Robert Wood Johnson University Hospital Participation in Top Off 3, April, 2005

ISSUE: September 11, 2002, was an alert to the nation that the level of preparedness to deal with catastrophic events needed to be improved. Since then, exercises known as Top Off, have been conducted in various parts of the nation in order to test and improve the status of readiness. PROJECT: In April of 2005, the third such exercise, Top Off 3, was conducted on the national and international level and involved New Jersey, Connecticut, Canada and the United Kingdom. New Jersey participated in a simulated biological attack that was subsequently identified as pneumonic plague. Participation was voluntary and hospitals that choose to “play” were permitted to select one of three levels of participation, each with increasing levels of involvement. Robert Wood Johnson University Hospital (RWJUH) in New Jersey participated from April 5th to the 7th, at the highest Level 3 that involved eight hours each day that was to include shift and incident command change. In all over 380 “victims were processed for treatment.” During the exercise, the Emergency Department (ED) with an average of 200 visits per day, continued to accept and treat non-exercise patients, adding the total of over three hundred daily visits for each of the three days. The ED has three negative pressure rooms, 3 portable negative pressure stretcher units and access to three negative pressure rooms in an adjacent unit. The hospital courtyard was converted into a 100 bed medical unit, dividing it into pods for pediatrics, adult, ventilated patients and critical. Assigned ED, first responders and administrative staff were provided 8 megahertz walkie talkies for communication needs. A “Command Central” location was set up that coordinated communication, supply, and staffing needs. RESULTS: The exercise highlighted that RWJUH is in an advanced state of preparedness compared to many other facilities. Some areas for improvement included communications between patient surge areas, patient tracking and distribution of supplies. Visitors to RWJUH during the exercise included State, Federal, and International observers, resulting in positive comments and invitations to assist an Asian country with their efforts and speaking engagements to many different organizations. LESSONS LEARNED: Valuable lessons learned specific to infection control included; systems to contain the spread of the agent once all isolation rooms were occupied; providing protective barriers that are comfortable for extended length of time and collecting data in a timely manner for Public Health without interfering in patient care.