Cities and Towns Prepare for the Worst

Just before 3 a.m. on November 22, 2006, a massive explosion blew apart a paint and ink factory in Danvers, Mass. The blast, triggered by a buildup of vapors from toxic solvents stored on the site, sent glass shards and other debris flying over a quarter-mile radius and damaged more than two dozen houses, leaving about 400 people homeless. But the fact that there were no casualties was more of a lucky break than a sign of good planning and quick response, says Paul Biddinger, an emergency physician at Massachusetts General Hospital and associate director of the Center for Public Health Preparedness at Harvard’s School of Public Health. “Most of the care providers who could have been called upon to help didn’t learn about the explosion until the morning news,” he says.

Hoping to improve disaster response coordination in the Boston area, Biddinger and several other leaders in medicine, emergency services, and public health are working with Harold Cox, associate dean of public health practice at the Boston University School of Public Health and the principal investigator for a $2.5 million grant from the U.S. Department of Health and Human Services. The grant is one of several such regional HHS initiatives, known as the Partnership for Effective Emergency Response (PEER). The work, which began this past fall and is scheduled to continue for 11 months, will involve more than 62 cities and towns in the region.

“This initiative is working with hospitals, public health departments, ambulance companies, police and fire departments, and long-term care facilities — five entities within the health arena whose work is often not coordinated,” explains Cox.

Currently there are no “good lines of communication” between the region’s public health departments, hospitals, and emergency services providers, says Lynn Schoeff, senior director of emergency preparedness in the Cambridge public health department and a project collaborator.

“Fire, ambulances, and police are very accustomed to communicating with each other through the 911 system,” Schoeff says. “But hospitals, long-term care facilities, and public health departments don’t have a specified place in the communications loop.”

That lack of communication could cost lives in the event of a major disaster, such as a terrorist attack or a massive flood, when it might be necessary to find multiple hospitals for large numbers of casualties, to give public health departments notice of a possible toxic release, or to coordinate the evacuation of patients from care facilities in affected towns. PEER participants include 27 acute care hospitals, 57 community health centers, 70 ambulance services, 62 local health departments and boards of health, and 132 nursing homes or long-term care facilities.

“Some of this initiative has to do with writing protocols and procedures — who is called by whom, where they are supposed to go, and what they are supposed to do,” says Cox. “And part of it will be addressing the kind of equipment needed.”

“Of course, the most important part of any of this will be training people on these new protocols and equipment — not only having a plan but drilling people on that plan.”

Accordingly, the project will culminate in early August with a fictional disaster drill. The mastermind of the fictional disaster is Biddinger, who says only that “it will be a major health event that creates a large number of patients and that could involve a large number of health responders.”

While there are 10 other PEER projects ongoing nationwide, the Boston-area initiative is the only one being led by a university, notes Cox, a former public health director of Cambridge. And this, he believes, could help overcome the very “turf issues” that have previously been a barrier to communication across both professional and town boundaries. “Having a neutral convener like a university is to everybody’s advantage,” he says.

Chris Berdik can be reached at cberdik@bu.edu.