May 6, 2019

Texas Children’s Emergency Management and Bone Marrow Transplant teams recently conducted their first full-scale radiation injury treatment exercise partnering with outside agencies to simulate their roles in a radiation-related event.

As a member of the Radiation Injury Treatment Network (RITN), Texas Children’s conducts annual exercises as part of our emergency preparedness activities. RITN is a system of hospitals affiliated with the National Marrow Donor Program providing comprehensive evaluation and treatment for victims of radiation exposure. MD Anderson Cancer Center is the only other RITN member organization in the Greater Houston area.

“Over the past three years, the Emergency Management team at Texas Children’s has worked closely with the Radiation Injury Treatment Network to increase the fidelity and realism of the drills we have been conducting,” said Dr. Brent Kaziny, Medical Director of Emergency Management. “Developing plans for such hopefully never-in-our-lifetime events is one of the many responsibilities of Emergency Management. Seeing plans tested first as tabletop drills and eventually as full scale exercises allow us to pinpoint where improvements need to be made. Texas Children’s Hospital has come so far, and watching these plans become operational is extremely rewarding.” 

Texas Children’s Emergency Management Manager Aaron Freedkin agreed and said if there was a radiation event nearby, Texas Children’s would get many of the affected pediatric patients.” 

“That’s why it’s so important for us to practice and prepare for such an event,” Freedkin said. “Last week’s exercise gave us a great opportunity to do that.”

The seven-hour event was the first full-scale radiation injury treatment exercise the organization has participated in and tested our response following the mock detonation of an improvised nuclear device that sends patients requiring bone marrow transplant or supportive medical care to Houston by way of the National Disaster Medical System.

The exercise involved various outside local, state and federal agencies including the Southeast Texas Regional Advisory Council, Veteran’s Affairs, and American Medical Response. The exercise began at Ellington Field, a joint military and civilian airport that would host the Patient Reception Center during a large-scale disaster. Run by the Veteran’s Affairs Federal Coordinating Center, the center would receive patients from outside Houston and coordinate available local resources.

Texas Children’s Bone Marrow Team Member Dr. John Craddock said understanding who the local players are and how to work with them is a great addition to the annual exercise, which typically has been a tabletop exercise with the exception of last year when it expanded to a large scale functional exercise involved Texas Children’s Hospital West Campus and Texas Children’s Hospital The Woodlands.

“This year, the exercise was full scale, giving us a more realistic idea of what we would be dealing with,” Craddock said. “I think it was very informative.”

During the exercise, Craddock and another members of the Bone Marrow Transplant team helped receive, triage and assign for transport to area hospitals 50 mock pediatric patients and 50 adult patients. The pediatric patients at Ellington Field were played by high school students from Friendswood High School. The adult patients at Ellington Field were played by adult volunteers from various civic groups including Bay CERT, a local Community Emergency Response Team.

The second half of the exercise took place on the fourth floor of the Pavilion for Women, part of which was turned into a Patient Reception Center for the patients coming to Texas Children’s Hospital for evaluation and/or treatment. Those mock patient and their family members were played by DeBakey High School students and saw members of our pathology, chaplain, social work, patient experience and case management teams before being transferred to a patient care room if necessary.

“This is the first time we’ve simulated going from plane to hospital,” said James Mitchell director of Organizational Resilience and Emergency Management. “Going through the entire process really expanded our knowledge about how this would work.”

March 5, 2019

When opportunities arise, Texas Children’s Emergency Management plans functional active shooter exercises on our campuses. Thanks to the leadership and staff of the Texas Children’s Health Plan, or the first time on February 27, the exercise was geared toward those who work in an office environment rather than a clinical space.

The purpose of these exercises is to test Texas Children’s emergency notification procedures, staff training for response to an active shooter (Run, Hide, Fight), and to give our law enforcement partners a chance to practice their tactical response to an active shooter. Holding this training in an administrative rather than a clinical setting provided an excellent opportunity to test the “Run, Hide, Fight” training and a different environment.

