In the weeks following the September 11 terrorist attacks on the World Trade Center and the Pentagon, AuntMinnie.com spoke with radiologists at hospitals in New York City and Washington, DC, about the role radiology played in caring for the victims. In a two-part series, we’d like to share with you how five facilities handled the crisis, the lessons they learned, and how their experiences might shape future responses.
The expected high patient loads never materialized in the days following the September 11 attacks. System failures certainly did occur. But more than anything, what strained the nerves of radiologists we spoke to was uncertainty about the day's events themselves: how many patients would arrive, how well would systems hold up, and what, exactly, was happening in a nation not yet braced for disaster.
Several facilities found that their PACS networks helped smooth operations by enabling them to route images more quickly and efficiently to trauma physicians. In a few cases, however, power and communications breakdowns underscored the need for backup and redundancy.
With the benefit of hindsight, some radiologists we spoke to concluded that their hospitals had far to go before they could consider themselves prepared. Others found that existing emergency systems were sound. In the profiles below, radiologists offer insight into the mechanics of emergency response.
Bellevue Hospital Center, New York City
Dr. Michael Ambrosino, assistant director of Bellevue’s department of radiology, believes that the disaster revealed all the efficiencies one would expect from a PACS network. The hospital’s system administrators facilitated a successful -- and easy -- adaptation of the PACS by creating a disaster worklist so that radiologists at nine workstations could access disaster-related images quickly, Ambrosino said.
Support staff also set up an extra workstation in the emergency room, which allowed trauma physicians to access the read films quickly and avoided potential delays from an initial volume of cases coming through the ER.
"With the worklists, films were read right away," Ambrosino said. "In fact, our reports were coming up in the emergency room as doctors there were reviewing the images, so they got the reports in real time."
Beth Israel Medical Center, New York City
Beth Israel Medical Center’s PACS network functioned well after the attacks. The hospital had two remote sites -- outpatient clinics -- that went down because data transmission lines were routed through downtown, according to Dr. Michael Abiri, radiology chair.
Those locations remained out of commission 10 days after the attacks, and were sending films by courier to Bellevue when necessary. The experience emphasized the importance of having adequate backup for a PACS, particularly remote archiving.
"If we were involved in any disaster with our PACS network, we’d go to a secondary wide-area network and only part of the system would function," Abiri said. "All our devices have the capability to store images for 24 to 48 hours, but after that if the network doesn’t come back up, we’re in trouble.
"We don’t have central archives in diverse places," he added. " We have two copies of our archives, but they’re all at one site. Having off-site archiving capability is crucial."
Washington Hospital Center, Washington, DC
Washington Hospital Center prepared for the possibility of more than 100 casualties from the Pentagon attack, but received only 15 patients, according to Dr. James Jelinek, radiology department chair. The hospital has a well-developed and well-practiced trauma protocol and mobilization plan, Jelinek said, which helped it to operate efficiently. Key to the plan is a system of trauma team leaders who manage specialists at the patient point of contact.
"It’s difficult to have five different physicians wanting to have various body parts imaged when a patient needs to get in and out of the trauma unit," Jelinek said. "We designate a few people, trauma surgeons, to call the shots, which makes patient care much more efficient in a disaster situation. Someone has to make the decision of what gets imaged."
The initial "code orange" advisory to hospital staff was delivered through a PA system and through dedicated phone lines. The latter proved crucial, as phone systems in the Washington, DC, area were jammed after the bombing. The facility also has a closed radio communications system in case all phones are inoperable in an emergency, Jelinek said.
He emphasized the importance of hospitals working with their metropolitan area’s disaster recovery personnel.
"We didn’t have great coordination this time between the military, the police, the local government, and the hospitals," Jelinek said. "We’re working on those lines of communication now. Sometimes, until these systems are tested, you don’t realize how much better they could be."
Virginia Hospital Center at Arlington, Arlington, VA
Radiology chief Dr. Russell McWey believes that what made his hospital operate smoothly after the attack on the Pentagon was a plethora of staff and simultaneous hard-copy and PACS tracking procedures. Virginia Hospital Center’s downtime system, although it didn’t end up being taxed by a large patient load, allowed emergency room doctors, technologists, and radiologists to work together efficiently and with little delay, McWey said.
"If you’re PACS-dependent, you need to realize the limitations of the system, especially under the potential burden of a lot of unknown patients," McWey said. "We already had a backup procedure in place so that we could register patients and track their images by manually entering a scan request into the computer. The tech assigned to that patient carried the printout from this request to the imaging unit, took the scan, and then carried the request with the image back to a radiologist for immediate reading. This system made it easier on our ER doctors, since they didn’t have to wait at all for the reading."
By Kate Madden Yee
AuntMinnie.com contributing writer
November 2, 2001
Related Reading
Front-line radiologists recall September 11, October 31, 2001
Chest CT pegs inhalation anthrax at Virginia facility, October 30, 2001
Imaging technology answers an urgent call for security, October 26, 2001
Copyright © 2001 AuntMinnie.com
