Saint Vincent Catholic Medical Centers of New York

1. Saint Vincent Catholic Medical Centers of New YorkResponse to the attack on the World Trade Centerand Report on Preparednessfor Future Events

2. Saint Vincent Catholic Medical Centers of New York • 7 Acute Care Hospitals in 4 Boroughs of NYC • Large Behavioral Health Network including a Specialty Hospital in Westchester County • 4 Nursing Homes and 3 Home Care Agencies • The Academic Medical Center of New York Medical College • $1.5 billion in revenue • St. Vincent’s Manhattan is the closest Trauma Center to WTC

3. Disaster Planning • Internal disaster drills twice each year. • City-wide drills led by OEM. • Close relationship with GNYHA which coordinates region-wide hospital efforts. • Experience with other disasters including the bombing of the World Trade Center. • Communications issues • Supply Delivery • City-wide traffic • City-wide Inter-hospital communications.

4. September 11, 20018:46 a.m.

5. The SVCMC Scenario • CEO David Campbell holding a meeting with his Hospital Presidents in the Board Room of St. Vincent’s, Manhattan. • Group hears airplane fly overhead and a “loud thump”. • E.R. Director informs the group that EMS has declared a major disaster. • Disaster plans activated in all 7 hospitals. • 14 St. Vincent’s Paramedics and hundreds of other first responders are dispatched immediately.

6. The First Hour • St. Vincent’s Manhattan under the direction of President Jane Connorton, activates its Incident Command Center, opens six “auxiliary” emergency rooms, moves all ER patients upstairs, orders extra supplies, sets up triage teams, stretchers, and wheelchairs on Seventh Ave and goes into full Trauma Center major disaster mode. • First Patients arrive by subway, taxi and passenger car. • Patients begin to arrive by ambulance, some with 8 -10 patients. • Second plane hits South Tower.

7. The Second Hour • More patients arrive at Manhattan trauma center, others begin to be transported by boat to St. Vincent’s Staten Island, and still others arrive at Brooklyn and Queens facilities by taxi, bus, and on foot. • Off -duty employees, physicians and nurses begin to arrive • South Tower collapses. An SVCMC ambulance is destroyed, 2 others damaged. Paramedics missing for a period of time.

8. The Second Hour (cont.) • Patients continue to stream into the Manhattan Trauma Center and SVCMC’s other emergency rooms. • Extra supplies begin to arrive. • North Tower collapses. • Media begins to arrive at St. Vincent’s Manhattan, regular briefings begin.

9. In the Center of the Biggest Media Event of the Century • Carefully designed disaster media plan put into effect. • All hands on deck…everyone to their station. • Keep the media in one place by providing what they need: • Constant information • Good visuals • Frequent new interviews • Easy access to visiting dignitaries • Food, coffee, sun block, bathrooms, tents, electricity, phone lines • One voice.

10. In the Center of the Biggest Media Event of the Century (cont.) • Coordination with city, state and federal spokespersons. • Coordination with other health providers. • Keeping the media’s interest. • Keeping the healthcare story on us. • Providing experts in various fields. • Honesty and integrity. • Patient and family privacy.

11. The Third Hour • Patients continue to arrive by foot, bus, boat, ambulance, and passenger car. • St. Vincent’s, Manhattan receives more than 450 patients in the first two hours. • St. Vincent’s, Staten Island more than 200. • Water pressure drops to dangerous levels at St. Vincent’s Manhattan. • Then…the sirens stop and the patients stop arriving.

12. Where is the Second Wave? • Physicians, nurses, administrators all waited for the second wave. • Only a modest number of additional survivors continued to arrive. • Neighbors and other New Yorkers began to surround the hospital. • All New Yorkers needed to do something.

13. The Afternoon • NYC OEM Command Center collapsed with the WTC. GNYHA expands its command center. • Part of Disaster Plan includes setting up a “Family Center”. • Thousands of families and friends arrived at the hospital or called in an effort to locate their loved one. • Small Family Center became overwhelmed. • New School University offers space.

14. The Days that Followed • More than 6500 families visit the SVCMC Family Center in the first days. • GNYHA coordinates sharing of patient information region wide. • Grief and trauma counseling are expanded. • More than 10,000 calls received at our emergency phone center. • Volunteers, food, clothing and blood donors continue to flood the hospital.

15. The Subsequent Weeks • Firefighters, police officers, and rescue workers continue to arrive from “Ground Zero” with injuries including eye abrasions, fractures, and breathing difficulties. • The Anthrax scares begin. • As Anthrax is confirmed in media offices and post offices, patients arrive by the hundreds seeking testing. • City-wide coordination of efforts by NYC Dept. of Health and GNYHA.

