Emergency Management: Being Prepared During a Crisis

Podcast Transcript

Carol Pehotsky (00:05):

Cleveland Clinic and Case Western Reserve University jointly hosted the 2020 Presidential Debate on our main campus. And as exciting an event as that is, it obviously comes with a lot of preparation, including emergency management preparation, should the worst occur. And there came a lot of feelings with that, especially in the middle of a pandemic. So it was thrilling to be part of those preparations, but also a little scary, right? What does that look like? How do we protect our city, our loved ones, each other in the middle of all that going on? And so, I was thrilled to be part of a new professional group that was part of those preparations, including my friend, Scott Hantz, who'll be joining us today. We'll talk about all sorts of things emergency management, including how important it's for all nurses to be ready for any type of emergency.

(00:55):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of Surgical Services Nursing.

(01:16):

Welcome back everyone. In my 20 years of being a nurse, what the phrase emergency management means or has meant has certainly evolved over that time. You know, thinking way back, that was really mostly reserved for natural disasters, right? You know, big car accident, a fire, something dreadful, that really took on a more na- natural piece, if you will. And, and unfortunately, has since then really evolved into what can happen when there are shootings, or other disruptive events that can happen either outside or even internal to a building. But nevertheless, we, we need to be ready for it as healthcare providers. Fast-forward to 2013 was really my first emergency readiness drill that I remember being part of as a leader, and really with the full-on actors who are portraying, you know, being part of a terrorist organization, all of that things, and, and really having that sort of gut punch as somebody's reeling past the red lines in an or that this is somebody who we're going to take care of, and trying to really immerse ourselves into the situation.

(02:22):

And grateful for that experience as a leader, and really sitting down and sitting down with the phone trees, and what if the power goes at the same time? And all of the what ifs. It was a very humbling experience, really thinking about, wow, we've done all the modules, we've done all the things, and we are not ready. And that really was that humbling moment, but always that piece of we need to get ready and stay ready and keep getting ready. So, along those lines, I'm thrilled to be joined today by my friend and colleague, Scott Hantz. So Scott is the institute director for Surgical Services Nursing, but is also an expert in the field of emergency management. Welcome, Scott. We're glad to have you today.

Scott Hantz (03:02):

Thank you, Carol. Thank you for having me. Looking forward to this today.

Carol Pehotsky (03:04):

So someday we'll have you back to talk about surgical services. (laughs) But today, love to hear more from you about your passion behind emergency management and how you got into that field.

Scott Hantz (03:13):

Well, you may or may not know that I've been a nurse for about 22 going on 23 years. And in that time, I've been fortunate enough to be an ICU nurse. I was an assistant manager, manager of emergency room.

Carol Pehotsky (03:26):

Mm-hmm.

Scott Hantz (03:26):

Cath lab manager. And then my role changed to be an OR director.

Carol Pehotsky (03:29):

Mm-hmm.

Scott Hantz (03:29):

And then my position today. But what you may not know is I've been a paramedic fireman for 23 years, and I'm a captain on the fire department even today, where I get to really work and share education readiness of with patients and staff where I live, which is quite honestly a huge honor for me.

Carol Pehotsky (03:48):

So you have that experience and you've stayed with it.

Scott Hantz (03:52):

Yes.

Carol Pehotsky (03:52):

So tell me a little bit more about how you balance all that.

Scott Hantz (03:56):

Well, it's difficult-

Carol Pehotsky (03:57):

(laughs)

Scott Hantz (03:57):

... as we all know, right?

Carol Pehotsky (03:57):

Yeah.

Scott Hantz (03:58):

It's a time management struggle, but I have kept my certification as both a paramedic fireman as a nurse up to date. Both paths really mirror each other. When I was in the ER world, I really worked with the emergency management perspective.

Carol Pehotsky (04:11):

Okay.

Scott Hantz (04:11):

We set up the tents-

Carol Pehotsky (04:11):

Mm-hmm.

Scott Hantz (04:12):

... for mass decon. I had the opportunity to go to Anniston Alabama for a week for FEMA training, which was probably the number one most eye-opening experience I've ever been a part of. And the reason I say that is, no matter how good we thought we were gonna be, they shoved 100 to 200 patients at us and we were gonna fail.

Carol Pehotsky (04:34):

Oh, (laughs) okay. Tell me more about that.

Scott Hantz (04:36):

Your, your volume of ability-

Carol Pehotsky (04:39):

Mm-hmm.

Scott Hantz (04:39):

... is going to be at, at a level, and we don't know what that level is gonna be. Your, your volume of staffing, of logistics, of beds, of supplies.

Carol Pehotsky (04:47):

Okay.

Scott Hantz (04:48):

So they pushed you to get to that breaking point and break it so that you were able to come after that fact and really have a, what's called a tabletop exercise-

Carol Pehotsky (04:48):

Mm-hmm.

