CT Hospital was Prepared for Power Plant Explosion

Sunday night's explosion at a power plant in Middletown, CT, brought with it hospital disaster response repercussions.

The explosion—believed to have been caused by some sort of natural gas leak or purge—occurred at the Kleen Energy Plant, which was under construction at the time and not operating, according to office of Middletown Mayor Sebastian N. Giuliano. Contractors were conducting various tests at the site when the explosion rocked the area.

Middlesex Hospital, a 275-bed community hospital in Middletown, was quickly put on alert about a potential mass casualty event, says Jim Hite, the facility's emergency planner and director of safety and security.

The medical center uses the Hospital Incident Command System, more commonly known as HICS (pronounced "hicks"). HICS is a popular incident management setup that uses a series of job action sheets to define staff roles during an emergency response. The job action sheets list specific duties for staff members to observe.

"We all have our established functions and our job action worksheets," says Peg Arico, Middlesex Hospital's manager of public relations and communications. By teaching clinician and support workers the structure of HICS, they have the ability to use it for any type of incident response, Hite says. "Staff training really paid off," he says regarding the success of response efforts.

During off-shifts and weekends, the nursing supervisor on duty at Middlesex Hospital is the designated incident commander. That approach was important because the plant explosion occurred on a Sunday morning during Super Bowl weekend, when many top administrators weren't at the hospital.

While the facility's e-mail and phone alert system reached out to off-duty managers and staff, the nursing supervisor huddled with other nurses, security officers, and hospitalists to plot out immediate actions in response to the explosion, Hite says. For example:

• Hospitalists began determining which patients could be rapidly discharged in order to free up beds
• OR staff began preparing the post-anesthesia care unit to open up beds
• Security officers were posted at every hospital entrance in anticipation that concerned visitors and reporters would congregate at the facility seeking information about victims

In the end, the hospital treated about two dozen people from the explosion scene, but initial projections indicated 60 to 100 potential victims. It also wasn't immediately clear what caused the explosion.

"At the time, we didn't know if there were chemicals involved," Hite says. Although a field morgue was set up at the power plant, Hite knew the hospital might be asked to store corpses. The facility's morgue capacity is 10 bodies, but the building has a utility hookup that allows refrigerated trucks to connect to hospital systems at the loading dock.

Had it been needed, the hospital could have had a refrigerated trailer at the hospital within a couple of hours to handle overflow cadavers, Hite says. As it turned out, there were five deaths in the explosion.

Another useful arrangement that Hite mentioned: The hospital's EMS manager kept tabs on what was happening in at the power plant from a paramedic on the scene. The EMS manager, in turn, acted as the liaison between the hospital's emergency operations center and the response scene, without the need to interact with busy police and fire officials, Hite said.