The most important aspect of the exercise is the difference in an administrative setting versus a healthcare setting. Hospitals have multiple patient rooms and storage rooms for other medical purposes, whereas, in most office buildings there are large open areas that have cubicles. When the staff practice the “Run, Hide, Fight” method, most people’s first thought is to hide under a cubicle desk.

“That is not the safest place during an active shooter situation,” manager of Texas Children’s Emergency Management Aaron Freedkin said. “They need to find another place, either leave the floor or find a room that they can lock or block the door with furniture. That’s preferable to just hiding under a desk.”

The exercise included 175 participants, 14 logistical volunteers, 32 observers and 48 law enforcement officers such as: UT Police, Bellaire Police, Houston Police Department, Precinct 5 Constables Office, and Pasadena Police Department SWAT. Having multiple agencies involved in simulating an active shooter incident response creates an environment that is as realistic as possible and allows law enforcement agencies to practice their skills in a new environment. A secondary benefit is having the opportunity to train in the office setting, which would be valuable in the event of a real active shooter incident. It is a chance for them to train together with other agencies and get exposed to different training aspects that ultimately have the same basic goals and mission.

“We are excited to partner with these law enforcement agencies,” Freedkin said. “They get many opportunities to practice in empty buildings with law enforcement participants. This exercise will give them all a chance to practice their building clearing and searches with the unpredictability of non-law enforcement officers playing the role of victims and so there is definitely something in it for everyone participating.”

After the participants arrived, they were put through a safety briefing with Texas Children’s Hospital Emergency Management, followed by further orientation with The University of Texas Police Department, and “Run, Hide, Fight” training provided by Texas Children’s Security. During these exercises blank ammunition was used to simulate gunfire to increase realism while maintaining safety.

Law enforcement was staged on the 13th floor and the exercise began as they proceeded down the stairwell. Meanwhile, there is a person on the 12th floor acting as the aggressor toward employees. The challenge then comes as the aggressor engages in a discussion with the employee that may result in them not thinking immediately about, “Run, Hide, Fight.” After the exercise is reset and begins a second time, there is quicker movement of people because they have had time to immediately think about it and learn from their initial mistakes.

“It is always interesting to observe an exercise such as this because people react in unexpected ways such as seeking shelter and protection in places that are not ideal,” Freedkin said. “That is one of the reasons we conduct this training so that people have an opportunity in advance to consider their training and what their reaction should be.”

There were three sessions and all were structured the same way. Between the first evolution and second evolution of each session, a portion of the scenario changed. A debrief discussion was later held and everyone was able to reflect on their reactions.

“The exercise went extremely well and was well received by the exercise participants and senior leadership who were present,” Freedkin said. “For future exercises, we are working with our law enforcement partners to add additional elements of realism to the exercise while still maintaining the safety of our participants.”

The Emergency Management Team looks forward to providing more trainings geared toward the administration staff throughout the system, and wants people to know if an opportunity comes up to participate in an active shooter exercise like this, staff should take advantage of it. The more realistic your training experience the better you’re going to react in an actual incident.

April 24, 2018
Texas Children’s emergency operations plan was put to the test during a comprehensive active shooter exercise on April 16. This was the first time an emergency exercise of this scale and scope with external and internal participants was completed at Texas Children’s Hospital Medical Center Campus. Two similar exercises were previously conducted at the Woodlands and West campuses in 2017.

The exercise included over 200 Texas Children’s staff and employees and 30 members of local law enforcement including, the University of Texas Police Department, Harris County SWAT Team, and the state department diplomatic security service. There were also multiple external observers and evaluators onsite. Having multiple agencies involved in simulating an active shooter incident creates an environment that is as realistic as possible and allows law enforcement agencies to practice their skills in a new environment. A secondary benefit is having the opportunity to train in our hospital footprint which would be valuable in the event of a real active shooter incident.

