Mobilization of Critical Resources

Background

Wellstar North Fulton Emergency Department, located in Roswell, Ga., was recently the primary receiving facility for multiple victims exposed to life-threatening carbon monoxide as a result of an accident in a nearby townhome neighborhood.

This tragedy occurred after a vehicle drove into the ground level of the multi-dwelling unit’s parking garage, parked the vehicle and unintentionally left the vehicle running after exiting the vehicle. At least one of the occupants had a carbon monoxide detector which was silenced after thinking the alerts were due to a malfunction of the device. Several hours passed before 911 was called and EMS units were dispatched for multiple ill patients and some reported unconscious from presumed carbon monoxide poisoning.

It was reported at least 7 victims were impacted by this tragedy. Several stable victims were taken from the scene to other area hospitals, and unfortunately there was at least one fatality on the scene.

Assembly of a Critical Resources Response Team

Multiple critical victims were expected to arrive in the morning hours when physician and nursing staffing are at a low point. With single physician coverage at this time, the Wellstar North Fulton ED team quickly mobilized a critical resources response team which included Dr. Jeff Greenwood, multiple ED nurses, techs, respiratory therapy, and critical care nursing from the ICU. An additional ED physician was called in early to help support the rest of the department, and the critical care and general surgery physicians were notified of the incident. The ED managers and house supervisors also came to assist the department.

Arrival to the ED & Immediate Care Team Response

It was clear all resources would be necessary when the first two victims arrived simultaneously, both unresponsive and requiring immediate intubation.

As Dr. Greenwood attended to both victims, the nursing, respiratory therapy and tech support coalesced into two separate teams to care for each victim. As the teams worked to stabilize and treat the two victims, a second ED physician and APC arrived. Both team members quickly took over the rest of the normal flow of ED patients, which included an additional stable CO victim.

Jeff Greenwood, MD

Stabilization & Securing Transfers

After intubating and stabilizing the critical patients, the team’s attention turned to determining where the patients could be transported for hyperbaric therapy, an essential measure to maximize both critical patients’ outcome. The department quickly dispatched a helicopter to Wellstar North Fulton and placed another on standby.

 

While Wellstar North Fulton has hyperbaric services, the chambers do not allow for treatment of ventilated patients. Several clinical team members began reaching out to other area hospitals searching for available hyperbaric chambers which would allow for therapy for ventilated patients.  The ED manager, house manager, and Dr. Duren, a hyperbaric physician, all assisted in making calls to determine which hyperbaric facilities were capable of treating these patients.

After determining there was no facility in the Atlanta-metro area with ventilator capable hyperbaric treatment, the search widened to outside of the state. The team was able to find a facility in Columbia, S.C. with a ventilator capable hyperbaric chamber and start the acceptance process of the patients to the facility. Instead of mobilizing a fixed wing aircraft, Air Methods determined the patients could go by way of helicopter, which saved a considerable amount of time. As with any exceedingly high CO exposure, time was of the essence for the patients’ outcome. Before transport, each patient required further stabilization with vasopressors. Dr. Coffman, Wellstar trauma surgeon, established central line access on one of the patients, while Dr. Greenwood secured acceptance on the transfers with the physician team in Columbia.

Once the acceptance was secured, the first patient was loaded into the helicopter which was already waiting on the helipad while a second helicopter circled above. Within about an hour of acceptance to the Wellstar North Fulton ED, both patients were airborne and en route to Columbia. Simultaneously, the third stable CO victim (not on a ventilator) was prepped for hyperbaric treatment at North Fulton.

This incident was a testament to Wellstar’s ability to mobilize critical resources on a moment’s notice. Multiple departments came together for the common goal of improving the outcomes of critical patients.

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