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MUSC safety, security officials keep an eye out for Charleston by Mary Helen Yarborough Public Relations While the term critical infrastructure evokes images of pipelines, water plants and bridges, it also includes medical facilities such as MUSC.   The view from aboard a port security vessell on the Ashley River overlooking the MUSC campus and the new hospital. MUSC is considered critical infrastructure. As a trauma center MUSC is a key component in an all-hazards response plan under the  S.C. Department of Health and Environmental Control (DHEC). MUSC also is working with the model federal program operated by the U.S. Department of Justice—Project Seahawk. Project Seahawk is a pilot project designed to address criminal activity (including acts of terrorism) that may compromise or impede the movement of intermodal traffic within the U.S.  This was done through the creation of a multi-agency law enforcement task force and intelligence section. Its purpose is to establish interagency cooperation; prevent, deter, investigate, and prosecute violations; facilitate information sharing; fuse and analyze intelligence; and conduct joint operations on a risk- based decision making model using a unified command system, all while working from a multi-agency facility which provides state-of-the-art situational awareness. The law enforcement task force works in support (resources and information as well as intelligence) of those lead agencies charged with port and maritime transportation security, including U.S. Customs and Border Protection and the Coast Guard.   Thus, Project Seahawk is a concentration of local, state and federal resources for an all-hazards response that largely is driven by manmade disasters. However, it is a potential resource for the community for even natural disasters that could impede commerce, said Sean Kittrell, an assistant U.S. Attorney for the Department of Justice who is with the anti-terrorism unit, and also was designated to implement the project.    While its primary goal is to protect the waterways and port of Charleston, the fourth largest in the United States, Project Seahawk was designed to be replicated in other major American ports. But first it must receive continued federal funding. The White House has proposed rescinding the $27-million project, but with Sen. Lindsey Graham’s efforts, 100 U.S. senators have vowed to keep it intact with full funding. Graham has introduced legislation to expand the SeaHawk concept to additional ports across America, and Rep. Henry Brown (R-SC) recently announced that he worked with the House Appropriations Subcommittee to add a provision to restore funding for Project SeaHawk.  So it appears the program is here to stay.   Meanwhile, possible events the Project Seahawk team is closely monitoring include those related to a bacterial or viral infestation, or radiological agents, into this region that would be introduced by cargo (smuggled fowl), workers or passengers on marine vessels. MUSC medical teams are on call to visit ships to test for possible infectious diseases. The project also is considering the results from an attack on a petroleum storage tank or pipeline, damage to a chemical facility of refinery, or an infliction that compromises a bridge and intermodal commerce. All of these facilities are but a few miles from MUSC and on the banks of the rivers that surround Charleston.   “MUSC is vitally important,” Kittrell said. “In fact, all hospitals play a fundamental role in contingency planning and response. MUSC also is a trauma center, so it works closely with DHEC in its planning. And we work closely with DHEC.”   Response from the community and the hospital would vary, depending on the release, attack or infection, according to Al Nesmith, MUSC hospital’s director of safety and security. For example, a chemical release or attack would cause facilities to transport patients and staff to upper levels in a facility, because most chemicals are heavier than air. A biological release or attack might require people to seek lower levels in a facility, because biological agents are lighter than air.   Nesmith said that in the event of an attack, a weather event or a pandemic flu outbreak, the hospital and university are working closely on planning. “In the past 20 years, MUSC has demonstrated its ability to respond to emergencies and ensure patient care,” Nesmith said. “We are quite self-sufficient in terms of our ability to continue operations during a crisis.”   MUSC, with its own law enforcement and security officials, is equipped to guard its own perimeter. But hospital and university security officials also work closely with county and state law enforcement, all of which are part of the Project Seahawk model. Man-made crises Terrorist attacks could come in many forms. A weapon of mass destruction brought in through a container is a real concern. Other attackscould include disrupting a gas pipeline causing an explosion and disrupting nearby bridge and highway traffic. These could include fire and toxic release hazards. A chemical release from one of several facilities in the region could result in a toxic cloud that sits in a valley or low-lying area for a period of time. Evacuation would be necessary, but the scope of an evacuation would depend on the threat and the reach of that threat. Because most chemical exposure causes respiratory and skin injury, special masks and gear would be used by first responders and those affected by the release.   