After the participants arrived, they were put through a safety briefing with Texas Children’s Hospital Emergency Management, followed by further orientation with The University of Texas Police Department, and “Run, Hide, Fight” Training provided by Texas Children’s Security. During these exercises blank ammunition was used to simulate gunfire increasing realism while maintaining safety.

The exercise was held on the twelfth floor of the Legacy Tower, a new extension of Texas Children’s Hospital that officially opens Tuesday, May 22. Legacy Tower was the perfect place to host this exercise since it is vacant, so patient care would not be disturbed, and due to its convenient location on Texas Children’s Hospital Medical Center Campus.

The exercise involved two scenarios both presented within each of the five sessions. The first scenario was a disgruntled parent seeking retribution against the staff following the recent death of his child. The enraged father came into the hospital looking for a particular physician, became agitated, pulled out a weapon, and then started shooting. Once the father started shooting, people began to scramble, and at that point, all the staff were expected to execute the “Run-Hide-Fight” training that was provided. The shooter eventually isolated himself then took his own life.

After law enforcement entered the scene they began searching the area, located the shooter, secured the floor and evacuated all of the participants to a safe area. At that point the first evolution of the exercise ended and all the participants were gathered for a quick debriefing to discuss what happened before being repositioned for the next evolution of the exercise with participants changing roles.

“So that first time kind of startles them,” Aaron Freedkin, manager of Emergency Management, said. “Then they really settle into the “Run-Hide-Fight” training.”

The second scenario was a domestic dispute involving a person looking for his ex-wife, accusing her of taking custody of their kids and seeking retribution. While the scenes played out looked and sounded real, fortunately, this was only an exercise. However, these realistic situations are needed to evoke the intensity that would arise in the event of a real active shooter incident.

According to Texas Children’s Hospital Emergency Management, the first time they ran through the drill participants had the tendency to hesitate rather than react. However, the second time they were more comfortable and as a result, their performance improved. After the second evolution of the exercise, Texas Children’s Hospital Emergency Management conducted a follow-up discussion and debriefing in a process to capture lessons learned from the exercise.

“We are always seeking to improve our processes and our plans, so we do what’s called an after action debriefing or a hot wash,” Freedkin said. “This is where we sit them down and talk about what they went through and ask them what went well and if there are any opportunities for improvement.”

During the process, Everbridge, our emergency notification system, was tested by sending messages stating that there is an active shooter, the specific floor, and everyone is told to “run-hide-fight.”

“Overall, it was a very successful exercise. We really want people to get that visceral reaction,” Freedkin said. “It’s one thing to show people a video or to give them a PowerPoint and show them how to respond during an active shooter event. It’s very different to stick them on a floor and then have somebody shooting off a weapon. So, this really gets your adrenaline going and gives them more of a realistic feel for what a real event would be like.”

We are better prepared today than we were before, and the lessons learned from this exercise will drive improvements to our planning and response for many months to come.

January 15, 2018

Inclement weather update no. 3: Resuming normal operations

As of this afternoon, normal operations have resumed throughout the Texas Children’s system. Our clinics and primary care offices are now seeing patients during our regular hours and accommodating appointments that had to be rescheduled.

We want to thank all of you for carefully braving the weather to come into work yesterday and today. Your efforts to be here and your dedication to our patients ensured that we provided them safe, seamless care, and further demonstrate that we are an organization of staff and employees who think and act quickly and thoughtfully during times of challenge.

As we prepare for another deep freeze tonight, please be careful as you return home to your families. We encourage you to exercise caution when navigating roadways as some areas may still be wet or icy from earlier precipitation.

Judy Swanson
Administrator On Call

James Mitchell
Emergency Management

Inclement weather update no. 2: Tuesday, 2:15 p.m.

As expected, much of the Houston area is experiencing rain and below freezing temperatures. As we continue to monitor local reports, Texas Children’s leadership throughout the day has been assessing the needs and staffing of both patient care and non-patient-care areas within the hospitals, clinics, practices and health centers.

New information

  • Inpatient operations. At this time, we are continuing operations as normal throughout the Texas Children’s system. Leaders will continue to assess staffing needs and will make adjustments accordingly. Staff who want to come in early prior to their shift should contact their leader.  If you choose to spend the night, bring an overnight bag. Cots will be available for staff if you are unable to return home.
  • Outpatient operations. We are planning to suspend outpatient services by 3 p.m. today. Outpatient clinics will open at 10 a.m. on Wednesday to allow patients and staff more time to arrive to their destination.
  • Shuttles services from Garage 19 and Meyer to the Medical Center  Campus are running on schedule.
  • One-to-one handoff will occur in the inpatient areas at shift change

Medical Center campus retail food service
Tuesday
Food Court: closing early at 3 p.m.
Fresh Bistro:  normal hours 6:30 a.m. – 3 p.m.
Coffee Corner: closing early at 9 p.m. (sandwiches, paninis, salads and soup) – usually stays open until 11pm

Wednesday
*This is the plan for now, although staffing could affect opening times
Coffee Corner: 6 a.m. – midnight
Fresh Bistro: 6:30 a.m. – 3 p.m. (will evaluate station closures based on staffing and volumes)
Food Court: 10:30 a.m. – 6:30 p.m. (will evaluate station closures based on staffing and volumes)

West Campus Retail Food Service
Tuesday
DOTS Kitchen – will remain open until 6:30 p.m., Deli window in DOTs will remain open until 8pm (EXTENDED HOURS).
Coffee Spot: Closes at 2:30 p.m. per normal operations.

Wednesday
*Planned to maintain normal hours, given that staff can arrive tomorrow morning safely.
Coffee Spot: will open at 6:30am
DOTS Kitchen: will open at 7am

Sleet and freezing rain are expected to create hazardous road conditions especially during the afternoon/evening commute. We encourage staff to exercise caution when navigating roadways especially on bridges and overpasses as water can freeze very quickly with a sudden drop in temperatures. Please plan for additional travel time, and be sure to communicate with your leaders should your arrival to work be delayed due to the inclement weather conditions.

We will continue to monitor the weather and assess any possible impacts to you, our patients and their families. and will send additional global alerts as needed. For more information, including the latest weather, traffic and road conditions, go to the Emergency Management Connect site and the National Weather Service website.

Judy Swanson
Administrator On Call

James Mitchell
Emergency Management

Inclement weather expected tomorrow: Monday, 9:30 p.m.

The National Weather Service is forecasting rain and below freezing temperatures across much of southeast Texas. Light rain is expected to begin at 2 a.m. on Tuesday. The morning commute is not expected to be affected. However, as temperatures begin to drop during the mid-morning hours, sleet and freezing rain could create hazardous road conditions especially during the afternoon commute.

We are monitoring local reports and will continue to do so throughout tonight and tomorrow morning. As of now, Texas Children’s is expected to remain fully operational. This includes both patient care and non-patient-care areas within the hospitals, clinics, practices and health centers. However, leaders are assessing the needs and staffing of their respective areas and will subsequently provide any further information or instruction.

We know staff and employees may be concerned about the impending weather conditions. Please remember that we all are here to take care of our patients, and ensuring that their care is safe and seamless is our priority. Please plan to get an early start tomorrow so you can make a thoughtful assessment of the current weather situation and your plans for reporting to work safely. We encourage you to exercise caution when navigating roadways and plan ahead in case there is an interruption to any city services or school closures.

For more information, including the latest weather, traffic and road conditions, go to the Emergency Management Connect site and the National Weather Service website.

Judy Swanson
Administrator On Call

James Mitchell
Emergency Management

May 9, 2017
The Department of Emergency Management is presenting its 11th Annual Emergency Management Bridge Event from 10 a.m. to 2 p.m. Wednesday, May 17, on The Auxiliary Bridge.

