- The Washington Times - Monday, January 24, 2005

“Ready to go to war, man?” Wasiu Ojuolape, a member of Washington Hospital Center’s Protective Services staff, said lightheartedly to colleague Chine Livingston during a recent training session in the Emergency Department’s extra-spacious Ready Room.

The remark was apt in more ways than one.

Mr. Livingston and others were encased in bulky protective suits and about to don hooded shields that, when tucked into place with breathing apparatus engaged, would seal them off from the outside world. When fully uniformed — complete with sidearms — the assembled group resembled moon people intent on some kind of special earthly mission, which in a way they were.

Protective Services personnel are the first line of defense responsible for guarding the hospital center and helping with victims in the event of a natural or man-made catastrophe that could be a chemical, biological or radiological attack.

Practice sessions directed by Craig DeAtley, a former paramedic and physician’s assistant who is deputy director of the center’s Institute for Public Health and Emergency Readiness, are held periodically for personnel in different hospital departments to rehearse routine procedures in the event of such a dire emergency.

The institute is part of the center’s grand plan — Project ER One — to erect within the next few years a state-of-the-art emergency facility called ER One that would be a national model of its kind.

This particular day, trainees were reviewing the 24 steps required for putting on the special clothing and equipment that would be needed in the event of a major chemical, or possibly biological, attack. Each set of clothing and equipment costs $1,250; not all of it is reusable; and ideally it should be donned within a few minutes’ time.

The steps on printed reminder sheets led off with a suggestion to drink between 6 and 12 ounces of water beforehand to prevent dehydration while inside the crinkly air-filled suit, which sounded like popcorn exploding when personnel ran around outside testing the suit’s flexibility.

They were taught how to handle stretcher cases and wheelchair patients as well as the proper use of handcuffs and their hidden sidearm. Later, they entered a mock decontamination chamber before doffing the suit and equipment and storing them in an outsized black satchel.

Training like this has not been unusual at Washington Hospital Center ever since the institution took the lead locally in upgrading its emergency medicine department, headed for the past nine years by Dr. Mark Smith.

The hospital, located two miles from Capitol Hill and the largest in the Washington area in terms of number of beds, had a bioterrorism task force in place in 1997.

Its major effort to date includes a congressionally funded study and design for ER One, introduced in May 2003, that cost $2.2 million. The hospital is pledged to contribute $25 million to $50 million for any future building, Dr. Smith notes, because it already had planned to construct a new emergency center of some kind.

In 1999, he and a colleague, Dr. Craig Feied, had gone to Capitol Hill to get support for their new concept.

“We felt that, in the event something occurred, Washington Hospital Center would be a major receiving center, and no one had thought how to design an emergency preparedness center that was optimized to take care of the medical consequences. ER design had not really progressed,” he says, crediting the offices of Sens. Alan Specter and Bill Frist as being instrumental in getting funds for developing the design.

“In 1999, we were like someone else making statements no one believed,” he says.

ER One’s exterior — at least on the drawing board — resembles a spaceship or, more appropriately, an airport terminal able to care for a constant stream of people and vehicles. The interior can be reconfigured for maximum flexibility, including the ability to seal off separate compartments to prevent contamination of air space.

The building could be used in different ways, depending on the nature of the emergency. Massive numbers of casualties resulting from a tornado or a calamitous automobile pile-up presumably would not involve the same security measures as those needed when dealing with the dangers of contagion from exposure to deadly chemicals or, to a lesser extent, biological agents.

But there are circumstances when the exact dangers are unknown, requiring full-scale protection as a preventive measure, Dr. Smith points out. Protective measures would have to extend to the facility itself.

“The core principle is dual use,” he emphasizes. “The things you do to protect staff and patients from smallpox, plague and anthrax are the same things you do to protect them from multi-drug-resistant tuberculosis, SARS and influenza. They can hit in Peoria just as in D.C.

“There are a lot of new technologies out there, for self-decontaminating for instance, to prevent germs from traveling, and a lot of these ideas we plan to incorporate into a demonstration facility,” he says.

Of course, there is much to learn along the way, which is why the ER One Institutes are being established by Dr. Smith and Dr. Feied; their purpose, in part, is to research better information and communication methods useful during large-scale emergencies.

In addition to Protective Services’ emergency training sessions, the institutes have coordinated with numerous area hospitals to provide 20-minute training vignettes available on the Internet to further the education in emergency preparedness for health personnel at all levels.

Another project involves the creation of software that would enable critical care personnel to control a computer by a signal or movement even when their hands are occupied.

Not the least of the challenges is getting hospital personnel acquainted with their tasks under pressure. Federal money has paid for equipment; the hospital pays personnel for their time. “Training isn’t a one-time thing, and personnel aren’t constant,” Dr. Smith says.

When the fully suited Protective Services’ training class moved outside to practice maneuvers, Mr. Livingston didn’t participate. He stood on the side without his helmet, saying, “I can’t get used to this.” He blamed an attack of claustrophobia.

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