17 June 2019

How the Hospital manages the risks of everything from a pandemic to leaking pipes

| Genevieve Jacobs
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Donna McKerlie’s emergency planning role for Canberra Health knits together resources across the whole region for a potential disaster. Photo: G Jacobs.

Do you know the difference between the red, white and blue powerpoints in a hospital ward? Or for that matter how long you could keep the Canberra Hospital running in a catastrophic firestorm?

Donna McKerlie knows all that and everything in between, from what the health impacts would be if the Commonwealth Avenue Bridge collapsed to how to manage a large water leak.

She’s the hospital emergency management co-ordinator for ACT Health, and that means she’s responsible for managing emergencies from a clinical perspective. If the electricity is out, do we have hand ventilators at the bottom of a bed? If the water goes, how can we feed everyone or sterilise the equipment? And if things really go bad, how long until they have to fall back to Bruce?

Well, perhaps that last scenario is a little far-fetched, but McKerlie points out that emergency planning at this level does involve every hospital in Canberra and all the facilities across the border.

Emergencies fall into three categories: at Level One, its something like a leaking water pipe that can be managed on the ground.

Level Two is an incident that might require the evacuation of a ward, requiring executive input. And at Level Three, it’s planning for a whole of Canberra Hospital and probably wider ACT community event – a bushfire, a pandemic, a mass casualty event that requires fullscale coordination with all emergency services and other hospitals.

And while the massive disasters are unlikely, that coordination happens more often than you might think. If there’s a large music festival, for example, emergency services and the hospital will forward plan for potential drug overdoses so that the best-qualified people are rostered.

Gaining the trust of emergency services has taken some time. “The first hurdle was to make sure people knew that I knew what I was talking about,” she says of that critical liaison.

The Canberra Hospital’s risk assessment includes everything from pandemics to leaking pipes. Photo: George Tsotsos.

So how do you actually test your planning systems for such a bewildering range of potential disasters? There are obvious things: protocols and guidelines, constantly updating plans. But then, there’s desktop simulation, using what McKerlie describes as “little goobers like a person, accompanied by their symptoms”. It’s a global program called Emergo Train, essentially a virtual hospital wargaming set-up.

“We inject these figures into the simulated hospital system,” McKerlie explains. “You match this person with this doctor, this staff member, this emergency bed, this ventilator and you put them under as much pressure as possible to see where the cracks are. We make people swap roles too, so that the bed management people are trying to manage the triage. Everyone gets a taste of how much pressure the whole system can take in a major emergency, not just the people on the front line.”

As a former nurse, McKerlie says that supporting staff as well as members of the public through trauma is an important part of the planning process, as is learning from other similarly sized hospitals. New risks in recent years do include terrorism, although Canberra’s bushfire vulnerability is a more likely disaster, including whether the hospital itself burns.

The planning for that likelihood is fascinating: McKerlie says that even if part of the hospital was on fire, major buildings are constructed to burn in isolated compartments, and wholesale evacuation wouldn’t necessarily happen because that itself is a major risk.

“We used to have people who knew the hospital inside out, but having that knowledge in one person is a single point of fault in itself. We now try to share and document all our procedures,” she says.

“There are 7000 staff in this organisation between the hospitals here and at UC, the walk-in centres, the community health centres and nurses on the road. And you can’t just shut a hospital down when things go wrong.”

And the powerpoints? The white indicates mains power, the red is backed up by generator, while the blue systems mitigate the risk of even a 30-second outage that could wreck complex equipment like the CT scanners. A perfect example of how the smallest details can matter as much as the biggest risks.

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Interesting that this puff piece comes out the day before a report in the Canberra Times about how hopeless the Canberra Hospital is at managing likely disasters.

A little more time managing risk instead of time managing the media, might be a good start.

barely functions on a good day (because of bed block). god help us if we actually had a catastrophic health alert

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