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Metro Crash: Hospitals Brace for Mass Injuries
Area Hospitals Treat 76 Injured in Metro Accident

Janis Orlowski, M.D.
Chief Medical Officer, Washington Hospital Center
Tuesday, June 23, 2009 2:00 PM

At least 76 people involved in the Metro Red Line crash were taken to area hospitals last night for treatment of injuries that ranged from minor to critical. Most went to Washington Adventist Hospital, Washington Hospital Center and Howard University Hospital, officials said.

Janis Orlowski, M.D., chief medical officer at Washington Hospital Center, was online Tuesday, June 23, at 2 p.m. ET to discuss how a major trauma center prepared for a mass casualty incident, first responders and other medical technicians and the types of injuries seen in this type of incident.

Submit your questions and comments before or during today's discussion.

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Janis Orlowski: Welcome to a discussion on yesterday's tragic Metro Red Line train crash. I am Dr. Janis Orlowski the Chief Medical Officer and Senior Vice President of Washington Hospital Center. I would be happy to help you understand our role in responding to emergencies in the metro Washington, D.C. area.

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Chesapeake Beach, Md.: Do you practice mass casualty drills more often since 9-11? Was there anything you've learned in some recent drills that helped make a difference yesterday?

Janis Orlowski: Yes as a matter of fact we have a city wide drill on Friday. We have participated in developing an emergency response for our hospital as well as the area. We work with the Department of Health, DC Fire and EMS and MPD as well as others to make sure that we are prepared at all times.

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Chesapeake Beach, Md.: Do you have different levels of 'mass casualty' responses at the hospital? i.e. is there 'everyone in the building get down here' vs. say 'everyone get to the hospital and get down here?' What was the response yesterday?

Janis Orlowski: Yes, we have different levels of response depending on how many injuries and what type of emergency. so for example we had our Hospital Emergency Command Center up and staffed all day on Inauguration Day. This was in anticipation of any problems. Thankfully we dealt with only a few serious injuries and then many "routine" emergencies. The levels of response can be everyone be alert to everyone come back to the hospital because we need all hands on deck.

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Washington, D.C.: When a large accident happens, how do you get ensure enough staff is on-hand to treat the injured? Yesterday, when did you realize how large an accident it was?

Janis Orlowski: I received information around 5pm about a "metro accident". We receive information from DC Fire and EMS as well as from a regional emergency response system that tells us about problems in the area. As I received further information from individuals at the scene as to the number of people involved and the type of injuries I made the decision as to the level of "response" we would develop. I communicated to DC emergency officials the number of critical care beds I could make available as well as how many ORs we could have immediately available. We had surgeons, orthopedic doctors, anesthesiologist, trauma surgeons prepare. We also look at how much blood and pharmaceutical drugs as well as other supplies we have available.

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WaPo Reader: How is it determined which hospitals to send the injured? For example, why were most sent to Washington Advent, the closest hospital, and not your hospital, the area's most experienced trauma hospital?

Janis Orlowski: At the site of a disaster, a triage officer will assess people's injuries and "tag" the person as a green-mild, yellow-moderate or red-severe injury. Typically the trauma hospitals, like the Washington Hospital Center will receive the yellow and red injured patients with outlying hospitals helping the response by administering to the "green" injuries. You may have seen that a bus with more than 20 patients went to a hospital further from the scene. These individuals did not require EMS transport but did need to be evaluated.

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Keshena, Wisc.: How will the proposed health care reforms affect your ability to respond to these types of situations?

Janis Orlowski: Hi Dad

It is very expensive to maintain at an "alert" status a level one trauma center. This requires nurses, doctors on site, ORs, blood products, experienced trauma and neurosurgeons and the expertise to respond immediately. As the president and Congress look to reform health care they will need to determine how to pay for primary care needs and how to maintain these centers of excellence in emergency response. The American people must also ask how much they are willing to pay for this level of care.

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Washington, D.C.: Will there be any way to determine how the driver of the train that struck into the stopped train died? It seems that, without black boxes, that will be the only way to know if the driver had some kind of medical problem before the crash.

Janis Orlowski: In situations like the Metro tragedy, the driver's medical history as well as a thorough evaluation by the Medical Examiners office (autopsy) will be performed to see if they can determine the cause of death. Sometimes this evaluation can determine if the person was ill before the accident.

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Washington, D.C.: How do you think the level of preparedness at your hospital compared to other disasters, such as 9/11?

Janis Orlowski: We debriefed this morning on our response to the emergency. We listed what we had done well, what we did poorly and what we would like to improve. Tomorrow the city will have a city wide debriefing to see how we acted as a emergency response system. Its only by critical review of our actions that we will improve, I can tell you that we were very pleased with the Washington Hospital Center's internal response. We had several hundred people return or stay at the hospital to help with the response. This is the commitment we have to the city to provide level 1 trauma care.

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Silver Spring, Md.: What kind of training is provided to hospital staff and/or first responders about talking to people about the casualties?

Janis Orlowski: We do train our staff on how to talk to people and their families who have been injured. In an emergency, besides doctors and nurses responding, we also ask our psychiatry staff and spiritual care staff to respond. They were part of our response yesterday.

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Albany, N.Y.: I'd like to confirm that all my friends in Takoma Park and Silver Spring are okay. Is there a list of victims out there somewhere?