Scott Hantz (04:56):

... and talk about the action after the actual action itself. And that's where you learn, that's where you make rational decisions for what if something similar or quite honestly, no disaster's the same, so how do we prepare for the unknown?

Carol Pehotsky (05:13):

All right. So we'll come back to the after action review (laughs) in a little bit. So let's talk about the preparedness, right? So ANA talks about our American Nurse Association. Disaster preparedness as part of nursing practice for all of us, right? So certainly, you mentioned being an ER nurse, but I've never worked in an ER. We have listeners who are nursing students all the way through mid to late career. Do you agree with that? I'm assuming you agree with that statement, and tell us more about why we should, we should all be prepared and, and how we should be thinking about that as nurses.

Scott Hantz (05:46):

So I'm also an Eagle Scout-

Carol Pehotsky (05:48):

Oh. (laughs)

Scott Hantz (05:48):

And I've always really felt that you have to be prepared, you always have to be prepared for a situation that's gonna happen. So whether you're an ICU nurse, a step-down nurse, an OR nurse or an ambulatory nurse-

Carol Pehotsky (06:01):

Mm-hmm.

Scott Hantz (06:01):

... the surge of patients that you may get on any given day due to call-offs.

Carol Pehotsky (06:06):

Yeah, sure.

Scott Hantz (06:06):

Due to extra patients jumping on a physician's schedule, because it's the right thing to do, we have to be able to really have situational awareness to be able to utilize our resources effectively, appropriately and patient-focused so that we can achieve any goal. I always said to my ER nurses, I'd walk in in the morning and we would have five or six patients on the docket. I was concerned that day with surge, but if I'd come in, I would see 20 to 25 patients, I was more comfortable because they were working at a certain level and they wouldn't have to-

Carol Pehotsky (06:40):

Oh, they're already ready for, yeah, yeah.

Scott Hantz (06:42):

Correct. Correct. They wouldn't have to ramp up. So it... Sometimes it's difficult to teach somebody something that may or may never happen. But I'm a firm believer in is if we prepare and it does happen, we won't even know it happens 'cause we're able to absorb whatever that is.

Carol Pehotsky (06:58):

Yeah. How do you get ready for that, right? It's a human nature. If I'm at the constant of busyness, it just, your day just flows. It's when I've ebbed into that slower pace, it's being able to dial it up, so what sort of things can we do to train ourselves to be ready for that surge?

Scott Hantz (07:15):

Exactly. I think a couple pieces that I articulated earlier is the tabletop exercise.

Carol Pehotsky (07:15):

Okay.

Scott Hantz (07:19):

And the actual live exercise. You may or may not know, we had a live exercise on November 4th, where we had about 20 patients that surged our emergency room. We had leaders from the in-house side, and OR side really work collectively together with our ER. And I said, ICU colleagues to understand where these patients are gonna go. So we obviously moulage some individuals, painted them up to look like they were shot, stabbed, or broken arms, broken legs. And the ER was able to assess those patients and move them through the continuum. We had a couple patients, I think, three that came to the ORs handful that went to the ICUs, and then a couple of them went discharged home. More importantly, we sat in that room as leaders and we were trying to think of all the other things that could potentially happen-

Carol Pehotsky (07:19):

Sure.

Scott Hantz (08:06):

... as you articulated IT, phones-

Carol Pehotsky (08:09):

Mm-hmm.

Scott Hantz (08:10):

... how are we gonna communicate with each other? Fun fact, most of these instances, a mass shooting and that's this, what this situation was usually is over 15, 30 minutes. So by the time we would get up and running, the situation would already be done.

Carol Pehotsky (08:26):

So it's all response. It's not necessarily, while the situation is still happening.

Scott Hantz (08:31):

So leaders would be on their phones on the way to-

Carol Pehotsky (08:34):

Mm-hmm.

Scott Hantz (08:35):

... the hospital.

Carol Pehotsky (08:36):

Versus a natural disaster, which could certainly still be extending.

Scott Hantz (08:39):

Correct.

Carol Pehotsky (08:39):

Yeah.

Scott Hantz (08:40):

And I think the national disasters sometimes are easier to plan for. You have sometimes days?

Carol Pehotsky (08:46):

[inaudible 00:08:46], yeah.

Scott Hantz (08:46):

Right? But the unknown of a shooting of a bus accident or what about a gas leak? So we have to be at a state of readiness and we have to trust that our education has taught the, the staff members, the supervisors-

Carol Pehotsky (09:02):

Mm-hmm.

Scott Hantz (09:02):

... the assistant managers who are probably gonna be the ones running the scene for a period of time. And if we could say to ourselves that we've articulated and educated to those individuals, then we're successful. That's, in my opinion, when when you break it all down, if you're able to answer that question, that's where success truly lies.

Carol Pehotsky (09:18):

Well, and you've unlocked a core memory, I think I was in high school, (laughs) they were looking for volunteers to moulage. It was, it was an airplane crash. And, and I, I made it to the hospital and then I didn't make it at that point. But there's something we said for truly taking a group of actors or volunteers and physically moving them through the system. You, you can do a tabletop, but it really does take putting a person on a stretcher in an ambulance, literally driving them somewhere sometimes to really push the buttons that says, does this work?

Scott Hantz (09:48):

Well, and the other piece of that is supplies, for example.

Carol Pehotsky (09:50):

Mm-hmm. Sure.

Scott Hantz (09:50):

One small, small sedatives. So hypothetically, if you have a mass shooting, or a really bad car accident and you need a bunch of chest tubes, for example, do we know where these extra chest tubes are located? Do we know how to communicate maybe with the floors or our colleagues and supply chain to bring those supplies to us?

Carol Pehotsky (10:08):

Mm-hmm.

Scott Hantz (10:09):

Do we have the right keys to open these doors?

Carol Pehotsky (10:11):

Yeah.

Scott Hantz (10:11):

Are we making sure monthly that these supplies aren't out of date?

Carol Pehotsky (10:15):

Mm-hmm.

Scott Hantz (10:15):

So there's a lot of pieces and parts that we have to systematically go through. And it takes a lot of work, and it takes a lot of education. But you're doing all this for the what if. But if you do it the correct way, the what if won't be as traumatic-

Carol Pehotsky (10:29):

Right.

Scott Hantz (10:29):

... because you're prepared.

Carol Pehotsky (10:31):

Well, and, you know, certainly you wanna make them look as realistic as possible. Why else is that important?

Scott Hantz (10:37):

Shock and awe. When we send new nurses, for example, into the, OR, we explain to them what they're gonna see. For a cardiac procedure, we're going to open their chest, for example. We could explain all we want, but until they really see it, that's the shock and awe. We don't know how people are gonna react in a traumatic situation. We don't know people's past history-

Carol Pehotsky (11:02):

Mm-hmm.

Scott Hantz (11:02):

... of traumatic situations.

Carol Pehotsky (11:03):

Mm-hmm.

Scott Hantz (11:04):

Maybe they've been a part of a gunshot issue. So now they see this secondary situation and they- they're not able to take care of this.

Carol Pehotsky (11:12):

Sure.

Scott Hantz (11:13):

Which is fact.

Carol Pehotsky (11:14):

[inaudible 00:11:14], yeah.

Scott Hantz (11:15):

So we have to support the patient-

Carol Pehotsky (11:15):

Mm-hmm.

Scott Hantz (11:17):

... the family. We have to support ourselves.

Carol Pehotsky (11:19):

Mm-hmm.

Scott Hantz (11:20):

So we have to, in a appropriate incident command system, we have a leader. No different than a, a individual running a full arrest, for example.

Carol Pehotsky (11:20):

Yeah, sure.

Scott Hantz (11:28):

A cardiac event.

Carol Pehotsky (11:29):

Yeah.

Scott Hantz (11:29):

And they're monitoring the whole situation. They're monitoring the flow of the patients. They're monitoring the supplies, but also monitoring the well-being of their teams.

Carol Pehotsky (11:38):

Mm-hmm.

Scott Hantz (11:38):

Because we have a pool of individuals that would be set up to help with rehab, for example, food, water, and mental fortitude, if you will.

Carol Pehotsky (11:48):

Yep. Well, and you think about, you know, our, our Cleveland Clinic locations in Florida, right. Like, knock on wood, we have a lot of weather issues in Cleveland. Hurricanes are not one of them. But we had tornadoes here this summer.

Scott Hantz (12:00):

Yes.

Carol Pehotsky (12:00):

And thankfully, we didn't need to call in incident teams, but we certainly did have some issues where we needed to move patients and reschedule things. But our Florida teams, they have an A and a B team.

Scott Hantz (12:09):

Yes.

Carol Pehotsky (12:09):

And for them to, to be thinking about how long will I have to be on site and, and the things that a, that a caregiver has to go through to respond to those emergencies, they have that planning. But it can be traumatic for them too, you know?

Scott Hantz (12:21):

Well, absolutely, 'cause we have families outside of here.

Carol Pehotsky (12:23):

Absolutely.

Scott Hantz (12:23):

So if we're asking people to come and potentially they may not be able to leave, what about their family?

Carol Pehotsky (12:31):

Right.

Scott Hantz (12:31):

What about their kids? What about daycare? When we talk about emergency management, it's not just here and now it's the whole scope of the situation.

Carol Pehotsky (12:40):

Mm-hmm. So we do a very realistic training exercise to, to do the shock and awe partially also to help train us how to try to establish some composure. And let's face it, as nurses, hopefully we learn skills on how to maintain our composure in other stressful circumstances. How do you wrap your arms and teach nurses, this is the most, sometimes the most stressful circumstances, and how to dig deep to maintain that composure in these types of situations?

Scott Hantz (13:08):

So I'm going to go back and forth from the EMS side and the paramedic-

Carol Pehotsky (13:12):

Okay.

Scott Hantz (13:12):

... side and the nursing side. I've been involved in some pretty bad motorcycle accidents.

Carol Pehotsky (13:17):

Oh gosh.

Scott Hantz (13:18):

And unfortunately, there were several team members on our fire department that knew these individuals. So having to pull these people, these staff off the call-

Carol Pehotsky (13:18):

Oh gosh. Yeah.

Scott Hantz (13:27):

... and then myself and other individuals jumping into it.

Carol Pehotsky (13:27):

Mm-hmm. Mm-hmm.

Scott Hantz (13:32):

Communication's the key to success.

Carol Pehotsky (13:33):

Yeah.

Scott Hantz (13:33):

Again, you don't know how a person's gonna react until it's time to react. The other very difficult perspective is this is during these mass casualty events, we're stabilizing patients.

Carol Pehotsky (13:33):

Mm-hmm.

Scott Hantz (13:43):

We may not be doing everything that we normally would be doing.

Carol Pehotsky (13:47):

Oh gosh. Yeah.

Scott Hantz (13:47):

So, so you, you stabilize a patient, and then go to the next patient. And there's certain situations where if there was only one patient, maybe you would work a little bit longer.

Carol Pehotsky (14:01):

Sure. You'd want to do more.

Scott Hantz (14:02):

But you have 20, 30 X amount of other cases.

Carol Pehotsky (14:04):

Mm-hmm.

Scott Hantz (14:04):

There's been a lot of documentation from other mass casualties, I.E. Vegas, for example.

Carol Pehotsky (14:05):

Mm-hmm.

Scott Hantz (14:11):

Or tornadoes down in Joplin. And some of the learnings from these documents are very hard because you are acting differently in those situations than you would do in a normal day to day operation.

Carol Pehotsky (14:23):

Sharing the load that those caregivers carry with them

Scott Hantz (14:26):

Forever. Very difficult.

Carol Pehotsky (14:28):

Mm-hmm.

Scott Hantz (14:28):

And again, that person that's running the situation, there's a lot of stress on that person.

Carol Pehotsky (14:33):

Gosh, yeah.

Scott Hantz (14:34):

Because they gotta make decisions of who may get a ventilator and who may not-

Carol Pehotsky (14:35):

Right.

Scott Hantz (14:38):

... get a ventilator, but they're also have to make decisions on when it's time to pull their caregivers out of that area-

Carol Pehotsky (14:45):

Mm-hmm.

Scott Hantz (14:45):

... to let somebody else jump in so that they can support them physically and mentally.

Carol Pehotsky (14:50):

Sure. What are some things that we can do to prepare ourselves for, well, hopefully, we don't end up in those situations, but we, we want to be able to respond to emergency? It's part of our code of conduct that we do respond. What can, what can we be doing to, to do the best we can to respond?

Scott Hantz (15:06):

So I think here at Cleveland Clinic we do a really good job. One, our volume of patients is very high.

Carol Pehotsky (15:10):

(laughs)

Scott Hantz (15:11):

So I look at each and every day that we see patients as a minor disaster, if you will, with having 200 OR cases at certain points of time, 200 plus emergency room cases. We have to be able to take care of these patients in appropriate and expedited manner, 'cause we don't know what else is coming in. But I do feel education is the key to success, as I've said once or twice before the tabletop exercises.

Carol Pehotsky (15:34):

Mm-hmm.

Scott Hantz (15:34):

And if you really break the tabletop exercises down in multiple fragments, almost chapters of a book, if you will, and you have key initiatives that you want to outline in each and every situation, you can start coming up with all these what ifs. And if your tabletop starts to get quote-unquote kind of "crazy" with all these different thoughts-

Carol Pehotsky (15:53):

(laughs)

Scott Hantz (15:54):

... then you're on the right track.

Carol Pehotsky (15:56):

Sure, yeah.

Scott Hantz (15:56):

'Cause you have to think outside the box. You have to think about if build an X goes down, where are we gonna move all these patients?

Carol Pehotsky (16:02):

Mm-hmm.

Scott Hantz (16:03):

What happens if we need to have different medications, different devices we may need, utilize different hospitals, staffing and or supplies. We're very fortunate that our supply chain has a robust network of both manufacturers and also other hospitals-

Carol Pehotsky (16:22):

Mm-hmm.

Scott Hantz (16:22):

... that can support us at certain times of the day. We learned that during COVID. We've learned that during different situations in Florida. So we're very fortunate with that. But again, a good tabletop exercise and, and I think emergency management does a very nice job. We're going through the process right now of really communication. What happens if the communication tree goes down?

