As hospital staff raced across campus gathering equipment and supplies for a massive influx of patients, the clock kept ticking.
More than an hour passed before everything was in place.
By then, a hundred patients had arrived. They were screaming. Their wounds were raw. They knocked over IVs, cried out, and pleaded, desperately, to see their parents.
It was a drill, with actors wearing moulage to mimic wounds and causing chaos to stress the staff. The goal was to replicate the intense, horrific reality of a mass casualty incident, to reveal holes in the hospital’s readiness.
“We weren’t prepared, not even close,” said Chris Riccardi, who oversaw disaster preparedness programs at two Los Angeles County hospitals at the time. “You have 15 minutes until victims show up.”
That reality became the motivation behind 15 Minutes ’til 50 Patients, a mass casualty incident response program designed to help hospitals rapidly deploy staff and equipment for a sudden medical surge.
Today, at least 600 hospitals across the country use the model, Riccardi estimates, including Rady Children’s Health in Orange County, formerly Children’s Hospital of Orange County, where he serves as the manager of emergency management and business continuity.
Developed by Riccardi and a few of his emergency department colleagues using Hospital Preparedness Program grant funding, 15 ’til 50 is available at no cost. “My goal was also to put a written plan into the hands of anybody who would want adopt it,” he said. “It’s find-and-replace. Put your hospital name here, and you’re good to go.”
Building a better response
Riccardi knows firsthand his program can be replicated at different health care facilities. He was recruited by Rady Children’s to do just that.
Rady Children's hospital campus in Orange County serves a county of 3.3 million residents, including roughly 800,000 children. Disneyland is just a few miles away. So is Knott’s Berry Farm, Angel Stadium, major freeways, and dozens of school districts.
“If it happens at a school, if it happens at Disneyland, if it happens on the freeway with a couple of buses, what is that going to look like for us?” Riccardi said. “That’s what we needed to figure out.”
So he implemented 15 ’til 50, which is built around four essential elements every hospital needs:
- Staff: People must know exactly where to go and what to do.
- Stuff: Supplies and equipment must be ready to deploy immediately.
- Space: An additional area must be able to absorb a sudden influx of patients.
- Systems: Everything must be tied together with systems.
Hospitals identify where a surge treatment area will be established, determine what equipment and supplies will be needed, and assign responsibilities across departments before a disaster occurs.
The toolkit includes a written response plan, job action sheets, department responsibilities, and implementation guidance organizations can adapt to their own operations.
At Rady Children’s, emergency department staff move into a designated surge area outside the department itself. Hospital leadership activates a command center. Pharmacy, radiology, laboratory services, blood bank teams, trauma staff, chaplains, case managers, and hospital leaders all have assigned responsibilities when a disaster is declared.
“We establish a whole new ED surge unit,” Riccardi said. “We keep the chaos outside, and we can manage the influx and patient throughput under our guidance.”
The program has been shaped through years of drills designed to replicate the pressure of a real incident.
“The only way to test the system is to stress the system,” Riccardi said. “This program has been tested, geez, 150 times, just by me. We never simulate with less than 100 patients.”
The model has proven adaptable far beyond the California hospitals where it began. Children’s hospitals, trauma centers, community hospitals, federally qualified health centers, and long-term care facilities have all adopted versions of the approach.
“This is completely scalable,” Riccardi said. “Scale up, scale down, depending on what resources you have available in your facility.”
Ensuring reunification
Treating injured children is only part of a pediatric disaster response.
Children, some of whom can’t communicate, may be separated from their parents, who sometimes don’t even know what hospital they were taken to.
Reuniting them is among the most important priorities.
Working with school districts across Orange County, Rady Children’s has incorporated school nurses into its reunification efforts. They help identify students, access emergency contact information, and assist hospitals in reconnecting children with their families after an incident.
“We found the missing link,” Riccardi said.
Today, all 28 school districts and all 26 hospitals in Orange County participate in the effort.
Ready before the patients arrive
The program’s widespread adoption remains surprising to Riccardi.
“We put together a plan because we thought we were behind the curve,” he said.
More than a decade later, hospitals across the country are still finding value in his solution.
The challenge it was built to address has not changed. Emergency departments remain crowded. Staff remain stretched. When a mass casualty event occurs, hospitals do not get additional time to prepare.
The patients are already on their way.
