March 26, 1999

Consider this scenario: A great number of previously healthy adults are coming to the MGH Emergency Department with flu symptoms – headache, muscle pains, shaking, chills and gastrointestinal problems. Patients are getting worse quickly, requiring intensive care. Some are dying. The Boston Emergency Medical Services (EMS) is overloaded with calls for help, and other hospitals in the city are reporting a similar epidemic.

Within two days, nearly 360 people have been transported to area hospitals, with at least 70 patients in intensive care suffering from symptoms of flu and pneumonia. Nearly 60 people have died. A triage nurse notes that some of the patients attended a hockey game earlier in the week. Lab tests soon confirm pneumonic plague, apparently caused by biological terrorism. A militia group claims to have released the agent at the hockey game.

This was the scenario presented at a tabletop disaster drill two weeks ago, sponsored by the City of Boston and the Conference of Boston Teaching Hospitals (COBTH). Representatives from the MGH joined those from other Boston hospitals, the Boston Public Health Commission, police and firefighters, EMS staff, the FBI and other government officials to discuss how to respond to such a disaster.

"We all learn from each other," says Maryfran Hughes, RN, nurse manager of MGH Emergency Services and chairperson of the COBTH Disaster Subcommittee. "As a group, we test our hospital disaster plans with public agencies and other emergency systems to assure a coordinated approach to patients if real events occur."

If such an incident actually occurred, the MGH would face some complex issues. How can the hospital rapidly protect patients and staff from infection? Should sick patients be quarantined? Are antibiotics available on such a large scale? How should patients and staff be supported psychologically?

The daylong drill, held in Dorchester, was one of several designed to help the City of Boston and COBTH prepare for a possible terrorist attack. In October, the city held a full-scale exercise with mock patients taken to hospitals in a scenario involving the release of a poisonous gas during a public gathering.