Worst-Case Scenario

Maryland's emergency response machine is among the nation's best - yet remains vulnerable to catastrophe

July 13, 2008|By Frank D. Roylance | Frank D. Roylance,Sun reporter

A bomb explodes. An airliner crashes. Fire engulfs an office tower.

The list of calamities that could send hundreds of casualties to Maryland hospitals is limited only by the human imagination.

As their counterparts elsewhere cope with earthquakes and tornadoes, the Marylanders charged with planning for the unimaginable say the state's emergency response infrastructure, communications networks, first-responders and hospitals are much improved since the events of Sept. 11, 2001.

But worrisome vulnerabilities remain, they concede. A radioactive "dirty bomb," a bioterrorist attack or even an outbreak of pandemic flu would add huge numbers and complexity to the management of our worst nightmares.

Infectious isolation rooms and burn-unit beds are not abundant here. And radiation decontamination facilities are slow. All could quickly be overwhelmed by a major disaster.

"What do you do when profoundly more people need health care than we can provide? ... We've never had to face that," said Dr. Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Services, which manages statewide emergency medical services day-to-day.

Of course, a truly cataclysmic event, such as the detonation of a small nuclear device as envisioned in recent testimony before the U.S. Senate Committee on Homeland Security, would likely overwhelm state and local plans and demand a federally-led response.

Cham E. Dallas, director of the Institute for Health Management and Mass Destruction Defense at the University of Georgia, told the committee that such a blast near the White House would kill 100,000 people, seriously injure and burn another 150,000, and put 100,000 in immediate need of decontamination.

Dallas told the committee that we "only have a fraction of the potential health care and security personnel that we'll need. A lot of people ... will be on their own in the first 24 hours. There won't be anyone there to help them."

Short of a calamity on that scale, Maryland's disaster planners say their plans are flexible enough to deal with the most likely events the future may throw at them.

Outside experts largely agree.

"Maryland has long been regarded as probably the exemplar in the country for understanding, valuing and organizing emergency medical services ... and, very significantly, the state has not backed off from that commitment," said Dr. Arthur L. Kellerman, associate dean for health policy at the Emory University School of Medicine.

That does not minimize the state's challenge, Bass said. "A mass-casualty, major incident is a scary deal. But in terms of our ability to handle it, I feel comfortable. We're probably as prepared as any state, and I would argue better than a whole lot of others."

Even so, he said, "we've got to continue to look at scenarios and at how to improve things, and we've got to do that every day."

Maryland's safety net is a complex web of state, county and local agencies, hospitals, private companies and nonprofits. Bass' agency -- known as MIEMSS - plays a central role. Staff in its downtown Baltimore control center already gather information from incident scenes and waiting hospitals, then coordinate the dispatch and destinations of ambulances and MedEvac helicopters.

Maryland pioneered the system in the late 1960s. The state has tested, improved and used it every day since then, Bass said. "You have to be able to function well day-to-day to be able to ramp up when something bad happens."

The nexus is a communications system that has seen important enhancements since Sept. 11. Staffers watching the disasters unfold in New York and Washington that day began to poll Maryland hospitals, via voice and fax channels, to see if they were ready for more mass casualties in the region. The volume of communications soon choked the system.

"We needed more information, more quickly, about what their status was, and they wanted more information about what was going on, and what was expected from them," Bass recalled.

Since then MIEMMS has developed and deployed an all-digital, Web-based network called "Facility Resources Emergency Database," or FRED. Today, controllers can poll every hospital in the state for readiness and occupancy in 90 minutes, compared to the 24 hours the task once required.

MIEMSS can alert emergency rooms to incoming ambulances or helicopters, or warn hospitals and health departments of emerging threats, from flu to tainted heroin. "The amount of information, and the number of folks we can send out to, went up exponentially," Bass said.

MIEMSS is also working with the state on a new, statewide communication system using 700 MHz frequencies that TV broadcasters will vacate next year when they switch to digital transmissions.

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