16. SVCMC System-wide Numbers • More than 1400 patients seen in ER’s • 148 Admissions • 6,900 visits to Family Center • 16,000 calls to crisis lines • More than 1200 visits for Anthrax concerns • 248 Anthrax tests conducted • More than 20,000 individuals undergoing ongoing counseling conducted by SVCMC Behavioral Health Service Division.

17. The City-wide Numbers • More than 7,300 patients seen in ER’s • 712 Admissions • 26,900 visits to Family Center • 376,000 calls to crisis lines • More than 2900 visits for Anthrax concerns • 482 Anthrax tests conducted • An estimated 500,000 suffering from Post Traumatic Stress Disorder • More than 100,000 individuals undergoing ongoing counseling.

18. The Financial Consequences • SVCMC has expended and lost revenue totaling more than $25 million. • City-wide healthcare totals will exceed $500 million. • After 12 months of aggressive advocacy efforts, HRSA releases $140 million in funding to hospitals. SVCMC receives a total $22 million. • Philanthropic gifts have increased. • Nuclear, Biological, and Chemical (NBC) terrorism preparedness is enhanced.

19. Lessons Learned • Special attention must be given to other patients, their families, community members, and your employees • Policy on volunteers and blood donors. • Policy on sharing of patient information. • Patient access in emergency area. • Additional communications needs • System-wide and city-wide. • Business Interruption Insurance. • The challenges of obtaining government funding. • Accelerate preparedness for next attack.

20. Media Lessons Learned • Having a carefully designed disaster media plan paid off. • Staff burn-out. • The media really did stay in one place because we provided what they needed: • Constant information • Good visuals • Frequent new interviews • Easy access to visiting dignitaries • Food, coffee, sun block, bathrooms, tents, electricity, phone lines • One voice.

21. Media Lessons Learned (cont.) • Coordination with city, state and federal spokespersons was vital and made us look better. • Coordination with other health providers was key. • We kept the media’s interest and kept the healthcare story on us. • Even in the weeks that followed and now 2 years later we are still called upon to provide experts in bioterrorism. • Honesty, integrity, patient and family privacy paid big dividends. • The media hogs. • You never know when that camera is live.

22. All Hazards Preparedness • Ongoing preparedness for the system, our communities, our patients, and our staff. • System representatives are serving on a regional, state and national level: -GNYHA - NYC DOH Healthcare Task Force of the Committee on Weapons of Mass Destruction -HANYS - AHA -JCAHO -US Dept of HHS Preparedness Task Force

23. Regional Preparedness • Working with with regional hospital association and city-wide OEM to develop ability to better communicate with city agencies and other hospitals in a disaster. • Developing new EMS protocols on transport of contaminated patients. • Developing a redundant communications system (800 megahertz radios). • Developing a data sharing system that enhances surveillance and detection, identifies excess capacity and needed resources and establishes a regional patient locator system. • Most recently, developed region-wide pharmaceutical stockpiles.

24. SVCMC System-wide Preparedness • System-wide Preparedness Committee continues developing new protocols for incorporation into the seven hospitals and four nursing homes disaster plans. • Focus is on staff training, pharmaceuticals, medical supplies, facilities needs, development of community disaster response plans and system communications to assure efficient sharing of resources. • Estimated cost of SVCMC preparations is $10 million.

25. SVCMC System-wide Preparedness • Preparedness Committee’s recommendations are currently being implemented and aim at assuring patient and staff safety: -NBC Protocols -Pharmaceuticals (Mark I kits, Sodium Thiosulfate and “Pre-Push Packs”.) -Training -First responder courses -Staff Courses (including discussions and planning for lock-down scenarios) -Community Education -Equipment (PPE) and facilities -Employee Health (N95 mask- fit testing for all employees) -Communications

26. SVCMC System-wide Preparedness • Working closely with city, regional, state-wide and national preparedness efforts. • Three SVCMC Emergency Rooms being rebuilt including the St. Vincent Manhattan Trauma Center which has been renamed the “Rudolph Giuliani Trauma Center at St. Vincent’s”. • To be entirely rebuilt and expanded by an additional 11,000 square feet. • Will include new ventilation system, expanded decontamination facilities, as well as “built in” surge capacity to quadruple the number of patients that can be seen at any one time, and a new all hazards mass casualty education center for healthcare professionals and community members.