Janis Orlowski: There is not a public listing of victims but the Department of Health will help you reunite with a friend or family member if needed. In DC call 311.

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Columbia: Doctor,

Would you explain for us, in general, the process for determining who goes to what hospital in a situation like yesterday's?

Thank you.

Janis Orlowski: This decision is made by the triage officer and DC EMS at the scene. They also have special managers on a radio system who will route them to specific hospitals depending on the type of injury.

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Washington, D.C.: What makes MedSTAR uniquely qualified to take the more seriously injured patients?

Janis Orlowski: MedSTAR/Washington Hospital Center is a level 1 trauma center with years of experience. That means that we have on site specific types of doctors and nurses who can respond to crush injuries, burns, blunt trauma as well as other types of injuries. We practice on a regular basis to be able to respond. We spend hospital resources to remain prepared. National regulatory agencies have come in to review and rate our response and have accredited us.

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Washington, D.C.: How many level one trauma centers are in D.C.?

Janis Orlowski: Four

Washington Hospital Center , Howard University Medical Center, Georgetown University Hospital, George Washington University Medical Center

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Greenville, N.C.: Do you have Critical Incident Stress Management Counseling available to your staff in the aftermath of such disasters?

Janis Orlowski: Yes we do. We want to keep our healthcare staff as healthy as possible so they can help you.

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Fairfax County, Va.: Sorry, Janis, I know this is a little off topic, but I took the Metro home last night from DC to Huntington and I didn't have a second of doubt as I trusted my life and timely arrival to the system once again. I have lived in the DC suburbs all my life and remember the pre-Metro era, the huge excitement of the first small section opening, and the local pride in our system.

Metro operators were also unsung heroes on September 11, going back into the city over and over again on their routes to ferry commuters back home. Of course they were doing their jobs, but they don't seem to get noticed and thanked as often for those actions at a life-or-death time as our first responders.

Anyway, this is just to say that this was a terrible tragedy and of course it had causes that must be corrected (I suspect they will boil down to inadequate funding one way or another), but I and many others in the region are still very grateful to Metro and can't imagine our area without it.

Janis Orlowski: I agree. I think Metro is a wonderful resource for the city. As a DC resident it is my favorite mode of transportation.

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Buffalo, N.Y.: Could you talk a little about NIMS and the other federal training that responders go through?

Janis Orlowski: We participate in a federal training program. The Washington regional area has tried to coordinate DC, Maryland and Virginia responses to emergency situations in the nation's capital. One of the ways to do this is for all to use a similar system and similar communication.

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Philadelphia, Pa.: Does your hospital use a helicopter? When hospitals use helicopters, what are the criteria for when they are used?

Janis Orlowski: We do have a helicopter service which has been in service since 1983 with over 45,000 missions. We did not use our service yesterday although we were on alert. Decisions to use a helicopter are based on severity of illness and distance. We also have a ground transportation system to complement our emergency response.

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D.C.: I was watching the news coverage on television last night and saw an injured passenger transported via helicopter to your hospital. It appeared to be extremely windy. I was surprised that petite, small framed hospital staff was sent to the roof to transport the injured to the OR, especially given the injured appeared to suffer from severe injuries.

Janis Orlowski: Our helicopter pad is not on the roof. We have landing pads outside of our trauma and emergency rooms. Our colleagues at Children's National Medical Center do have a roof top landing where they receive injured children. There is protection on both helicopter pads and procedures to use for staff so that they are safe when approaching the helicopter.

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Washington, D.C.: Do you know how long it took for emergency crews to arrive on the scene? I remember reading about the derailment on the green line a little while ago and how 911 was not alerted until well after the incident.

Janis Orlowski: I don't know what the response time was yesterday but national studies on DC response times and transport to an appropriate trauma center are excellent.

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Buffalo N.Y.: Will first responders and hospital staff go through critical incident stress debriefings after dealing with this tragedy?

Janis Orlowski: Yes

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Gaithersburg, Md.: Is there an "after incident report" where the performance of all concerned is evaluated?

Janis Orlowski: Yes, tomorrow morning there will be an evaluation and debriefing

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City's emergency response protocol?: What happens to alert/prepare hospitals in the event of an emergency? Who decides if a situation warrants a general alert and how does that information get disseminated?

What then happens at the hospital level to respond to such an alert?

Janis Orlowski: We have special protocols for communication between all hospitals and DC Fire and EMS. The call into the Washington Hospital Center is then sent to the appropriate level of person. We have an "administrator on call" each day of the year. That person is always notified. That person then uses their experience to determine the level of response

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Bowie, Md: I really admire the work that you do in treating the injured. When your team participates in trauma on a "mass scale," do many of them have problems afterwards dealing with the tragedy of it? In other words, when they see a lot of severely injured people in a short period of time, how traumatic is it for the hospital staff?

Janis Orlowski: Although these are very experienced doctors, nurses and staff we realize that they may be affected by what they see and need to treat. We have a very robust mechanism to provide help and counseling to our staff. This is one of the most important jobs for a hospital administrator to remember, take care of your talented staff.

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Janis Orlowski: Thank you for the opportunity to speak with you this afternoon. I love being a doctor at Washington Hospital Center. It allows me to work with dedicated medical professionals and provide service to the community. If you would like to learn more about the Washington Hospital Center please visit us at whcenter.org

Best regards,

Janis M. Orlowski, MD

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