A Community Pulls Together

On March 24, 1998, a tragedy occurred in Jonesboro, a northeast Arkansas community of approximately 52,000. As students were beginning their afternoon at Westside Middle School, two students allegedly shot and killed four young girls and a teacher. Another teacher and nine other students suffered gunshot wounds. The marketing department of St. Bernards Regional Medical Center documented the event.

Every hospital has a detailed disaster plan that has been well rehearsed; it is the hope of every medical professional that it will never be implemented. Unfortunately, on the afternoon of March 24, 1998, that hope was dashed for the staff at St. Bernards Regional Medical Center in Jonesboro, Arkansas. Despite the terrible incident at Westside School, officials at St. Bernards were pleased with the staff and community organizations that joined forces to respond during this crisis.

The initial call to St. Bernards was received at approximately 12:41 p.m. Dr. Robert Beaton, Medical Director of the Emergency Department explains. "This call was of a shooting at Westside Middle School, with no mention of the number or types of injuries. Within five minutes the hospital was again notified of multiple victims at the scene, with three 'trauma codes' being transported. It was at this time the hospital's disaster plan was initiated."

Lois Johnson, Director of Emergency Services, remembers that day as being unusually slow in the ER until they got that call. "I could tell by the urgency in the operator's voice, this was not a drill."

Once the plan was activated, the ancillary departments at St. Bernards shifted into gear with many independently reporting to the ER and Administration to help. Every department at St. Bernards has its own specific responsibilities during a disaster, explains Jimmy Cooper, Director of Safety and Plant Management at St. Bernards. "A central area is established for administrative direction, runners are available for communication between various parts of the hospital, physicians are notified of an emergency and admissions personnel check with area medical facilities on the availability of rooms. Supply personnel pave the way for securing additional hospital supplies if needed. And other employees take care of still more duties."

Within 10-13 minutes of the initiation of the disaster plan, six general surgeons, two cardiovascular surgeons, one neurosurgeon, five orthopedic surgeons, ER nurses, OR nurses and critical care nurses were assembled and waiting. As victims were brought in by ambulance, they were triaged at the ambulance bay by the Emergency Department manager and physicians. "The staff assembled was the most competent I have ever seen at work," said Johnson, who has been with St. Bernards since 1977 and has spent the last three years in emergency care.

"From the time you are notified, you have a limited time to prepare for what you think will happen," said John Heer, St. Bernards Chief Operating Officer. In this particular instance the hospital had 50 minutes from the time personnel received the initial call until patients started arriving. "The many drills and simulations of a disaster began to fall into place. When you are faced with such an ordeal you cope with it the best you can. As tough as it may be, you remove yourself emotionally and do what is expected of you."

The parking lot was closed to traffic to clear the way for emergency vehicles. A uniformed officer directed arriving families to Stroud Hall, a building directly across from the Emergency Room. There, Ben E. Owens, president of the hospital, gave updates on the conditions of victims every 15 minutes. Once confirmed that their child or wife had been injured, the immediate family was escorted to the emergency room. This eliminated a frenzy of concerned relatives and friends in the ER itself.

St. Bernards' ER has 23 beds, so it was not necessary to utilize other areas of the hospital for immediate care. The last victims left the emergency room for care in other departments approximately two hours and fifteen minutes after they began arriving. The average time it took to stabilize a victim and get them to surgery was 22 minutes.

As things turned out, the emergency happened at a time when about half of St. Bernards' 16 operating rooms were unoccupied and it was possible to delay several minor surgeries scheduled for that afternoon. Upon receiving the call, the surgery department worked to transfer the few patients still in the OR to recovery, clearing the rooms for as many victims as necessary. Patients ready to be discharged were processed immediately so their rooms could be cleaned and ready.

The incident drew almost immediate international media attention, the likes of which a community the size of Jonesboro did not expect, but St. Bernards' Administration was able to accommodate. According to Jane McDaniel, SBRMC Director of Marketing, "Our day to day policy for providing information to the media enabled us to manage this crisis. Our first and foremost responsibility is to protect the privacy of our patients and their families. Secondly, to provide appropriate information to the media for the purpose of informing the public. The decision was made to hold briefings and interviews at St. Bernards' Auditorium, adjacent to the hospital. From that point on, the auditorium was the hospital's media center for news conferences, updates and individual interviews. Dr. Robert Beaton was designated as the hospital spokesperson for this crisis."

With the immediate media coverage, there was an influx of phone calls making telephone communications extremely difficult. Additional phone lines were made available and special lines allowed news agencies from all over the world to have live access to the media briefings.

McDaniel stated, "It is good to know that in a time of crisis and need, a community can pull together and work through such a tragedy as Jonesboro has done. We are fortunate to be a part of this community and appreciate the support of other hospitals that offered their assistance during this time. One would never want to think such misfortune could fall on their hometown, however as we have learned, it can."

HHS Language Assistance Policy

The Department of Health and Human Services (HHS), Office for Civil Rights (OCR), recently issued a policy memorandum regarding nondiscrimination based on national origin, particularly as it relates to communicating with individuals who are Limited-English Proficient (LEP). OCR sent the memorandum to the Arkansas Department of Health for distribution to Arkansas health and social services programs funded by HHS.

