We don’t know what we don’t know” (1) The challenge to emergency preparedness…..

The OPIOD CRISIS developed under-the-radar into a large scale national epidemic. This calamity was created, not by a virus, but by the over-production of very profitable prescription pain medication, and over-prescribing due in part to “pain management” goals and patient demand.

And in the recent past ZIKA spread on an unpredictable trajectory followed by a confirmed link between ZIKA and microcephaly.

The OPIOD CRISIS, like ZIKA, is a complex problem where participants have to reach agreement on goals while simultaneously evaluating options, in the context of “unknown unknowns.” Previous experience, even with Ebola, were not necessarily templates for ZIKA and the many existing and emerging mosquito-borne viruses. There is no real existing template for the OPIOD CRISIS.

The OPIOD CRISIS and the ZIKA EPIDEMIC led me to reflect on my professional hospital administrator experience with “disasters”.

My first experience was in 1975; I was 30 years old, the Mount Sinai Administrator at Elmhurst Hospital. “A powerful bomb ripped through a baggage area crowded with holiday travelers at LaGuardia Airport….. killing 12 persons and injuring at least 75 others.” (2) The most seriously injured were transported to nearby EH, a trauma center. I manned a security post keeping family members and press out of the E.R., observed much but learned little.

The first World Trade Center bombing was in 1993, four years into my tenure as President and CEO of Jersey City Medical Center. (3) As the nearby EMS service we sent all our ambulances through the Holland Tunnel into Manhattan. They got caught in the gridlock, were useless, and we didn’t get them back for three days and had to rely on Mutual Assist to cover our home turf.

In the mid 1990’s we had a 4-alarm arson fire in the hospital. The extraordinary efforts of the JCFD saved the day and 400 patients as we were evacuating the smoke-filled hospital, hampered by archaic elevators and narrow, dark stairways.

My focus on LESSONS LEARNED started on September 11th, 2001 when as President and CEO of Jersey City Medical Center we were a lead responder to the World Trade Center attacks. A confidential LESSONS LEARNED memorandum to the New Jersey Commissioner of Health became public when the Mayor of Jersey, who was out of the country on Sept 11th and was planning a run for governor, leaked the report “Schundler Assails New Jersey’s Response to Terrorist Attack.” (4) The Governor’s Office was not happy.

In 2004 I was visited by a Secret Service agent who told me that JCMC had been one of two hospitals designated as the primary back-up facilities for the Republican National Convention in Madison Square Garden and that we had to be fully staffed during the week before Labor Day, one of the slowest weeks of the year – and I couldn’t tell anyone why.

In 2009 I suggested to the new Acting Mayor of Hoboken that the Swine Flu maps showed it pointing to the NYC/ Hoboken metropolitan area. This led to ““Hoboken Creates Swine Flu Task Force.” (5) Interestingly Swine Flu did not reach epidemic proportions most probably due to “herd” immunity (6) from the prior year’s sub-clinical outbreak.
I monitored the Ebola outbreak starting in 2014 and advocated for the designation of regional centers as even as community hospitals “marketed” their preparedness. (7)

While I was not involved in Super Storm Sandy in 2015, the new Jersey City Medical Center opened in 2004 was hard hit even though it had been built to withstand the “100 year flood plain.” The hospitals in Hoboken and nearby North Bergen were totally evacuated.

While it may be true that “no battle plan ever survives the first encounter with the enemy” (8), plans for “New” types of emergencies are always needed as a starting point.

I taught an MBA/ MPA/ MPHA course “Project Management. The hardest part about getting started……is getting started.” The public needs confidence that OPIOD CRISIS planning is underway.

Bronx-Lebanon Hospital Siege Offers Counterterrorism Lessons (9)

1. Donald Rumsfeld. “There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”
2. http://www.nydailynews.com/new-york/queens/laguardia-airport-bombing-kills-10-1975-article-1.2454144
3. http://news.bbc.co.uk/onthisday/hi/dates/stories/february/26/newsid_2516000/2516469.stm
4. http://www.nytimes.com/2001/09/22/nyregion/schundler-assails-new-jersey-s-response-to-terrorist-attack.html
5. http://www.nj.com/hobokennow/index.ssf/2009/08/hoboken_creates_swine_flu_task.html
6. http://www.vaccinestoday.eu/vaccines/what-is-herd-immunity/
7. http://hudsonreporter.com/view/full_story/25983889/article-Ebola–Local-medical-professional-releases-paper-on-what-to-do
8. http://www.lexician.com/lexblog/2010/11/no-battle-plan-survives-contact-with-the-enemy/
9. https://www.nytimes.com/2017/08/24/nyregion/bronx-lebanon-hospital-siege-counterterrorism-nypd.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0