Carol Pehotsky (16:41):

Sure.

Scott Hantz (16:42):

What happens if nurses can't document? I mean, you and I have been nurses for a period of time.

Carol Pehotsky (16:42):

(laughs)

Scott Hantz (16:46):

We didn't learn how to document on a computer.

Carol Pehotsky (16:48):

We did not. But plenty nurses now do, yeah.

Scott Hantz (16:50):

Right. And so, if you throw the two of us in a room to take care of-

Carol Pehotsky (16:51):

(laughs)

Scott Hantz (16:54):

... patients-

Carol Pehotsky (16:55):

Give me a pen and a piece of paper.

Scott Hantz (16:55):

Exactly.

Carol Pehotsky (16:55):

Yeah.

Scott Hantz (16:58):

Exactly. Because I can... I'm very confident I can take care of a patient, but my charting is probably not gonna be that great. But if you give me a piece of paper, I can do what I can do. And so individuals like us, we're gonna be utilized.

Carol Pehotsky (17:10):

We don't have to read our handwriting, but we can write it down. (laughs)

Scott Hantz (17:12):

Yeah, so.

Carol Pehotsky (17:14):

But yeah, sure. Absolutely.

Scott Hantz (17:15):

We can, we can help.

Carol Pehotsky (17:16):

Yeah.

Scott Hantz (17:16):

We can help and teach and nurture through that situation. Because again, experience is huge.

Carol Pehotsky (17:22):

Yeah.

Scott Hantz (17:23):

The more you see, the more you're able to do. You put everything in a cookie jar with all your little ideas and at certain points in times you have to pull certain ideas out, because another example, IVs, how many IV catheters have you seen in your career?

Carol Pehotsky (17:38):

Oh, boy. (laughs) A lot.

Scott Hantz (17:39):

Right?

Carol Pehotsky (17:40):

Sure.

Scott Hantz (17:40):

And, you know, we just went through a couple of years back with the IV that self-occludes. Again, as a paramedic, I can... Give me an IV and-

Carol Pehotsky (17:48):

Sure, you can-

Scott Hantz (17:48):

I can start.

Carol Pehotsky (17:49):

... yeah, you've seen them all. Yep.

Scott Hantz (17:50):

But there's a lot of individuals like, "Well, I don't like this IV." Again, train, train, train. We're going to see different times in different, different parts of our career where the old is new and new is old.

Carol Pehotsky (18:01):

Sure. Yeah. You're in disaster situation, you're handed an IV. It's different than what you're used to if you've never had the opportunity to interact with any other different type of supply. Yeah, taking that deep breath and, "All right, let me figure out how to use this." We've not necessarily afforded people the opportunity to work with different supplies. That's a good point.

Scott Hantz (18:18):

We, we change.

Carol Pehotsky (18:18):

Yeah.

Scott Hantz (18:19):

You know, we change all the time. And look, look at our IV fluids, right?

Carol Pehotsky (18:19):

(laughs)

Scott Hantz (18:23):

We have to look at and see how we're doing or procedures, bedside procedures, doctor's office procedures, three different areas. They use IV fluids and we have had a change.

Carol Pehotsky (18:34):

Mm-hmm.

Scott Hantz (18:34):

I've been in conversations with you- yourself and other individuals. Are we gonna go back to where we were, or is there gonna be some type of new normal in between?

Carol Pehotsky (18:42):

Right.

Scott Hantz (18:42):

And I... And that's not necessarily a bad thing, right? So we have to be able to, I think, one thing in our profession is very clear. We have to be able to change. We have to look at it. Open eyes, we have to ask a lot of questions.

Carol Pehotsky (18:54):

Mm-hmm.

Scott Hantz (18:55):

Because when we change anything, why are we changing? What's the pros? What's the cons? But change is okay. And if people are able to adjust with change and appropriate change, of course, they may be able to adapt to the emergency management disaster perspective a little bit easier because-

Carol Pehotsky (18:55):

Sure.

Scott Hantz (19:14):

... things change drastically.

Carol Pehotsky (19:15):

And you bring your previous experience with you and say, "Yeah, some- something happens in the disaster. I have this previous experience to build off of."

Scott Hantz (19:24):

Absolutely.

Carol Pehotsky (19:25):

So let's go back to this after action review. It's a great point we wanna linger on is because that's where the learning happens, right? So talk to me a little bit more about that process and how you bring up that learning. please.

Scott Hantz (19:34):

So in the last situation we had, the disaster itself probably was about an hour and a half or so. And we've had two after action reviews to the point. And I think we're gonna be having another one.

Carol Pehotsky (19:46):

Mm-hmm.

Scott Hantz (19:46):

And emergency management actually broke down and is breaking down each branch. From the medical branch perspective, there's four of us, and we're, we're talking about what's good, what's bad, what can we change. But what's great about these after action reviews is during a regular situation, you have a incident commander, and he or she's job is to run the operation.

