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Around Johns Hopkins: Preparing for the Unexpected

Robert “Bob” Maloney (center), senior director for the
Johns Hopkins Medicine Office of Emergency
Management, leads the “Operation Unplugged” exercise
in April 2018. Also pictured are Stephanie Reel,
chief information officer for the Johns Hopkins University
and Health System, and Andrew Frake, senior director of
health information technology.

In a time of crisis, a hospital’s emergency management team oversees the response. Outside a crisis, the emergency management team is preparing for events through exercises and training.

In this issue of Hopkins on Alert, CEPAR spotlights the emergency management team for the Johns Hopkins Heath System and the Johns Hopkins University School of Medicine. Robert “Bob” Maloney, senior director, Johns Hopkins Medicine Office of Emergency Management, oversees the team responsible for disaster prevention, mitigation, preparedness, response and recovery.

Prior to joining Johns Hopkins in 2017, Maloney was the emergency manager for the city of Baltimore for more than a decade, responsible for citywide emergency preparedness and homeland security funding and coordination. He was also deputy mayor of emergency management and public safety, coordinating public safety, emergency management and related operational agencies. Maloney also served in the U.S. Naval Reserve, deploying for a year to Fallujah, Iraq.

He recently spoke with CEPAR about his and his team’s efforts at Johns Hopkins.

Q: What is your role in emergency management?

A:  I am part of a remarkable team that is responsible for building resiliency to hazard and crises that may interrupt the mission of Johns Hopkins Medicine, including an efficient and effective response when events occur. 

Q: How did you become interested in emergency management?

A: In 1994, I decided I wanted to join the Baltimore City Fire Department. Around that time, fire service across the country was going through a transition from primarily firefighting to a fire-based emergency medical services (EMS) system, because the majority of 911 calls were EMS-related. To prepare myself for the fire department, I earned my EMT-Basic certification, and I also volunteered at a local hospital. The first night I volunteered, I watched paramedics bring in and care for a gunshot victim. In that moment, I knew what I wanted to do for the rest of my life. I wanted to be in a profession where I helped people. 

The field of emergency management really began to grow after the 9/11 attacks and Hurricane Katrina. When I became the fire department’s chief of staff, I handled day-to-day emergency management tasks for the fire chief, who was the acting emergency manager. During this time, I gained a tremendous amount of experience organizing a team to work in a unified system when responding to crises. So, after the fire chief retired, I was honored to be appointed by Mayor Sheila Dixon as the city’s emergency manager.

Q: What are some of the unique emergency preparedness challenges The Johns Hopkins Health System and school of medicine face? How are you working to overcome these challenges?  

A:  Baltimore City government, with the exception of essential services, can close. At Johns Hopkins Medicine, however, we must maintain our mission of patient care, teaching and research every day. Our patients and many other people count on us to deliver. By maintaining our mission, whether it’s for the person who needs a lifesaving surgery, the person who ran out of medication, the student learning to be a doctor, or the critical research needed to make key decisions, we must deliver. We are the best health system in the world, and so our emergency management program needs to be equal to that. And the onus is on all the individuals who work in preparedness to do everything we can to enable the caregivers, researchers and teachers to do their job — without interruption.

The breadth, diversity and locations of Johns Hopkins Medicine offer unique challenges. For example, Johns Hopkins All Children’s Hospital is in a hurricane zone and, therefore, more susceptible to major storms, while The Johns Hopkins Hospital is fortunate to have most of its entities on the East Baltimore campus, and Johns Hopkins Community Physicians has locations throughout the region.

Q: How do you determine the subject of emergency preparedness drills? 

A: We have a hazard vulnerability analysis that we collectively develop each year. We determine what hazards are most likely to happen, and the magnitude of those hazards on the enterprise. These determine what we drill and exercise. During the last year, we’ve put a tremendous amount of focus on information technology and building resiliency in that area. We also recently completed a mass decontamination drill, which we did outside the Johns Hopkins Hospital emergency department. Unfortunately, the events in the country also demonstrate an increasing need to be ready for incidences of mass trauma/surge of patients. We have increased our ability to respond to such events.

