BOSTON - It started innocently enough: an internal alert that a cluster of "patients" were displaying weakness, fever, shortness of breath that rapidly turned into pneumonia and respiratory failure. By the time the five-day emergency preparedness exercise ended, Beth Israel Deaconess Medical Center clinicians and staff had coped with a simulated outbreak of pneumonic plague that taxed clinical and administrative systems.
Operation Contagion was one of about 20 drills conducted annually across the medical center to test responses to mass casualty accidents, infant abductions and infectious disease outbreaks. The drills are interspersed with real time reaction to an average of 18 real events like floods and power failures annually.
"Drilling is very helpful for us because it actually brings our plans down to the frontline worker," says Meg Femino, BIDMC's director of emergency management. "Some of those drills are table top exercises where a group of people may gather and we run through a scenario. Others are full scale exercises. That's where we find out that 'hey this didn't work so well, so what are we going to do?' we're going to go back to the table and figure out how we can build a better system."
The ambitious scenario began with a heads-up to Employee Occupational Health, infection control and the emergency department, alerting them to a simulated rise in illness that resulted in 25 "employees" hospitalized, including six in medical intensive care. The scenario rapidly escalated to the point where 1,000 employees - or their family members - reported being ill, 200 hospitalized across the state and six having died.
Epidemiologists determined the "outbreak" started after the return of 25 clinicians from northwest China who, on the last day of their 10-day trip, took a cooking course using raw marmot, a type of squirrel. Unaware of their "illness," they worked through the week of their return.
Once the "contagion" was identified, staff across the medical center simulated responses - from making sure there were enough respirators and antibiotics to treating both employees and family.
"We activated the incident management team and we had a full scale emergency operation exercise that involved about 26 departments from across the hospital, including nine people from the medical staff and 60 people from within the hospital that all got together," says Femino. "We also were represented our 14 external partners, including Health and Human Services, FEMA, the state Department of Public Health and the Boston Public Heath Commission. There was a lot of cross pollination between our hospital departments and our external agencies who we would normally contact during something like this."
In the following days, a section of a working inpatient unit was isolated and critical care doctors and nurses worked side-by-side with unit staff to treat their seriously ill "patients" and teams worked to package and distribute "antibiotics" to staff and family members.
Femino proclaimed the drill successful, particularly by allowing events to play out along a continuous five-day timeline rather than in a helter-skelter fashion over the course of a year. And while she hopes the scenarios never play out in real time, there's considerable value in taking the time to drill, because people tell her "I am so glad that I practiced these emergency procedures. And the people that don't, you hear them say, 'if we had only thought and practiced it ahead of time it would have made things much different.'"
While drills can demand a lot of time and attention, Femino believes they more than justify the human and financial resources.
"It's tough for hospitals to put money and time into preparing for what might never occur or what might occur," she says. But because we do it here, people know their role. They know their job. They know what they might be asked to do and they're not uncomfortable with it. We go around and we do drills at a lot of other hospitals and I see people that are kind of like deer in the headlights because they've never done this before. They have no idea how to make sense out of the chaos. I think we do that very well here, but it's from practice. It's from people putting their boots on the ground and having practice with it."
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently
ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit