How a hospital must face a massive emergency: the case of Martini Hospital, Turin

The terms “disaster” or “surge capability”, referred to hospitals, are often used to define a massive casualty admission. This may be a misleading concept, because emergency may as well arise from inside hospitals, and the last years high figures related to fires in the about 2,000 italian hospitals should suggest a different point of view. In this article the authors describe their experience in hospital preparedness at Ospedale Martini in Turin. Hospital operators regularly attend basic (GOM) and advanced (HDM©) courses about disaster response and organization, and a specific course is dedicated to operators involved in internal safety (fire emergency). In this courses, computer simulations are widely used, associated with conventional didactic. If education is one of the two cornerstones of disaster preparedness at Ospedale Martini, well designed emergency plans and an effective disaster management are the other one. The Internal Emergency Plan (Fire and Evacuation) is aimed to give a proper response to fires and other events arising from inside the hospital and potentially requiring its partial or total evacuation. The Massive Casualties Admission Emergency Plan increases the surge capability of the hospital allowing to take care of a great number of injured people, and at the same time avoiding a dramatic fall in the treatment quality. The “Hospital Disaster Management©” system, created by the authors, is an organizational scheme based on team work. Its aim is to “put order in chaos” when hospitals are facing a disaster. Properly trained physicians and nurses, assigned to key positions, act in this system as Hospital Disaster Managers: their tasks are to coordinate the teams, to manage critical resources and to use the emergency plans as powerful instruments.