Hennepin County Medical Center

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Hennepin County Medical Center

• I-35W Bridge Collapse Response
• AUGUST 1, 2007

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35W Bridge

• Built 1967
• Rated in recent years as structurally
  deficient, but not in immediate need of
  replacement
• 2000 ft span, 64 ft high
• 141,000 cars / day
• Mississippi 390 ft wide, avg 7ft depth

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August 1st, 2007

• Collapse _at_ 605 pm
• Traffic over the bridge travelling lt15mph-most
• cars fell straight down
• Twins ball game _at_ 7pm
• Stadium is immediately adjacent to largest
  nearby level 1 trauma center- HCMC!

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HAZARDS

• Too many to name

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RESPONSE SUMMARY

• Collapse to last patient transported
• Initial clearing of all sectors 1 hr 35 mins
• Last EMS transport 2 hrs 6 mins
• 50 patients transported by EMS
• 8-13 casualties via other vehicle
• Over 100 patients treated in 24 hours
• 13 deaths
• No serious injuries to first responders
• 29 ambulances used in first 4 hours

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Destination Hospitals - EMS
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Hospital C
Hospital B
Clinics
Hospital A
Healthsystem
Regional Hospital Resource Center
Multi-Agency Coordination Center EM
EMS PH
A
A
B
B
C
C
A
C
Jurisdiction Emergency Management
B
Public Health Agencies
EMS Agencies
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HCMC Response

• Initial information at 610pm
• Hospital near capacity 5 ICU beds available
• 2 current critical cases in resuscitation area
• Charge RN turned on TV
• Alert Orange declared at 615
• ED staff paged get to HCMC now
• Initial patients received (critical) at 640

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HCMC Response

• 25 patients received in 2 hours
• 1 dead on arrival
• 6 intubated
• 5 directly to OR
• 16 total admissions (60)
• By 7pm
• 25 ICU beds open
• 10 OR open and staffed
• 3 CT scanners running

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MD perspective

• Physicians at the scene
• Minneapolis EMS has several MDs that ride with
  staff. 3 reported directly to scene and provided
  support to the command post and direct field
  triage
• Many additional medical personnel came to the
  scene (from nearby hospitals). Appreciated BUT
  created safety concerns as they were ill-equipped
  and ill-trained to be working in such a hazardous
  environment.

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HCMC central role

• HCMC provides primary paramedic service
• Closest Level 1 trauma center
• Houses the West Metropolitan Medical Resource
  Control Center (WMMRC) that provides information
  to regional hospitals and ambulances
• Web based MNTRAC system kept live information
  flowing about ER status, bed availability,
  patient numbers and patient destination. (HAVabed
  system is analagous)

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HCMC-ED

• Lead ER MD declared an external disaster
• Orange Alert automatically
• Recalls key personnel, holds on duty personnel
• Clears patient reception areas
• Opens hospital command center staffed by key
  administrative and clinical personnel identified
  by premade vests.
• 24 critically ill patients brought to ED, 5 in
  the back of pick-up trucks (with EMTs)

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HCMC Incident communication

• Communication was difficult
• Volume of calls overwhelmed land and cell phone
  lines
• GET and WIPS- Government priority access for land
  and wireless lines now available
• Some solutions archaic but nonetheless worked
  example runners within the hospital
• 800 MHz radios, walkie talkies, MNTRAC- Web based
  communication worked best

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HCMC Media- PR

• Intense national attention
• Few designated spokespersons systematically
  provided information and interviews on a
  scheduled basis.
• Allowed consistent and focused information
• Early in the event media provided misinformation
  (they requested any medically trained person to
  go to the bridge to help, recalled all HCMC
  personnel and to go to the HOSPITALS to donate
  blood-oops!)

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HIPAA considerations

• Patient tracking difficult and patients (even
  from the same family) taken to different
  hospitals
• HIPAA issues addressed PRIOR to this event by
  inter-hospital compact that allowed for sharing
  of information for public safety tracking and
  reunification.
• Questions about sharing with other agencies being
  clarified by Minnesota Department of Health

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HCMC Disaster Plan

• Incident went smoothly BECAUSE a pre-plan was in
  place AND drilled regularly.
• Plan includes notification of off-duty personnel,
• Web based action sheets
• Job action information availability at every work
  station
• Ability to expand/contract as needed
• John Hick the middle of a disaster is not a
  great time to be exchanging business cards

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Supplies and Equipment

• ED supplies became temporarily exhausted
• Hospitals may wish to have disaster supplies
  brought to ED by default and need to have a good
  replacement mechanism in place.
• Stockpiles of commonly needed items should be
  available based on guidance by departments of
  health and preparedness program efforts.

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Medical Reserve Corps

• National system of local corps
• Pre-credential medical personnel to assist in the
  event of external disasters
• Provide training on mass casualty, mass public
  health initiative (vaccination, drug dispensing),
  pychological care during disasters

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Medical Reserve Corps
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Medical Reserve Corps Southeast Nebraska

• Mission To provide an organized network of
  trained medical and well intentioned volunteers
  to expand the capacities of emergency health
  responders and to strengthen the public health
  infrastructure within southeastern Nebraska.
• 215 Centennial Mall South Suite 340 Lincoln, NE
  68508 http//www.volunteerpartners.org
• Melanie Hooks
• Phone [phone] cell 904-703-4870

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Transfusion issues

• MBC contacted surrounding hospitals and level 1
  trauma centers within 30 minutes
• Additional group O cells sent to hospital sites
  likely to receive patients, even if hospital
  didnt request them
• Concern was raised that Twins and disaster
  traffic might preclude timely delivery further
  into the event
• However, only 13 units used that evening all at
  HCMC and 50 products for the 24 critically
  injured patients by the end of the week.

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Emergency Tx and Rh Group O policy

• Emergency Tx Males may receive O
• There is NO immediate consequence of transfusing
  Rh positive red cell units into Rh negative
  recipients.
• RBC will be more rapidly cleared-so follow up
  required if emergency crossing over Rh types
• Major issue is sensitization in females of future
  child bearing potential
• THERE are NO Rh antigens on platelets

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HCMC Massive Transfusion Policy

• Blood bank works with staff to monitor patients
  with large ongoing needs
• Obtain frequent labs (Hct/Hgb, plt, PT (INR),
  PTT, fibrinogen to guide Tx
• Dont wait for coagulopathy to develop
• As RBC transfused approaches 1 x blood volume
  platelets are often depleted before coag factors

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Historical perspective

• Hess review
• US civilian disasters 105-131 units
• Skywalk collapse in KC hotel
• Airliner Sioux City Iowa
• Oklahoma City Govt. Center bombing
• Columbine high school
• 9-11
• About 600 extra units used following WTC
  collapse, NYBC collects gt1000 daily!

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In Memory

• Greg Jolstad
• Vera Peck
• Richard Chit
• Sadiya Sahal
• Hanah Mohamed
• Christina Sacorafas
• Scott Sathers

• Artemio Trinidad-Mena
• Sherry Engebretsen
• Julia Blackhawk
• Peter Hausmann
• Patrick Holmes
• Paul Eickstadt

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References

• Hess JR, Thomas MJG Blood use in war and
  disaster lessons from the past century
  Transfusion (2003) 431622-1633