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Saving lives in emergencies takes planning and training

Jul 02, 2013 | 5747 Views

By Daniel J. Castillo, M.D., M.B.A.
Medical Director
The Joint Commission

Every second counts. I have heard that phrase uttered often, especially during my training as an emergency medicine physician. There are clinical cases where quick, decisive action must be taken in order to save a person’s life. Fortunately, many of these cases occur infrequently, but this perceived benefit introduces the predicament of preparedness for the uncommon presentations. In these situations, simulation education helps prepare physicians to treat patients quickly and appropriately. I will never forget the night I was working in the Emergency Department, one of my first as an attending, and a 16-year-old female came in with acute anaphylaxis. She had been out to dinner with friends and made the innocent mistake of sharing food at a Thai restaurant even though she had a severe peanut allergy.  Within seconds she could barely breathe due to the swelling in her throat. Luckily, the restaurant was just down the street from the ED, and she got to me within minutes of symptom onset. I was able to perform the duties that eventually saved her life, in large part, due to the simulated exercises I had completed during residency.  
Every second counts. That phrase took on additional meaning when reading and listening to interviews of the medical staff that took care of victims of the recent Boston Marathon bombing. I, like many others who read the stories, was amazed by how quickly the Boston EMS and Hospital Systems responded to the tragedy. Lives and limbs were literally saved because of the Boston medical community’s preparedness for the uncommon. I was especially struck by an interview in Bloomberg Businessweek, with Dr. Paul Biddinger, the medical director for emergency preparedness at Massachusetts General. He happened to be working at one of the medical tents set up along the marathon to offer care to the runners. He stated:

“We can clearly point to a couple of people who went to the operating room first – truly minutes mattered, If this hadn’t gone smoothly – from the marathon itself, to the transport, to the care in the hospital – had not every single step been perfect, they would have died. Overall I would like to think we saved limbs and lives, but there is no question that we have a couple of people that lived because the system worked the way it did.’’ 

The question must then be asked: How do we prepare for such uncommon, urgent events?

The solution lies within simulated exercises. The Joint Commission, as part of its Emergency Management chapter, outlines processes that must be in place to help manage these rare, yet catastrophic events. The elements of the chapter have been built over the years by gathering experts in the field as well as communicating with and learning from organizations that have previously had to mitigate these disasters. The emphasis is on planning. Planning allows the organization, along with its community, to put together a comprehensive Emergency Operations Plan (EOP) that can then be tested several times each year. The results of these simulated exercises must then be analyzed and learned from.  Fortunately, these tragic events are uncommon, but it is only through training that we can be prepared, and preparedness is crucial when every second counts. 

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