Stanford Hospital doctors treated empty water bottles, people-sized stuffed animals and volunteers in the role of patients April 30 during a disaster drill. In the drill, a powerful earthquake struck. Local roads and buildings were damaged and a water line broke in the emergency department, requiring that the ED be moved outside. Tents outside the emergency entrance sheltered a triage area and gurneys for treating patients.

The drill was part of the medical center’s ongoing preparation for emergencies. The hospitals are required to hold three to four drills a year, but in reality hold them more often, said Eric A. Weiss, MD, assistant professor of surgery and a member of the emergency medicine department who heads the disaster preparedness committee.

"Patients" were treated in fully equipped tents outside the emergency department during a disaster preparedness drill last week. In the scenario, damage to the hospital prevented incoming "patients" from entering the ED. Photo: Helen Fields

Emergency drills help prep staff to work effectively with the stress that comes after a disaster. "That high-anxiety atmosphere could generate a lot of confusion and chaos," Weiss said. But the drill went well, he noted. "People get very used to procedures and practices," he said, so drills teach them to improvise when they’re working in unusual conditions.

Reid Conant, MD, a senior resident in emergency medicine, wore a bright orange hard hat and a vest over his scrubs with "treatment area supervisor" written on it. During the drill, he supervised the triage area and nearby treatment areas, sending patients to the operating room, Lucile Packard Children’s Hospital, other parts of the hospital or to be discharged. He also took part in a previous drill, a "dirty bomb" scenario in December. "This went a little smoother. There were more personnel available," Conant said.

An hour after the "quake" hit, a volunteer with a bandaged hand moaned convincingly from her stretcher on the grass outside the hospital’s emergency entrance. Nurses under a tent read the list of symptoms taped to a 5-gallon water bottle, playing the part of a pediatric patient, in a wheelchair. Hospital security fended off "reporters" from the public affairs office pretending to be local media. The weather was sunny and warm, although the drill was scheduled to go ahead in rain or shine.

Staff from all parts of the hospitals took part in the drill, from administrators to technicians to trauma surgeons. During the drill, the ED remained open and patients continued to enter, bypassing the exercise outside.

For the next drill, Weiss said he would like to improve communication between different parts of the hospital. Since phone lines could be unavailable, staff had to use radios. "Asking them to use a radio puts a foreign object in their hands," he said, which can be confusing. Also, he said he would like the next drill to focus on walking wounded, patients who come in with less critical problems like cuts and broken bones.

The "walking worried" could be even more of a problem, Weiss said. For example, after a bioterrorism attack, patients with vague respiratory problems could easily overwhelm the emergency department. Then, everyone from psychologists to psychiatrists and social workers to chaplains would play a large part in dealing with anxious coughers who weren’t being admitted.