Greg Brison's business card reads "Director of Safety, Security and Emergency Management."
What it should really say is "paid worrier."
Since the day three years ago when terrorists piloted a hijacked jetliner into the Pentagon, Brison has made it his mission to ready Inova Alexandria Hospital for the possibility of a future attack. It's his job to safeguard the welfare of hospital staff and make sure the facility is prepared to treat an injured public.
Taking visitors deep into the recesses of Inova Alexandria last week, Brison unveiled a newly completed room that he has spent months stocking with supplies and organizing with the precision of a firehouse -- everything is ready to go at a moment's notice.
In the room, disaster feels imminent. The walls are lined with uniform cubbyholes, each filled with a black duffle bag containing a chemical-protective respirator hood that doctors and nurses will put on to keep from inhaling potentially contaminated air. Next to each bag is a bottle of water that employees have been instructed to drink before donning their suits, to avoid dehydration.
The bags are flanked by dozens of pairs of nuclear-orange steel-toed boots, already numbered and sized and ready for the specified wearer. Protective suits are stored in gigantic rubber containers. Each outfit, with parts purchased at a bulk discount, cost about $800.
"Protecting our staff is our number one priority," Brison said. "If you can't take care of the staff, you can't take care of anyone else."
Since Sept. 11, 2001, hospitals across the region have taken up the same call, organizing incident command structures, upgrading communication systems, beefing up drug inventories and using grant money from the Department of Homeland Security and the U.S. Department of Health and Human Services' Health Resources and Services Administration to stockpile equipment and draw up protocol to deal with what officials refer to as "the worst-case scenario." One of the goals, hospital officials say, is to staff and supply each facility in a way that will make it self-sufficient for 48 to 72 hours after an incident, until help can arrive.
Some of the changes hospitals have implemented have been logical extensions of their everyday operations. Other measures are less conventional.
Area hospitals have been practicing decontamination drills for nearly two years now, bringing in mock patients, tagging and bagging their clothes while they scrub down in outdoor showers. That wasn't enough for Brison, who questioned whether a regulation washcloth and bar of soap could really do the trick in removing petroleum-based contaminants.
After conducting a few tests, he decided to include kitchen sponges in the hospital's decontamination packs. He swapped the bar soap for grease-cutting Liquid Dawn dish detergent, which is more effective. "I was thinking," Brison said, gazing at the hospital's emergency equipment room and the many improvements he has devised. "I stay up nights thinking." One of his last "lying-in-bed brainstorms" was the purchase of foot-pedal trash cans to dispose of contaminated sponges.
Disaster preparedness "is still a top-tier priority for hospitals," said Dan Hanfling, director of emergency management and disaster medicine for Inova Health System. "Every day that something doesn't happen allows us to get more prepared . . . for what is coming down the road." At Virginia Hospital Center-Arlington, which was in the process of a major renovation and expansion when terrorists struck the Pentagon, officials stopped to rethink their plans. They revised them to include deployable decontamination showers and more emergency department capacity.
The hospital, which is scheduled to open its new section Nov. 1, will have disaster preparedness items such as Geiger counters, chemical suits, ventilators and dosimeters (pocket radiation detection devices) for staff.
"We do have a real sense of urgency," said Yorke Allen III, chief of emergency medicine at the hospital, where 44 victims from the Pentagon were treated. "If anyone needs to be prepared, it needs to be us."
Hospitals are just one piece of the local preparedness puzzle. Last week the Virginia Department of Health announced the receipt of a $19.9 million federal grant from the federal Centers for Disease Control and Prevention to improve the state's public health infrastructure and health care system in responses to bioterrorism, infectious disease outbreaks and other public health emergencies.
In addition, the state Health Department will receive $584,000 in state money to help pay six of the 35 local epidemiologists hired throughout the state post-9/11. It was in the hours and days after Sept. 11 that hospitals learned the hard way that their ability to communicate with fire, police -- even one another -- was not adequate. Since then, 13 hospitals in Northern Virginia -- clinical and administrative decision-makers as well as state and local health departments and the emergency medical service community -- have banded together to map the future, forming the Northern Virginia Emergency Response Coalition.
A year later Northern Virginia Hospital Alliance was created to focus specifically on disaster planning.
"Everyone has really come together as a team over the last 24 months," said Michael K. Wyrick, a retired Air Force major general who is executive director of the alliance. "It's been absolutely key," he said, in order to meet the goal of ramping up emergency preparedness.
Among the alliance's accomplishments is the creation of an emergency radio network to share information in the event of a large-scale medical emergency, such as a biological attack. In an emergency, Inova Fairfax Hospital would gather information on the availability of beds and specialty care at each hospital and provide that information to emergency medical system managers.
"During 9/11, there was no communication," Brison said. "We were watching CNN wondering if we'd get patients."
The focus now is on using a $1 million grant from the Department of Homeland Security to upgrade the hospitals' capability to handle patient surge capacity, as well as the installation of a Web-based information management system that will allow the police and other emergency responders, including hospitals, to communicate better, as well as know where incoming patients are being taken or moved.
Officials say it's not just about learning new procedures but also honing the learned techniques. Preparedness drills are an important part of that.
On Saturday, Reagan National Airport will conduct a mass casualty exercise in which Virginia Hospital Center-Arlington will participate. On Monday, the Metropolitan Washington Council of Governments will conduct a regional exercise. Inova Alexandria will conduct an exercise of its own in tandem.