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Early one morning in October, word came to St. Joseph’s Medical Center in Paterson and Bergen New Bridge Medical Center in Paramus that patients injured in an explosion and release of a toxic gas at a Bergen County shopping mall would arrive within minutes at their emergency rooms.

Quickly, the staffs erected “decon” tents near the ER doors. Triage nurses assembled. Crash carts and protective equipment — masks, gloves, gowns and breathing apparatuses — were placed at the ready. Doctors huddled in the hospitals’ incident command centers to await word on the exposures and injuries so they could prep medical supplies and plan treatments.

It was all a drill.

But the practice exercise — called “15 ‘til 50,” short for “15 minutes ‘til 50 patients” — simulated an all-too-real possibility in North Jersey, where threats both natural and manmade could flood area hospitals with injured or chemically-exposed patients.

That October morning, nine hospitals in a seven-county area each prepared to receive 50 patients within 15 minutes, people who would arrive by ambulance and private vehicles, as might be expected in a real emergency. As the day wore on, new “injects” to the scenario — information about the toxic agent (chlorine) and the number of casualties — were pushed out to the simulators.  

The exercise was organized by the Urban Area Strategic Initiative, a federally funded emergency preparedness program established in the wake of the 9/11 terrorist attacks. The Northern Jersey-Jersey City/Newark UASI is considered Tier One for risk — a calculation based on an assessment of potential threats, vulnerabilities and consequences. That’s equivalent to New York City and the nation’s capital.

The program’s Rachel Tkatch organized the October training exercise, which took place at the American Dream mall and entertainment complex in East Rutherford.

“I think we’re more ready than most places,” said James Sheehan, program manager for North Jersey. “But are you ever totally ready? I’d never say 100%.”

Hospitals plan and drill for emergencies large and small as a requirement for receiving national accreditation. They have plans for a variety of threats, from smoke and chemical fires to radiation exposure, bombs and shootings.

"All hospitals that participate in government health programs like Medicare [must] have a comprehensive emergency plan that includes, among other things, a risk assessment and response plan for hazards that exist in their community," said Kerry McKean Kelly, vice president of the New Jersey Hospital Association. They develop these detailed "all-hazards" plans in cooperation with emergency management agencies to protect members of the community as well as health care teams and first responders.

Regional agreements are in place in case patients must be “decanted” or discharged to make room for incoming patients with greater medical needs, as occurred during the first weeks of the COVID-19 pandemic. And there are agreements to accept nursing home residents or patients at other facilities who must be evacuated from a risky situation, as occurred during Superstorm Sandy’s flooding in Bergen County.

“These exercises are a stress test as to how much you can endure,” said Anthony Tesoriero, vice president of facility operations at St. Joseph’s Health, with hospitals in Paterson and Wayne. “It keeps you on your toes. It always points out areas where you can improve in some way and make it better.”

New Jersey hospitals have standardized their emergency codes: Code Red means fire, Code Yellow means a bomb threat, Code Gray is a security emergency and Code Silver means a hostage situation. If Code Orange sounds over the loudspeaker, it means an emergency involving hazardous materials — with decontamination needed.

A typical plan involves nearly all hospital employees — security guards, housekeepers and facility staff, communications workers, registrars, supply chain managers, nurses, physicians and incident commanders. All are expected to know their role in each scenario and report to their places.

Security personnel direct traffic to make sure that ambulances and private vehicles with the injured can quickly reach the ED. Custodial and housekeeping staff erect tents and demarcate triage and isolation areas. Communications people set up family information and waiting areas, prepare public information announcements and coordinate messages to the staff.

Materials staff bring personal protective equipment to the areas needed, while pharmacy and respiratory therapists ready the medication, oxygen supplies and ventilators that patients will need. Nurses help to triage the injured, while doctors and other medical professionals assess and treat the patients.

“Preparedness is not a steady state,” said Deborah Visconi, CEO of Bergen New Bridge, the county-owned hospital in Paramus that would be expected to handle a variety of patients, from those who are acutely ill or ventilator-dependent to those needing psychiatric or long-term care. “It constantly requires improvement: frequent testing of plans, drills, exercises, training and refreshing individuals’ knowledge. Over the last few years, we’ve seen emergencies like COVID. We take it very seriously.”

Jonathan Rodriguez, emergency management incident commander at St. Mary's General Hospital in Passaic, said the hospital performs a minimum two to three drills annually “to test hospital readiness and capacity.”

During the Majestic Industries-Qualco fire in Passaic a year ago, St. Mary’s stationed an emergency rehab unit at the scene to help firefighters and first responders with minor medical needs and rehydration. Hospital staff on the rig served as a conduit of information for the emergency department, where at least one first responder was treated.

“The hospital was on standby to activate the emergency management plan for a 'Code Triage,'” or disaster situation, if the Qualco building with stored chlorine products and other pool chemicals had exploded and exposed a city neighborhood to the caustic chemicals, Rodriguez said.

Fortunately, that wasn’t necessary.

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