An officer with Project Seahawk conducts a port security sweep. Hospital staff, as well as community medical service providers, is being urged to spot injuries that could have resulted from biological or chemical exposure.   “We’re asking businesses and people in the community, like taxi drivers, doc-in-the boxes, and whether they have seen anything suspicious or anyone with any weird skin injuries or strange illnesses,” Kittrell said. He explained that key evidence at the patient level could help avert a larger event.    “Our goal is identifying the person who might be getting ready to do  a Cole-style attack before he gets in the boat,” said Kittrell, referring to the Oct. 12, 2000, terrorist attack on the USS Cole in the Port of Yemen. “While we have an operations room essentially run by the US Coast Guard which has or is getting a bunch of sensors (like radar, wireless cameras, thermal imaging, intrusion detection devices, radiological detection devices, intelligent video, and camera arrays), the core of the project is the task force with state and local law enforcement task force officers, who are deputized as special U.S. deputy marshals.”  Kittrell said that while Project Seahawk is a model based on a concept of intelligence-led policing, “Former U.S. Attorney General John Ashcroft instructed all of us in the Department of Justice that prevention is more important than prosecution,” he said. “Deterrence and what we could use to prevent a horrible event is our mission. We work to eliminate turf, and are attempting to help bridge gaps between agencies and stakeholders in contingency planning.”   MUSC plays a key role in planning for any event that could impair the health of one or hundreds of people at any given time. For that reason, MUSC disaster and emergency planners are in constant communication with local, state and federal authorities to plan for response.   Disaster planning generally takes an all-hazards approach at MUSC, said Joe Avant, manager of MUSC’s occupational safety and health program said. While immediate concerns focus on hurricane and avoiding  Katrina-style nightmares, Avant said that MUSC personnel is prepared for a variety of events.   “When Hugo hit, the National Guard brought in generators, water and ice,” Avant said. “The infrastructure was taxed. …We had a unified command. We’ve learned not to exhaust our resources until they’re needed. Team A deals with issues during a storm or event, and Team B comes in and their primary role is damage assessment. We go through every room and every building. After Hugo, we had a lot of chemical spills where windows were blown out. That was Team B’s responsibility, to go in and clean out the various hazards and establish clearance for re-occupancy.”   Avant also said that existing key personnel are able to wear many hats.   “Available staff during events are able to perform a wide variety of duties. For example, during and after Hugo, we were putting up plastic on windows, responding to fire alarms, and assisting in patient evacuation,” Avant said. “This was performed by about anyone who was available—nurses, doctors, maintenance personnel, and security.” Preparedness and MOUs Meetings are held and drills are conducted regularly involving MUSC. Periodically, tabletop drills test worst-case scenarios that include situations that couldresult from a massive chemical release, a terrorist attack, radiological events, earthquake, and, of course, a devastating hurricane. The drills enable planners to present scenarios using models and assess the response and outcomes. They are instructive, and the results help plan for more drills that account for lessons learned. In addition, methods for evacuating large numbers of patients have been tested. These plans have included airlift and ground transport planning. Currently, MUSC has memoranda of understanding (MOUs) with hospitals located in the South Carolina Upstate and in other inland areas to accept patients in an evacuation, said Brian Fletcher, MUSC’s disaster preparedness coordinator. Fletcher said MUSC also has MOUs with other transport companies to bring in ambulances in the event that the hospital’s fleet is being used.   MUSC is ready with its existing staff, which would be divided into teams A, B, C, and D. All nonessential personnel would stay home or evacuate. Because the area would be in a disaster mode, the census of patients likely would be reduced. The existing personnel would be sufficient to handle what is required. In the event of a more catastrophic event that would impair the workforce, the university side would be tapped for its medical experts to fill in where clinical staff would be strained.   Volunteers, who are so important to the quality of care during normal conditions, would not be used during a disaster, due to safety concerns for the volunteers, though they may be called upon in the aftermath of an event, said Katy Kuder, MUSC’s volunteer manager.   In terms of a pandemic influenza outbreak, MUSC is adopting the U.S. Department of Health and Human Service plan. A pandemic may present issues that are very different from a relatively short-lived hurricane. Should the community face a pandemic, it could last about eight weeks. MUSC officials meet regularly to address those issues and are following state, federal and facility guidelines to assure the best quality of care to the patients and employees of MUSC, said Nesmith. Editor's note: The Catalyst will feature updates on the various disaster plans underway at MUSC.     Friday, July 7, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.