Carol Pehotsky (20:10):

Mm-hmm.

Scott Hantz (20:11):

If there's something that's going to hurt someone or something, then you're gonna speak up. Besides that, you're running with the show.

Carol Pehotsky (20:18):

Sure. Here, here's what you have to work with. (laughs)

Scott Hantz (20:21):

This, this is... Yeah, it is. It's a lot.

Carol Pehotsky (20:23):

Mm-hmm.

Scott Hantz (20:23):

It's a very stressful position. That being said, when we're done with the actual review, we get to speak up. What about this? What about that?

Carol Pehotsky (20:32):

Mm-hmm.

Scott Hantz (20:32):

So there's a lot of individuals in the room that don't actually have a position. There's the A, B and C group, and then there's visitors, if you will.

Carol Pehotsky (20:41):

Mm-hmm.

Scott Hantz (20:41):

So we had visitors from UH Hospital, we had visitors-

Carol Pehotsky (20:41):

Oh, great.

Scott Hantz (20:44):

... from Cleveland Fire, Cleveland Police with our own police. So there's a lot of individuals, a lot of knowledge in that room and, and we're all listening to each other.

Carol Pehotsky (20:52):

Mm-hmm.

Scott Hantz (20:52):

So that's where, you know, they say no idea is a bad idea. And-

Carol Pehotsky (20:52):

That's right.

Scott Hantz (20:56):

... in that situation-

Carol Pehotsky (20:56):

Mm-hmm.

Scott Hantz (20:57):

... that truly, really resonates because there was a lot of ideas from individuals that had nothing to do with this scenario that were saying, "What about this? What about this IT? What about this communication? Did you know we have these devices over in this location?"

Carol Pehotsky (21:11):

Oh, sure. Mm-hmm.

Scott Hantz (21:12):

So we learned a lot about supplies. I have to say I think we did a very nice job with the throughput of the emergency room patients to the OR to the ICUs. But we've trained in that quite a bit.

Carol Pehotsky (21:12):

Right.

Scott Hantz (21:23):

If you remember the presidential debates.

Carol Pehotsky (21:24):

Oh, yes.

Scott Hantz (21:25):

You and I, I think, we're in a room for close to-

Carol Pehotsky (21:27):

Very late. (laughs)

Scott Hantz (21:29):

20, 20 hours.

Carol Pehotsky (21:30):

Yep. Yep.

Scott Hantz (21:31):

And there, there was year, year and a half of work that went into that.

Carol Pehotsky (21:33):

Mm-hmm.

Scott Hantz (21:34):

So I think we're very good at the throughput. What we have opportunity is if those individuals in the room are not there, is the knowledge at the next level.

Carol Pehotsky (21:34):

Sure.

Scott Hantz (21:44):

And two levels down.

Carol Pehotsky (21:45):

Mm-hmm. Mm-hmm.

Scott Hantz (21:46):

That's what would keep me up at night to have an assistant manager who may be a nurse for three, four years if that.

Carol Pehotsky (21:52):

Sure.

Scott Hantz (21:53):

At the middle of the night something happens, what do you do? It's gonna be a period of time before you and I get there.

Carol Pehotsky (21:53):

Yeah.

Scott Hantz (21:59):

So we have to have the resources. And the one thing we know is people change a lot.

Carol Pehotsky (22:05):

Yeah.

Scott Hantz (22:05):

So we... A phone tree, or here's this book.

Carol Pehotsky (22:09):

It's obviously the menu print practically,

Scott Hantz (22:09):

Exactly.

Carol Pehotsky (22:09):

Yep.

Scott Hantz (22:09):

Exactly.

Carol Pehotsky (22:12):

Yeah. Well, and, and, and I wanna linger there for our audience is that it's a, it's a great point, you know. The, the drill I mentioned in my opening discussion was 2013, so that's a long time ago. And so we... And they.... I'm sure they were doing drills much before then. That's the first one I was in. And so, when you think about it, we like having the right answer. But when it comes to drills, you wanna really robust after action review. So it's not about getting the right answer, it's asking the question, asking the question. And to have our partners at University Hospital, and our partners in the rest of the city coming, being part of it and coming together to say, "If something dreadful happens in Greater Cleveland, we absolutely have to come together to solve it." And it's not about this hospital, that hospital, this system that it's about coming together for the good of our community. We absolutely need to come together. And so to drill together and ask questions together, what a wonderful thing for our communities.

Scott Hantz (23:08):

No, we're super fortunate.

Carol Pehotsky (23:09):

Yeah.

Scott Hantz (23:09):

Um, if you look around the United States, there's not many places that have this many hospital beds, emergency rooms-

Carol Pehotsky (23:16):

Right.

Scott Hantz (23:16):

... and qualified, and I'm gonna say the word again, qualified a hospital staff.