The lengthy (seven-page) guidance policy addresses language assistance that may be required for communicating with LEP persons. It spells out factors that OCR will consider when determining to what extent HHS-funded programs comply with provisions of Title VI of the Civil Rights Act of 1964, which make providers responsible for establishing and implementing policies and procedures to fulfill their obligations to LEP populations. The policy applies not only to the hospitals, but other services and facilities they operate, including their home health agencies, skilled nursing services, hospices, and rural health clinics.

Val Buck, director of health facility services at the Arkansas Department of Health, asked the Arkansas Hospital Association to distribute the policy memorandum to hospital CEOs who are urged to read the memorandum carefully and pass it along to the appropriate people in their hospitals. The policy can be accessed at the OCR web site, www.hhs.gov/progorg/ocr/facts.html.

Arkansas Commission Rejects LTC Networks

In an April 29 public hearing, the Arkansas Health Services Commission (HSC) rejected a proposal that would have allowed long term care providers who network together to enter into home health, hospice, residential day care, and adult day care services without having to establish need under the state's Permit of Approval process. The decision came after the Arkansas Hospital Association and hospital-based home health agency directors testified against the plan. The Arkansas Health Care Association, which represents the state's nursing homes, was the only organization to show support for the proposal.

On another matter, the Commission upheld its earlier decision to deny Olsten Health Services a permit of approval for Class A and B home health licenses in five locations encompassing several counties in Arkansas. Olsten is now likely to follow the same path taken by another home health agency, CareNetwork, and appeal the matter to circuit court. CareNetwork was denied a similar request by the HSC last year. Olsten Health Services and CareNetwork both previously provided home health extended care services statewide, even though they were not licensed to do so. New rules and regulations forced both companies to cease operations in areas where they are not licensed. Neither agency has been able to demonstrate that a need exists for their services in those disputed areas, which would be necessary to receive a Permit of Approval from the HSC.

1999 JCAHO Workshops

The Arkansas Hospital Association will sponsor in 1999 the following workshops offered by the Joint Commission on Accreditation of Healthcare Organizations. All six workshops will be presented in Little Rock.

January 29    Hospital Accreditation Standards and Survey Process: The Advanced Course (Overview of 1999 standards and survey process, with an emphasis on new or challenging standards and recent capping changes. Course assumes participants have a basic familiarity with JCAHO survey process.)

February 11-12     The Advanced Course--Home Care Survey Preparation Clinic (Provides operational understanding of JCAHO standards for home care; how to relate those standards to specific organization and services, while reviewing strategies and management solutions designed to increase effectiveness of patient/client care and service delivery outcomes.)

May 11    Minimizing Medication Errors in Health Care (Describes guiding principles behind current healthcare changes as they relate to medication use; emphasis on practical application of these principles in a multidisciplinary patient-oriented environment.)

July 8-9     Accreditation Standards for Improving Your Organization's Performance (Focus on practical application of the IOP standards and relevant standards from the Leadership and Management of Information chapters.)

September 29     Assessment and Treatment Planning in Behavioral Health Care (Provides working knowledge of assessment and treatment plans; special populations, i.e., alcohol/drug, children and adolescents, and mentally retarded/developmentally disabled will be addressed; special focus will include special care needs including medication, nutrition, rehabilitation and special treatment procedures.)

November 15    OSHA Compliance and Joint Commission Accreditation: An Educational Partnership (Review of standards from the Management of Environment of Care Standards and discussion of similarities and linkages between Joint Commission and OSHA regulations.)

From the Chaplain

Jack Pollard, Chaplain
Sparks Regional Medical Center
Fort Smith

Wandering around trying to locate what you came to purchase seems to be a part of shopping in a large discount store, which is why I was delightfully surprised to have three different employees ask if they could help me when I recently entered one such store.

I was so impressed, I mentioned this unexpected helpfulness to the cashier who rose to her full height, looked me in the eye, and said, "Yes sir, helping you is what we get paid for!"

Two things are apparently going on in that store: Someone at the top has said, "We value people, and you get paid to help them." And the employees seem to be taking this value seriously! Am I the only one who thinks this attitude is rare in stores these days?

I drove home thinking about the helpfulness of the employees in that store and how important it is for me to reflect the same attitude in my work.

One of the most successful businessmen I know heard me struggling with the use of the word "customer" when referring to hospital patients and their families. "What's wrong with the word?" he asked. He reminded me that this is a noble word, not a demeaning one, pointing out that customers are the most valuable asset any business or institution can have, for without them there is no future for any kind of enterprise.

Discovering and meeting the needs of those we serve, putting those needs first on our agenda, is truly our mission.

All I needed at the discount store was a bulb for my flashlight, but it was a gratifying experience to be treated as though my needs were important.

I hope I can help create an equally positive experience for the anxious people I see entering our Medical Center with its maze of hallways, complicated technology, and strange terminology. Helping them is what I get paid to do.