UMC process for alert code largely the same

‘Internal disaster’ sparked confusion

While police and fire department records show misuse of a hospital code known as “internal disaster” by University Medical Center contributed to confusion after the Oct. 1 shooting, little has been done in the year since to prevent a recurrence.

Officials at the county-run hospital have changed some internal procedures for calling such an alert, which is intended to notify first responders when a hospital’s environment is unsafe for patients, but neither they nor local public health officials have changed their policies to preclude its use during a mass casualty event.

For more than seven hours following the Route 91 Harvest festival shooting that killed 58 and wounded hundreds more, UMC, the state’s only hospital with a Level 1 trauma unit, operated under an internal disaster alert.

That apparently contributed to an erroneous radio dispatch to emergency responders stating the hospital was “completely out of beds,” Clark County Fire Department and Metropolitan Police Department records show. While UMC officials contend they never ran short on space, the message remained uncorrected for about 15 minutes.

90-minute rule

Roughly a year after the shooting, the mechanisms that run the internal disaster alert have been re-programmed, but county procedure on when they can be triggered remains unchanged, according to John Hammond, the Southern Nevada Health District’s EMS and trauma systems manager.

“Some of the problem was there were no changes made on internal disaster for a while, so we’ve automated the system so it’s more user-friendly,” Hammond said.

The change is aimed at limiting the time a hospital operates under internal disaster status.

Any hospital in the Las Vegas Valley can still issue the computerized alert at will, triggering a dispatch telling first responders to avoid the facility . The alert was developed to address hazardous conditions like flooding or power failures, but UMC and other valley hospitals increasingly used it to signal emergency room overcrowding.

Until early March, hospital personnel had to switch off the alert manually once the facility could again accept patients by ambulance. Now the computerized system will automatically kick hospitals off “internal disaster” 90 minutes after the alert was issued, Hammond said.

1 percent decrease

Though the “internal disaster” alert was created to do away with diversion due to overcapacity, it hasn’t fulfilled that goal. Nearly all “internal disaster” notifications issued last year were related to capacity issues.

UMC CEO Mason VanHouweling said in an emailed statement that the hospital has “instituted a detailed communication and approval procedure for high capacity notifications.” In a follow-up statement, Thomas Tierney, clinical director of critical care, emergency department and trauma, said the hospital’s chief nursing officer must sign off on capacity notifications.

The process takes into account hospital volume, a patient’s risk level and pending patient transfers, his statement said. The hospital also is making structural changes to improve capacity, including adding 21 beds to the emergency department and a discharge lounge for patients to “wait comfortably for their ride home without occupying an inpatient bed.”

The project should be complete by early 2019, Tierney said.

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

Patrick Connolly Las Vegas Review-Journal University Medical Center has slightly reduced its use of the “internal disaster” alert for overcrowding in the past year.