Carol Pehotsky (23:21):

Mm-hmm. Mm-hmm.

Scott Hantz (23:21):

That works in this area. We are very fortunate.

Carol Pehotsky (23:24):

So we've got listeners from all over and your point's well taken too about, it's, it's great to have people who enjoy these, these drills and who really have built them out and participate in them. I'm sure there's parts of this country where not quite as robust yet, or people who would love to do more of this, but they're not part of a system like ours. What advice would you, for even a nursing student who says, "Yeah, I would love to get involved in some of this work. What can they do on their own or what should they turn to their hospital and say, "Hey, are we doing this?"

Scott Hantz (23:53):

So there's lots of documentation, a lot of very similar to this podcast. You know, the fire EMS world, this is what we do. Every call that I go on for a car accident, house fire, even EMS, we call command.

Carol Pehotsky (24:08):

Mm-hmm.

Scott Hantz (24:08):

We take over, we articulate what we have.

Carol Pehotsky (24:10):

Okay.

Scott Hantz (24:11):

What we need, and do we need more resources?

Carol Pehotsky (24:14):

Mm-hmm. Okay.

Scott Hantz (24:14):

So whether I fight a house fire and we, we have a house fire. I got like seven departments coming.

Carol Pehotsky (24:14):

Mm-hmm.

Scott Hantz (24:20):

I have a lot of people, but car accidents where I live-

Carol Pehotsky (24:23):

Mm-hmm.

Scott Hantz (24:23):

It's, it's all 50 mile an hour roads.

Carol Pehotsky (24:24):

Ooh.

Scott Hantz (24:24):

So, so they-

Carol Pehotsky (24:25):

Yikes, yeah.

Scott Hantz (24:26):

... they get pretty, pretty intense.

Carol Pehotsky (24:28):

Yeah.

Scott Hantz (24:28):

We fly people out. We need multiple squads. So I need to be able to articulate what I need, what I have.

Carol Pehotsky (24:34):

Sure.

Scott Hantz (24:34):

So there's a lot of education out there. If, if individuals want to Google emergency management fire related, there's a lot of how to, how and how not to. From the, from the hospital side, there's many, many, many books. I would reach out to your, uh, emergency room leadership. They've probably been a part of conversations with guarding mass casualty, with hurt teams, setting up tents for decon. There's a lot of education there. A lot of hospitals from what I found, 'cause when I went to Anniston, Alabama, there was a hospital from Alaska.

Carol Pehotsky (25:04):

Oh, awesome. (laughs)

Scott Hantz (25:04):

There was a hospital from Midwest, and their emergency management evacuation plan was to back up the semi to put their three patient beds in that truck and drive away.

Carol Pehotsky (25:17):

All right. There you.

Scott Hantz (25:17):

So-

Carol Pehotsky (25:17):

Oh, wow.

Scott Hantz (25:17):

Yeah. There's-

Carol Pehotsky (25:17):

You got to do what you gotta do, yeah.

Scott Hantz (25:17):

There's all different sizes.

Carol Pehotsky (25:19):

Mm-hmm. Mm-hmm.

Scott Hantz (25:19):

So we can learn from a lot of different people.

Carol Pehotsky (25:19):

Absolutely.

Scott Hantz (25:21):

Reach out to your presidents, your hospitals. There's a lot of education, there's a lot of individuals that can come. If you don't have any background-

Carol Pehotsky (25:27):

Mm-hmm.

Scott Hantz (25:27):

there's individuals that can be guest lectures and less speakers to really help you get going on this initiative.

Carol Pehotsky (25:31):

Wonderful. You know, when we think about preparing for the worst, the shock and awe, certainly we, we hear about sometimes people have to get creative, they have to improvise. And you can't really train for that. Or I guess maybe my... So part one of my question is, can you train for that? And/or how do you know, you know, you mentioned sort of the, is there a, a mass event where you're starting to decide how you decide it's time to move on to the next patient? You've got an incident commander, or you don't, how do you start making those really difficult decisions about whether to improvise and when to change your level of care?

Scott Hantz (26:13):

So that is a very difficult question, and it's a, a question that, you know, I don't think anybody takes light-heartedly when they start-

Carol Pehotsky (26:20):

Sure.

Scott Hantz (26:20):

... to think about this.

Carol Pehotsky (26:20):

Of course not.

Scott Hantz (26:22):

I think you have to know a couple pieces of information. One, what is your capacity? What is your surge ability?

Carol Pehotsky (26:22):

Yeah.

Scott Hantz (26:28):

So what do I mean by that? If you're in emergency room that has five beds-

Carol Pehotsky (26:28):

Mm-hmm.

Scott Hantz (26:31):

... and you get 30 patients, okay, you're gonna be real busy, real quick.

Carol Pehotsky (26:35):

Things have changed, yeah.

