Maryland Hospital Uses AHRQ Tools to Develop Disaster Readiness Plan

October 2008

Suburban Hospital, a community-based hospital in Bethesda, Maryland, is using AHRQ's emergency preparedness tools as part of its disaster-readiness plan. The hospital has used both the Tool for Evaluating Core Elements of Hospital Disaster Drills and the Hospital Surge Model.

Cindy Notobartolo, Corporate Director of Emergency/Trauma, Safety and Security Service at Suburban, is an avid user of AHRQ's emergency preparedness tools. She participated in AHRQ's Knowledge Transfer Webcast, "Public Health Emergency Preparedness: Planning and Practicing for a Disaster." Held in February 2009, the Webcast featured various tool demonstrations by developers and insights from users. One of the resources discussed was the Tool for Evaluating Core Elements of Hospital Disaster Drill.

Disaster preparedness is an important aspect of Suburban Hospital's culture. As a Regional Trauma Center, it is committed to emergency preparedness. Notobartolo says that "Some events of massive proportions are difficult to plan or practice in drills, but the AHRQ materials assist in the creation and evaluation of large-scale scenarios."

Prior to using AHRQ's Tool for Evaluating Core Elements of Hospital Disaster Drills, Suburban had either created its own evaluation tools or adapted them from existing templates to conduct exercises. Dissatisfaction with these tools led the hospital's staff to AHRQ's emergency preparedness resources. Staff was drawn to the AHRQ evaluation tool because of its logical framework, pre-populated fields, comment sections, and prompting questions.

Developed by the Johns Hopkins University Evidence-based Practice Center in Baltimore, the Tool for Evaluating Core Elements of Hospital Disaster Drills is a series of evidence-based modules that provide standardized checklists to document observations during a disaster exercise. Using the observations, hospitals can identify areas for improvement, make appropriate changes, and set benchmarks to track those changes over time.

Notobartolo learned of the AHRQ tool in time to incorporate it into an October 2008 drill that simulated a regional large-scale explosive event. "I was unbelievably happy to learn of this tool. For me—especially having been an emergency manager and also being a nurse—it had a logical framework. The flow and the sequence matched actual events," says Notobartolo.

Suburban Hospital staff designed, planned, and conducted the drill that involved 40 military, research, national, state, county and private entities. It was designed to include thousands of participants and hundreds of casualties.

The individual modules of the AHRQ tool assess the adequacy of response by different functional "zones" set up within a hospital during a disaster: command center, decontamination area, triage, and treatment. A pre-drill module is also included, and a debriefing module helps capture feedback from all participants, including observations that occur across multiple functional zones.

Notobartolo says of the tool's flexibility, "It has logical modules. One can select individual sections or use the tool in its entirety. Also the tool has such wonderful questions you can ask to illicit information from participants." Such questions in the group debriefing module include, "Did people have a good understanding of their roles as defined in the disaster plan?" "Were there problems with information flow through the hospital?" "Did the right individuals show up?" "Did they show up in time?"

During Suburban's drill, the Incident Command Module prompted important time parameters, such as beginning and ending of the event. It also prompted response times of staff and allowed for targeting the need for after-action response. The staff found that with the tool, the post-event documentation was easy and efficient. As a result of using this module, they also realized that the External Triage Zone used in the drill was much too small an area for a large incident.

Notobartolo says, "I have been telling everyone I know to use the AHRQ tools. The more we refine our plan as a health care community, the better we can meet our community needs in the event that a real disaster occurs."

Suburban Hospital has served Montgomery County, Maryland, and the surrounding area since 1943. It is the only designated trauma center in Montgomery County verified as a Level II Trauma Center. In February 2007, Suburban Hospital was the only trauma center on the East Coast to be recognized by the National Foundation for Trauma Care as one of the five "Highly Prepared Trauma Centers" in the event of a natural or human-caused event of mass scale in the nation. The Trauma Center sees approximately 1,500 patients annually. On July 1, 2009, Suburban Hospital Healthcare System became a member of Johns Hopkins Medicine.

Impact Case Study Identifier: 
AHRQ Product(s): Hospital Disaster Drills Evaluation Tool, Public Health Emergency Preparedness Webcast
Topics(s): Emergency Preparedness
Geographic Location: District of Columbia, Maryland
Implementer: Suburban Hospital
Date: 10/01/2008

Cosgrove SE, Jenckes MW, Wilson LM, et al. Tool for Evaluating Core Elements of Hospital Disaster Drills. AHRQ Publication No. 08-0019, June 2008. Agency for Healthcare Research and Quality, Rockville, MD.

Addressing Surge Capacity in a Mass Casualty Event, Web Conference, broadcast on October 26, 2004. Agency for Healthcare Research and Quality, Rockville, MD.

Rich T, Casagrande R, Hupert N, Callahan M. Hospital Surge Model Version 1.2: Description. Prepared by Abt Associates, Inc., under Contract No. 290-20-0600-011I. AHRQ Publication No. 07-0084-1-EF, July 2008. Agency for Healthcare Research and Quality, Rockville, MD.

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