Members of the Children’s Hospital of San Antonio Team don their PPE, personal protective equipment. Photo by Cherise Rohr-Allegrini.
Members of the Children’s Hospital of San Antonio Team don their PPE, personal protective equipment. Photo by Cherise Rohr-Allegrini.

We’ve been hearing a lot about “readiness,” about hospitals “being prepared” to handle Ebola and other public health threats. Are they really ready?

In 1989, the state established Regional Advisory Councils(RACS), whose function is to coordinate all health care systems from transport to discharge. This includes coordination of air and ground assets to determine who gets transported where and when, gear, training, and building coalitions among the health care systems to include hospitals, EMS, police, fire, and public health. For 22 counties in south Texas, including Bexar, we have the South Texas Regional Advisory Council (STRAC), led by Executive Director Eric Epley, since 1998.

When a public health emergency occurs, the Alamo Regional Command Center (ARCC) activates the Texas State Operations Center (SOC), which activates the STRAC, which may then activate the Regional Medical Operations Center (RMOC) . Got all those acronyms yet?

RMOC Incident Command Trailer. Photo by Cherise Rohr-Allegrini.
RMOC Incident Command Trailer. Photo by Cherise Rohr-Allegrini.

Labor Day Weekend, 2005, the RMOC was activated for the first time in response to Hurricane Katrina. Representatives from each of the hospital systems, San Antonio Metro Health District, and the Department of State Health Services Region 8 camped out in the basement of the library at the University of Texas Health Science Center at San Antonio for four weeks, monitoring hospital beds, coordinating transports of arrivals of critically ill evacuees, providing triage teams to the shelters, and coordinating desperately needed supplies. The atmosphere was intense, the room stuffy and cramped, but the collaboration was admirable. And it is because of such collaboration that San Antonio and the 21 surrounding counties are well-staged to handle a crisis.

The RMOC has since moved into the City of San Antonio’s Emergency Operations Center (EOC) at Brooks City Base, where the public health response to Hurricanes Dolly, Gustav, and Ike was directed with teams from SAMHD and DSHS Region 8. In 2009, when H1N1 was identified in Bexar, Comal, and Guadalupe counties, the CDC joined the teams in the RMOC to conduct the investigation.

So what happens when disaster strikes? Each hospital has a “Decon Team” at the ready. These are a collection of health professionals from different areas of the hospital who are trained by strict OSHA standards to be called on to respond to any crisis. The key to being prepared is practice, practice, practice.

Enter the Decon Rodeo, hosted by STRAC. Six teams from Methodist Specialty and Transplant Hospital, University Hospital, SAMMC, the Children’s Hospital of San Antonio, Methodist Metro, and Uvalde Memorial Hospital competed Thursday in four areas: PPE, Hot Zone, Radiation, and Written Hazmat Exam.

Mass Casualty Incident Trailer stocked with supplies, ready to roll. Photo by Cherise Rohr-Allegrini.
Mass Casualty Incident Trailer stocked with supplies, ready to roll. Photo by Cherise Rohr-Allegrini.

Personal Protective Equipment, or PPE, is all the rage these days. Everyone wants his or her own Tyvek suit. But do you know how to put it on properly, and most importantly, how to take it off? Each team raced against the clock to don appropriate PPE, including Chemical Tyvek suits, booties, gloves, PAPRs (Powered Air Purifying Respirators), and good old duct tape. Once on, the team then removed the contaminated clothing from a mannequin, appropriately stored it, and doffed their own PPE without contaminating themselves in the process. The motto of SAMMC is “Slow is Smooth, Smooth is Fast.”

“The key to putting on PPE is to do buddy checks, to work quickly but calmly. Practicing, competing against other teams makes us step up our game,” said Sergeant Kenneth Venable.

Sgt. Kenneth Venable puts on his PPE while his teammate makes sure it's secure. Photo by Cherise Rohr-Allegrini.
Sgt. Kenneth Venable puts on his PPE while his teammate makes sure it’s secure. Photo by Cherise Rohr-Allegrini.

Next the teams moved to the Radiation Zone where they conducted tests for radiation exposure. Each team worked in twos while they questioned a “patient” exposed to radiation and evaluated him with a Geiger counter. For the team from The Children’s Hospital of San Antonio, this was a great learning experience.

“Though we practice all the time, we could see what other teams do and learn their techniques,” one team member said.

The Hot Zone

What disaster would be complete without a Hot Zone? If there’s a chemical spill and a need for decontamination, the hospitals have Zumro tents, which can function as emergency hospitals or decontamination showers. They’re attached to a grey water bladder so the water doesn’t go into the sewage system. Have a patient who can’t walk? No problem. The tents include a table with rollers, so a patient can be put on a flat stretcher and rolled through to be decontaminated. This works for the health care teams who need to decon themselves. Each team raced to set up and take down the tents in record time.

“We have to work as a team – each person knows (his or her) role in setting it up, which makes us more effective,” according to Reina Rojas, Emergency Center technician at University Hospital.

Uvalde Memorial Hospital Decon Team get ready for the Hot Zone. Photo by Cherise Rohr-Allegrini.
Uvalde Memorial Hospital Decon Team get ready for the Hot Zone. Photo by Cherise Rohr-Allegrini.

Finally, though not as exciting to watch, one critical element is understanding the dangers they may encounter, so the competition included a written exam with HAZMAT questions: Which kinds of chemicals? What do you do in response to this chemical? What about that biological reagent?

The teams competing weren’t the only hospitals represented, though. The Decon Rodeo was a learning experience for those involved, but also for those new to it all. With the oil boom in the rural areas outside San Antonio, small community hospitals have recognized the need to have their own staff prepared for a disaster.

“In our small hospital, all of us have multiple jobs, so we have to be prepared for everything,” said Radiology Technician Stan Fling from the Nix Community Hospital of Dilley.

Technicians from smaller towns study the teams intensely, learning from the bigger hospitals. As ER Nurse Yuracy Salazar said, “Even if a patient will be airlifted to San Antonio, we’re the ones on the ground. We have to be able to stabilize the patient and the situation until more help arrives.”

So who ultimately won the rodeo? The people of South Texas, who have prepared and capable teams ready to respond to the next crisis.

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*Featured/top image: Members of the Children’s Hospital of San Antonio Team don their PPE, personal protective equipment. Photo by Cherise Rohr-Allegrini.

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Cherise Rohr-Allegrini

Cherise Rohr-Allegrini is an infectious disease epidemiologist and consultant. She is currently the San Antonio Program Director for The Immunization Partnership. Dr. Rohr-Allegrini was the Pandemic Flu...