Scott Hantz (26:36):

If you have 30 beds and you get four patients from a car accident, yeah. It's, it's surging your ability 'cause you have four critically ill patients, but nothing should change. So you have to know what type of event's happening.

Carol Pehotsky (26:49):

Probably where you're at.

Scott Hantz (26:49):

Where you're at.

Carol Pehotsky (26:49):

Yeah.

Scott Hantz (26:51):

And is it gonna continue to come in?

Carol Pehotsky (26:51):

Okay.

Scott Hantz (26:53):

So what, what do I mean by that? If you have a national disaster where you have a hurricane, tornado, some sort of-

Carol Pehotsky (27:01):

Mm-hmm.

Scott Hantz (27:01):

... of, and you may be getting patients for a day and a half.

Carol Pehotsky (27:05):

Yeah, with no end in sight, yeah.

Scott Hantz (27:06):

If you have a shooting, as I said earlier, that shooting may end pretty quickly and you're gonna know probably before the news even happens that there's a shooting. So your first question to yourself is what's going on? Once you figure that is-

Carol Pehotsky (27:07):

Right.

Scott Hantz (27:23):

... what's your capability of your hospital? How many ORs do you have? How many ICU beds? How many ED beds do you have? And that's gonna be a specific question. Each location has to ask themselves.

Carol Pehotsky (27:34):

Mm-hmm.

Scott Hantz (27:34):

Because some hospitals may surge at three patients, some may surge at 25 to 50.

Carol Pehotsky (27:38):

Mm-hmm. Sure. Yeah, that's fair.

Scott Hantz (27:39):

It, it all depends. And then what type of surge is it? Are you need a bunch of ventilators, a bunch of chest tubes? So it, you may go into smaller pockets of those actual patients coming in. So pre-planning as we talked about a lot.

Carol Pehotsky (27:54):

Yeah.

Scott Hantz (27:54):

After action review, as you talked about a lot, knowing when, and I have to say in all the situations I've been a part of, you know when. There... It's not a question, you know, it's a-

Carol Pehotsky (28:06):

It's a gut thing.

Scott Hantz (28:07):

... this is a bad situation.

Carol Pehotsky (28:08):

Yeah.

Scott Hantz (28:09):

I need more resources. And in the, as we do in the fire service, you could always call off mutual aid or help, but if you don't call them early, it's gonna be late. So always call for help earlier-

Carol Pehotsky (28:21):

Sure.

Scott Hantz (28:22):

... than wait till too it's too late.

Carol Pehotsky (28:24):

And it is time to improvise. How do you train somebody to improvise?

Scott Hantz (28:30):

So I've never had to be in that situation.

Carol Pehotsky (28:33):

Okay.

Scott Hantz (28:33):

So I'm not, I'm not going to-

Carol Pehotsky (28:34):

Yeah. That's fair.

Scott Hantz (28:34):

... to tell how to.

Carol Pehotsky (28:36):

Yeah.

Scott Hantz (28:36):

But I will... Si- situation from Joplin, if you wanna read a good after action of what a-

Carol Pehotsky (28:37):

Mm-hmm.

Scott Hantz (28:43):

... a traumatic event was they had to intubate patients in the back of a pickup truck while they were bagging the patients going to a hospital that wasn't destroyed.

Carol Pehotsky (28:56):

Oh my gosh.

Scott Hantz (28:56):

That's when you know your-

Carol Pehotsky (28:56):

That's improvisation. Yeah.

Scott Hantz (28:56):

Yes.

Carol Pehotsky (28:56):

Yeah. Well, thank you, Scott. You've shared a ton of really important information for us all. So before we close for the day, I wanted to spend a few moments to flip us into the speed round. So like to ask you a fun little question to help our audience get to know you as an amazing human being and not just as an amazing subject matter expert. So what's something about you that surprises people?

Scott Hantz (29:18):

Well, up until last three years, I wasn't much of a tennis fan, but my daughter, who's a sophomore took tennis up and this year finished fourth in the state of Ohio, so.

Carol Pehotsky (29:28):

In three years?

Scott Hantz (29:29):

In three years.

Carol Pehotsky (29:29):

Oh my gosh. That's fantastic.

Scott Hantz (29:29):

Yeah, so-

Carol Pehotsky (29:29):

(laughs)

Scott Hantz (29:32):

... so it's, uh, I wa- for people who know me, they know that every weekend I'm traveling somewhere to watch my daughter play tennis.

Carol Pehotsky (29:32):

(laughs)

Scott Hantz (29:38):

And as one of my physician colleagues says, you'll be very sad when it's over.

Carol Pehotsky (29:42):

That's right. Well, enjoy every minute of it and thanks for joining us today.

Scott Hantz (29:45):

Thank you Carol. Thank you for having me.

Carol Pehotsky (29:50):

As always, thanks so much for joining us for today's discussion. Don't miss out, Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(30:24):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.