Have you ever spent hours, days, or even weeks preparing for a cataclysmic event that might occur in your workplace, hoping that your preparation will somehow keep such an event from ever occurring?

Well a few months ago, in our Emergency Department, that preparation was tested. And what then transpired brought together our team and other departments in a way that showed me what the Acute Care Continuum is really about.

On the morning of Saturday, August 18,we faced a challenge in the ED at Memorial Hospital Los Banos. Every day the farming communities that make up Los Banos are alive with activity. On this day in particular, migrant workers were picking tomatoes at a local farm while a plane sprayed insecticide over neighboring farmland. Normally the two activities would occur independent of each other, but an abrupt change in wind direction blew the insecticide toward the workers. Soon, farming personnel began to lose equilibrium, succumb to nausea and vomiting, and have trouble breathing.

What they did not realize was that the morning drafts of air swirling above them had suddenly become a toxic tempest containing a compound known as organophosphate, a substance notorious for drowning human beings in their own bronchial secretions.

Back in the ED, we didn’t know how many were affected and how bad.  As a line of these workers began assembling at the back entrance to our ED in full view of our team, it quickly became obvious that this was not a false alarm. One woman in her mid-twenties collapsed and appeared to be struggling to breathe. All the emergency medical training, education and preparation that each one of us had ever received was put to the test.

In any mass exposure, be it biological chemical or nuclear, there are rules, and what we learned that day is worth sharing as an example of how we came together in this emergency:

Rule #1: Do not contaminate the hospital.

Bernard Bourque, our chief safety officer, assembled an outdoor shower fashioned with portable screens large enough to accommodate the patients and to maintain their privacy.

He later shared with me that, as a contingency plan, we had a portable tent complete with heaters or air conditioners that would accommodate 30-50 victims, depending upon the need.

Rule #2: Don’t become a victim.

As much as I wanted to run out without protective clothing to attend the sickest patient, I did not.

Rule #3: Decontaminate with water and use lots of it.

Water, the essence of all life on the planet, is a powerful ally against biological, nuclear or chemical agents and will decontaminate all agents. All patients were required to remove their contaminated clothing, which was secured in plastic bags, followed by a complete head to toe water decontamination. Once completely watered down, patients were given gowns and then only allowed into the ED.

Rule #4: Contact sister hospitals and other members of the Acute Care Continuum to enlist their support and resources, assuming that you will consume your hospital’s supply of counteractive drugs.

Our most affected patient required only modest doses of atropine, the drug that counteracts organophosphate poisoning; but since no one knew this initially, I asked our pharmacy department personnel to send out couriers to our sister hospitals in the Sutter system, such as Memorial Modesto, and sequester all available atropine in case massive doses were needed.

The management of the entire event required a team approach. For example, our CEO Rick Liszewski arrived to manage media, public relations, and extra personnel; while also establishing contingency space in the hospital that might be needed to treat and observe less critical patients. To the credit of our hospital, these contingencies had already been planned and were quickly implemented.

Cindy Mattos, our supervising nurse for the day, functioned as incident commander handling updates to the various local and regional agencies that needed progress reports of our situation. Jennifer Nunes, our Nursing Manager, along with many others came to work early and stayed late.

I was impressed how everyone, including our providers, nurses, technicians, respiratory therapists, x-ray techs, and our CEO jumped in to help. What I saw that morning was true teamwork without thought for self, as well as preparation paying off. It is apparent to me that the whole of the Acute Care Continuum is greater than the sum of its parts.

Phillip Silverstein, MD, received his medical degree from Upstate Medical University/College of Health Professions.  He currently works as an emergency physician at Memorial Hospital Los Banos, where he also serves as the Emergency Department Assistant Medical Director.