Case Studies

Brian Martin – Medical City Plano and Medical City Frisco

Emergency preparedness: when practice better make perfect

No matter what the health crisis at Medical City Plano in North Texas, Facilities Management Director Brian Martin says the 600+ bed hospital, located in thriving Collin County, is ready.

As Collin County’s only Level I trauma center, Medical City Plano regularly accepts transfer patients from more than 200 hospitals in a four-state region. Level I trauma patients include those suffering from stroke, burn injury, spine injury and other neurological incidents, as well as high-risk women’s and neonatal issues.

A seasoned emergency management expert, Martin is helping guide the hospital’s response to a historic global health crisis: COVID-19

The key to caring for patients in a time of crisis, he says, is having a solid emergency management system in place, holding regular disaster drills, working with local authorities and anticipating response to critical situations.

For Martin, the best way to test the hospital’s capabilities comes down to three simple words: practice, practice, practice.

“We’re ready for anything—and at a moment’s notice,” he says. “Responding in a prepared and uniform fashion helps save lives. Our mission is to the care and improvement of human life, and that drives everything we do.”

Training, practice are crucial

With a broad background in emergency preparedness, Martin knows what he’s talking about. A former U.S. Air Force defense instructor, he has also been a disaster trainer and regional planner, and now serves as an adjunct professor of emergency management and disaster science at the University of North Texas.

Joining Medical City in April 2019 was a step up in responsibility from his prior work as assistant director of plant operations at a smaller local hospital. Martin’s role continued to expand to include Medical City Frisco. For the two Medical City Healthcare hospitals, his primary responsibilities are to oversee engineering, maintenance and emergency management.

Martin believes that organizations should identify and anticipate what disasters and emergency responses are relevant to their industry in advance of an actual occurrence.

“You can have the best emergency plan in the world, but if you don’t review it and practice it regularly with your team, it will be difficult to respond quickly and efficiently in an actual emergency situation,” he advises.

Martin summarizes his immediate response to a disaster in a hospital setting: assess current surge capacity, anticipate need or additional resources, and modify existing infrastructure with the goal of expanding patient capacity if, and when, necessary.

“Emergency management is all about successfully managing unusual and unexpected scenarios without interrupting ongoing operations,” he notes. “This is an important subspecialty, with multiple applications throughout our society. The key is to prepare and practice all the time.”

Medical monitoring

At Medical City Plano, ongoing assessment is essential to monitoring the numbers and types of patients in-house. The need is amplified with the high-acuity care provided in a Level I trauma center.

Each patient’s census snapshot informs planners about the number of beds available, staffing levels required for optimal care, the number of medical devices needed, and physical space required to house and handle any volume surge in patients.

Like the government and many private sector businesses, Medical City Healthcare follows the National Incident Management System that establishes protocols and opens its own command center when disaster strikes. As Martin explains, this is a formal, standardized response that can be applied to any situation. A defined chain-of-command for the decision-making process is determined far in advance, with processes that guide the flow of information and accountability through clearly defined roles.

“The question becomes, how many additional patients can we take on to accommodate a growing or unexpected patient population, while maintaining exceptional care for the patients that are either already in-house or scheduled to come in for treatment,” Martin says.

That balance allows hospitals like Medical City Plano to develop what is known as a “patient surge expansion” to accommodate additional needs. This form of forecasting helps planners evaluate what’s required a few hours, days, weeks—or even months—in advance.

Anticipated scenarios range from natural disasters and mass casualties to infectious diseases like Ebola, flu and COVID-19. The standard of care never changes. In addition, communication is a constant between first responders, local city emergency offices, and other local and state authorities, such as county health departments, North Central Texas Regional Trauma Advisory Council and the DFW Hospital Council.

“We are forever watching what is going on in our community or the state or the world, for that matter, and tailoring our local response accordingly,” Martin says.

Pandemic punch list

Given the immediate COVID-19 crisis, Medical City Plano expanded its environmental protocols to prevent infection. This included restricting visitors, limiting entrances and exits, and establishing screening stations so that all physician, patient and staff temperatures were checked and their hands sanitized before entering the hospital. Waiting areas, the cafeteria, and break rooms were also rearranged to model the very best social distancing practices.

Using the AutoCAD computer program in this capacity was also a helpful tool. With AutoCAD, Martin could reconfigure the use of hospital space to modify the number of employee break rooms or create extra space for patients.

“AutoCAD allows us to gain a bird’s eye view of every floor and tower to get an accurate square footage,” he says. “We can then control the process and anticipate needs to pivot when necessary.”

Room pressurization

CDC isolation guidelines for COVID-19 include taking droplet precautions and focusing on donning proper personal protective equipment such as masks, gowns and eye protection. When aerosolization risk is present, the recommendation is to place the patient in a negative pressure room where the pressure inside the room is lower than outside the room. When the door is opened, potentially contaminated air or other dangerous particles from inside the room will not flow outside into non-contaminated areas. Contaminated air is removed with exhaust systems that clean the air before it is pumped outdoors and away from the hospital.

While the use of negative pressure rooms is only a recommendation, it does present a unique challenge for hospital engineering directors working to provide additional facilities for COVID-19 patients. The Medical City Plano team improvised by quickly acquiring portable, negative pressure HEPA air filtration units and installing them in regular patient rooms, ducting the filtration units outdoors through the windows.

Once they got the hang of it, critical thinking and ingenuity allowed the engineering team at Medical City Plano to flip a traditional medical-surgical patient room to an airborne isolation room in less than an hour.

Ready for action

Dedicating his career to planning, responding to and successfully managing the challenges that arise from an emergency fulfills Martin’s sense of purpose—one that began many years ago.

“Emergency management struck a chord with me, caught my attention and motivated me to continue my education,” he recalls. “While there are many ways to help and save people, emergency preparedness and disaster science inspired me to help save others in unexpected and extreme situations.”

After earning a degree in disaster preparedness from the Community College of the Air Force in 2004, Martin also acquired a degree in emergency administration and planning from the University of North Texas in 2009 and a master’s degree in public administration from Argosy University in 2013. He holds a certified healthcare safety professional license and is certified as a healthcare facility manager by the American Hospital Association.

“People don’t like to contemplate disasters, perhaps thinking these types of things won’t happen to them,” Martin says. “Our team is focused on preventing problems and preparing for what’s coming next.”

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