. Through the training, the interactive dialogue and concept of mental pre-planning helped staff highlight the need to consider “Run, Hide, Fight” and other ethical dilemmas should such an incident take place. We have also embedded behavioral health components and treatment areas in all our mass casualty incident exercises since these are ever-present in all stressful events.

Q: What is one of the more recent exercises you have planned?

A: In April 2018, our team helped plan Suburban Hospital’s preparedness for an enterprisewide IT disruption. The exercise was well worth the time and energy. Before the exercise, each department began by reviewing and updating their Continuity of Operations Plan — plans that help the respective areas continue providing essential services during unanticipated events or loss of basic infrastructure, supplies or services. During the exercise, each department responded to the impact of the IT disruption and how staff members were able to function without the internet, electronic medical records and more. One of the most significant lessons learned was the importance of the flow of communications between IT and operations leaders. The emergency management team, along with experts from the communications and IT departments, worked together to develop an algorithm to assist the flow of information and aid the decision-making process. The algorithm, which has since been successfully implemented, will be useful in the event of an actual IT interruption — one of the more common types of emergencies that lead to executing response plans. After different IT interruptions at Suburban, we have adjusted and refined our plans.

Q: What are some of the projects that you have worked on or are working on at Suburban Hospital of which you are most proud?

A: Our team has led the Stop the Bleed initiative at Suburban Hospital since September 2016. Stop the Bleed is an awareness campaign and a call to action launched by the White House in October 2015 that encourages bystanders to become trained, equipped and empowered to help control bleeding before professional medical help arrives. Since its inception at Suburban, our trauma staff members have held more than 20 Stop the Bleed training sessions. Suburban’s program has also had contact with more than 400 people in the community in addition to hospital employees.

Stop the Bleed training has been included in regional disaster exercises, of which Suburban has been a part. Many groups in the hospital have received the training, including the Department of Surgery and the Nursing Professional Development Council. Suburban staff members have also held several Stop the Bleed classes for the community at Montgomery Mall and have taught techniques to teams from agencies including the Montgomery County Citizen Emergency Response Team, the National Cancer Institute, Whelan Security at the Discovery Building and the Maryland Institute for Emergency Medical Services Systems. The Suburban Stop the Bleed team also participated in Stop the Bleed training at the Miller Senate Building in Annapolis, raising awareness and teaching our state lawmakers to become immediate responders.

Another major project began in February 2004, when our team helped establish Suburban Hospital as a founding member of the Bethesda Hospitals’ Emergency Preparedness Partnership (BHEPP), a joint effort that continues today. The partnership created the first emergency response collaboration of the Department of Defense and federal and private health care facilities in the U.S. The partnership currently includes Walter Reed National Military Medical Center, National Institutes of Health Clinical Center, National Library of Medicine and Suburban Hospital. The principal goals of the collaboration are to integrate and leverage our complementary resources to provide an immediate and sustained response to any local, regional or national emergency and to develop a transportable, proven model for defining best practices in casualty care management and mutual aid through ongoing multiagency collaboration and training.

One of the first initiatives implemented by the BHEPP was the Collaborative Multi-Agency Exercise (CMAX), a health care coalition that has since expanded to include other regional partners. Through CMAX, collaborators share resources associated with an established patient decontamination program as well as other equipment and supplies in case of a real-world emergency event. In the past, CMAX has held yearly large-scale mass casualty exercises — some with up to 600 participants — in order to practice communications, coordination and resource sharing.

The BHEPP is also a member of the Maryland Region V Emergency Preparedness Coalition, which includes 14 acute care hospitals, public health facilities and others, and plays a critical role in health care delivery system preparedness and response in the Washington, D.C., area. Together, the BHEPP and the Region V Emergency Preparedness Coalition provide a strong mechanism for our community to be able to respond rapidly to any emergency situation.