Q: Why are preparedness exercises important?

A: It’s an opportunity to test our plans, identify preparedness gaps and make changes, thus building resiliency. First and foremost, during all exercises, we test the command structure to make certain we can coordinate and maintain control. Second, we test our response capabilities, depending upon the crisis. Take, for example, a cyberattack. We want to test our ability to stop the spread of the attack. Or, if it’s a mass decontamination event, we want to avoid further contamination, so we take the necessary steps to protect patients before entering the hospital. Whatever the emergency, it’s our opportunity to simulate practicing our response to things we may not experience day to day.

What is a hospital incident command system, and what does it take to set up this structure?

It’s an organizational structure that facilitates integration to effectively solve problems and delegate responsibilities. A hospital incident command system relies on a team of people, working in unison, who are trained to respond to incidents such as an influx of patients or a weather emergency. The structure is expandable. So if necessary, we can include all essential stakeholders.

We now have a team of more than 50 people who have been trained to come to a central location, or command center, and perform the specific functions of the staffing positions necessary to set up a hospital incident command system. When those individuals are notified, they immediately come to the hospital to receive the situational assessment, determine an incident action plan moving forward, provide notification and information to the public, staff and visitors, inform senior leadership and seek advice when necessary. The team ensures an exchange of timely and accurate information so the best response policy and direction can be implemented.

During an event, the incident command will remain open until the situation is resolved. There are policies and procedures that dictate when we open up the command at The Johns Hopkins Hospital. That is always done in consultation with hospital leadership.

When was the last time you set up the hospital incident command center during an actual incident?

The last time we set up our command center due to a real incident was during last flu season. The Johns Hopkins Hospital was full, and the emergency department was seeing an influx of patients who needed to be admitted. So we set up the hospital incident command center to alleviate stress on the emergency department. During this activation, patient care in the emergency department was disrupted by a water-related issue that happened at the same time as the surge. Setting up the command center during this event, without a doubt, helped us maintain the mission continuity of the hospital. In addition, there have been several times that entities throughout the enterprise have set up incident command centers, and my team was integrated into the command structure to assist.

What are some of the projects that you have worked on or are working on at Johns Hopkins of which you are most proud?

There have been many projects. My team worked on the standardization of color codes on ID badges at The Johns Hopkins Hospital. We’ve collaborated with departments to place stop the bleed supplies throughout all Johns Hopkins Health System hospitals to equip bystanders with bleeding control tools in the event of mass casualty events. We also led “Operation Unplugged,” the largest exercise ever done at Johns Hopkins Medicine.

But I’m most proud that during crises, as a team, we have been able to come together to build a system that’s not dependent on one person to minimize crisis impact and maintain our continuity of operations. As we continue to build our capabilities — increase radios, supply caches, drills and exercises, and training — and refine our policies and procedures, the system will get more and more robust, and we will be even more ready. Our job is to be ready. We always have to be prepared.

It’s also important to note that senior leadership has been supportive of emergency management and understanding of the importance of preparedness, resiliency and reducing risk. And that’s huge.

What should faculty and staff know about emergency preparedness?

Faculty and staff should remember to build resiliency at home, because they will likely have to work during an emergency, particularly during snow or severe weather. If their home and family are inadequately prepared — not equipped with an emergency supply kit, a generator or food, or a family communications plan — they’re going to be at work worrying. So it’s really taking the opportunity to think about how they could be better prepared.

All of this is easier said than done, especially considering our day-to-day responsibilities. But when we are prepared, loss of life and property damage or destruction will be reduced, and we will get back to normal operations sooner. That’s what you’re trying to do, trying to get back to normal during crises.

Finally, we want everyone on team Johns Hopkins to know how much we appreciate the support and efforts toward resiliency and preparedness. And please don’t hesitate to reach out to us for assistance in building resiliency. We can be reached at 410-502-6122, or visit our website.