Preparing to Be Prepared

Recently, the American College of Emergency Physicians issued a national report card on the state of emergency medicine, and the whole country received a grade of C-minus. Minnesota, which is generally the slightly smug and self-satisfied Lisa Simpson character amongst its peer states in these ratings, was issued a slightly improved C-plus, a devastating blow to our “quality of life”-based ego. (Granted, one of the college’s five criteria was Minnesota’s medical-liability climate, where we were rated a D-minus, a grade which one presumes would be improved by a medical-liability damages cap or by exporting HMO hawk Mike Hatch to Wisconsin.)

Recently, I had a firsthand opportunity to test our state’s emergency

preparedness at an early morning bio-terrorism drill at one of the metro area’s major hospitals. I was forwarded an invitation that went out to hundreds of public-health students at the University of Minnesota, soliciting volunteers. It may have been the fact that the drill started at 6:00 a.m. on what turned out to be the coldest day of winter thus far, or that we were advised to wear a swimsuit under our clothes in order to retain modesty during a decontamination shower, but in the conference room where the drilling team assembled, I was one of only three volunteers who weren’t actually employed by the hospital. Our small but brave cadre of outsiders received many thanks, complimentary coffee, and a single powdered doughnut that we were asked to smear on our clothes and faces in order to simulate an anthrax exposure.

While I yearned for more fully developed backstory (“OK, you’re a renegade genetics researcher, and your attempts to create the world’s first pig-soybean hybrid have drawn the ire of animal-rights extremists. One day you receive a suspicious envelope … ”), we volunteers were merely asked to run into the emergency room and tell the attendant we believed we were exposed to anthrax at a building across the street. Emergency-room workers were not supposed to be tipped off to the drill, but some may have grown suspicious at the post-midnight assembly of two shower tents, one in a heated garage and one outside the main entrance, in below-zero windchills.

The organizers staggered our arrival at the emergency room. I was volunteer number seven, so by the time I walked in, the novelty had worn off for the nurses on duty. They barely raised an eyebrow, and, from behind protective glass at the desk, they directed me back outside to the ambulance garage in order to be decontaminated. In the garage, the mood was not so blasé, and there was a lot of muffled consultation going back and forth between hospital staff members clad in hazmat suits who, with their bright-orange boots, looked like a cross between Oompa Loompas and astronauts. In a barely intelligible voice, one of them told me to come with him to the outside shower, but before I could even protest, news arrived that the waterlines to the outside shower had frozen. My relief was short-lived as I stripped down to my swimsuit and was herded into the garage’s shower tent, blasted with water that was only slightly warmer than ice, swaddled in towels, and then rolled in a wheelchair into the ER, where I and my fellow victims were “monitored” for signs of infection by the nursing staff.

At a debriefing that followed, the problems were enumerated: the hazmat suits took too long to don, there was a shortage of bags for contaminated clothing, and the “victims” did not receive quick or understandable instructions. But these problems paled when compared with the adventures of one of the hospital staff’s more entrepreneurial victim-volunteers: When he found himself undirected and unsupervised in the garage, he wandered into the ER and beyond, presumably “infecting” entire wings of the hospital. What’s more, a hospital security guard who had been in an infected area returned to the situation-control room, thereby “infecting” the response-management team. The drill organizers assessed these events soberly. Clearly, this exercise was a starting point, but there would seem to be many more early mornings—and powdered doughnuts—in all of their futures. —Dan Gilchrist