Representatives from various Texas Children’s departments as well as external partners such as the City of Houston Office of Emergency Management will be onsite to help you prepare for hurricane season by assisting you with registering in the Employee Disaster Roster (EDR), getting your emergency supplies ready, and making sure you know where to go and what to do during a disaster.

Plan to stop by The Auxiliary Bridge to learn safety tips to help you prepare yourself, your family and your patients for the 2017 hurricane season.

April 4, 2017
Texas Children’s Hospital in partnership with the Montgomery County Sheriff’s Office, University of Texas Police at Houston, Montgomery County Hospital District, Montgomery County Office of Homeland Security and Emergency Management, and the Houston Police Department conducted two active shooter exercises on March 3 and then an active shooter exercise followed by a mass casualty exercise on March 10. The exercises were conducted in the Emergency Center, lobby and cafeteria of the hospital, which will open its doors to the public on April 11.

“I think these are critical exercises to undertake and am proud to see Texas Children’s Hospital performing these,” said Dr. Jennifer Arnold, medical director of the Texas Children’s Hospital Pediatric Simulation Center. “The opportunity to identify system flaws before a real life threatening emergency occurs is priceless.”

View photos from the exercises below.

The scenario for one of the exercises was of a disgruntled family member of a deceased patient seeking retribution on the Emergency Center physician. A police officer dressed in normal clothes and carrying a plastic training weapon played the shooter and 25 employees from across the Texas Children’s system played either an employee, patient, or family member.

The purpose of the exercise was to test Texas Children’s emergency notification procedures, staff training for response to an active shooter (Run, Hide, Fight), and to give our law enforcement partners a chance to practice their tactical response to an active shooter in our new building.

“As nurses we enter the profession to provide care to others and in these situations there is a pivotal moment where you must place yourself first to ensure safety,” said Tarra Kerr, director of nursing for Texas Children’s Hospital Emergency Center. “This is hard to do and we must continue these training opportunities to prepare, and more importantly create an avenue to have open dialogue about these prevalent issues.”

The second exercise involved an active shooter exercise in the cafeteria and common areas of the hospital, followed by a mass casualty incident and medical surge exercise in the Emergency Center using 20 young people volunteering to be patients and dressed in Moulage or simulated injuries using special effects makeup.

According to various participants, the exercises were very successful and lessons learned will allow staff to improve Texas Children’s emergency plans for an active shooter event, improve our emergency notification processes, and improve our staff training.

“While I hope to never encounter a scenario such as an active shooter on site, this drill certainly gave me and my colleagues the skills to be prepared for and to survive this terrible and hopefully exceedingly rare event,” said Dr. Joseph Allen, medical director of Texas Children’s Hospital The Woodlands Emergency Center.

February 19, 2017
globalalert640
Sunday, February 19, 2017: 6:26 p.m.

Texas Children’s leadership and the Department of Emergency Management are closely monitoring the weather as the Greater Houston area is expecting a potential threat of heavy rainfall overnight.

Rain is forecasted to begin around 2 a.m. Monday morning and reach the Texas Medical Center by 4 a.m.  Heavy downpour is expected to continue until 9 a.m. Some areas may receive up to 4 to 6 inches of rain, which subsequently could cause street flooding.

We urge employees to exercise caution when navigating roadways and avoid flooded areas as you head home or make your way into work. Please plan for additional travel time and be prepared to identify alternate routes in case roadways are flooded. Also, be sure to communicate with your leaders should your arrival to work be delayed due to the inclement weather conditions.

As for clinical staff, there may be the possibility for one-to-one switch-outs on Monday morning if some staff are having trouble arriving to work due to treacherous road conditions.

We  urge staff in our outpatient operations, Texas Children’s Pediatrics, Health Centers and The Centers for Women and Children to be prepared to reach out to patients regarding potential scheduling changes.

At this time, we are planning for normal operations. We will keep you posted should this status change.

For more information, including the latest weather, traffic and road conditions, go to the Emergency Management Connect site and the National Weather Service website.

Ivett Shah
Administrator on call

James Mitchell
Emergency Management