By Michelle Spivak, Director Community Relations and Public Affairs
VA Medical Center, Washington, DC

It's 9:00 p.m. on Monday, the Martin Luther King, Jr. holiday, and there's excited chatter in the usually silent halls of the Washington DC VA Medical Center (DCVAMC). Staff in Redskins sweats, Betty Boop scrubs, well-worn blue jeans and fluffy slippers sign-in for duty - a 24-hour shift that will take them through inauguration festivities on January 20. Carrying pillows and overnight bags to their assigned sleeping areas, they test the inflation on their air mattresses, plug-in personal DVD players to check crowd activity on the Mall, turn down their "Property of the Department of Veterans Affairs" sheets and try to get some shut-eye before the big day.

More than 200 doctors, nurses, clerks, housekeepers, plumbers, pharmacists, and administrators worked that long shift. Over 100 of them were "sheltered in place" at the medical center as part of inauguration preparations that began many weeks before. City and Federal predictions of record-breaking crowds descending on Washington, DC, required major road and bridge closures. That meant hospitals had to get people at their posts prior to the potential onslaught. Initially, nearly 400 DCVAMC employees volunteered to the work the 9 p.m. to 9 p.m. shift, even though most could have joined their families and the throngs making history at the Capitol and along Pennsylvania Avenue.

Inauguration events created a formidable planning task for capital city hospitals. The DC VA Medical Center started to work earlier than most. Chiefs of key services began meeting shortly after Thanksgiving to assess staff and supply needs. Working within the guidance of our Emergency Management Plan and District of Columbia Hospital Association (DCHA) agreements, the medical center would get all emergency patients identified as veterans.

Fernando O. Rivera, Medical Center Director, and Mike Dunfee, Associate Medical Center Director and Commander of the Emergency Command Center, decided to double the Emergency Department (ED) staff on duty. A general surgeon, an anesthesiologist, radiology and surgical support staff would also be required.

Ambulance service was a major hurdle to jump - accessibility and safe movement required complex choreography on a city-wide scale. DCVAMC requested an ambulance from the Martinsburg West Virginia VAMC for emergency transfers as there was no assurance that commercial ambulances would be available due to shortages and transportation gridlock.

That's where the alphabet soup of city health care oversight teams came in. They include DCDOH, the Washington, DC Department of Health, and DCEHC, the District of Columbia Emergency Health Coalition. Steve Mabley, VISN 5 Regional Emergency Manager, represents the medical center on the Health Coalition, the umbrella organization for all emergency health operations in the capital city. The Health Coalition is the staging association for regional hospital exercises and determines information sharing strategies pertaining to potential violence, infectious disease, bed availability, ambulance service, transportation, housing for staff and more.

Hospitals communicate with each other on a dedicated radio frequency called the Hospital Mutual Aid Radio System or HMARS. This radio system and a secure website, the Healthcare Information Sharing System (HIS), take the pulse of the city's needs throughout emergency situations and share data on an agreed upon schedule, increasing communication frequency as the event proceeds. Police and fire officials use the website when allocating patients and ambulance runs. It's also used to determine which transport routes to open when traffic pile-ups, metro closes train stations, and when violent incidents occur.

Throughout the holiday weekend and Inauguration Day, hospitals shared bed-counts and emergency room admissions on the website and during daily Health Coalition conference calls. There were over 200 patients treated in EDs throughout the city and eight at the VA hospital. One primary care clinic remained open to walk-in traffic and for transfers of non-emergent patients from the ED. The Charlotte Hall, Maryland Community Based Outpatient Clinic (CBOC) was also open.

Fifty-two DOH health stations and five Disaster Medical Assistance Teams (DMATS) were deployed to strategic locations along the parade route and on the Mall. These mobile medical units took care of scrapes, bruises and freezing cold fingers freeing up hospital emergency departments for more serious cases. DMATS had over 100 ambulances at their disposal, many brought in from distant locations.

With an estimated 1.8 million Americans and foreign nationals, working folks and dignitaries, overflowing streets and parks in the frigid city, it is miraculous that DC hospitals did not encounter more emergency admissions. Thirty children were separated from their families over the weekend. Good Samaritans brought them to police officials and all were safely returned to their families.

DCVAMC leaders took care to demonstrate their appreciation of staff hard at work during this historic weekend. Two of the three hospital shuttles serving metro stations remained in operation for their convenience. Meals were provided throughout the 24-hour shelter period. The canteen and retail store were open for business and even the Starbucks Cafe was making lattes and smoothies. A large flat-screen TV was moved into the atrium café so that staff and volunteers could watch the proceedings of the day together. And for those eager to keep their new year's resolutions, the hospital's Wellness Center was open for workouts (and showers).

VAMHCS, the VA Maryland Health Care System, supported DCVAMC by providing additional medical supplies well in advance of projected road closures. "VISN 5 facilities really pulled together, ensuring DCVAMC would be fully supported and operational throughout the weekend," remarked Fernando Rivera. "It's gratifying to be working with leaders and staff who can so quickly and efficiently determine needs and fulfill them."

DCVAMC has a well-trained Decontamination Team (DECON) and a well-equipped DECON Unit. The team was activated for Inauguration Day. In keeping with our Emergency Management Plan, equipment and clothing were inventoried in advance. All equipment repairs and/or replacements were dealt with prior to the weekend. A six-member DECON Training Unit comprised of VA employees from around the nation was called on to support the DC crew and to give them additional training.

Safety Officer, Nancy Lansing, had the lion's share of the logistics job for the medical center, as managing the Emergency Preparedness Program is one of her functions. "Preparing for this historic weekend was a monumental task. But, with the professionalism and commitment of our great staff, we were fully prepared and ready to take care of all veterans no matter what happened. I am proud to be a part of this team," says Lansing.

Coordinated Public Affairs is crucial in emergency situations. The DCVAMC Public Affairs staff always has a seat at the Emergency Command Center table. Employees were kept up-to-date on transportation, building security, access to supplies and the all-important meal schedule through email announcements, hardcopy fact sheets, and the medical center's intranet site.

The Public Affairs office was open 24/7 during the Martin Luther King, Jr. holiday and throughout Inauguration Day to keep "sheltered in place" staff informed and to deal with what could potentially have become a media event. Prior to the inauguration, Public Affairs staff worked with USA Today and the local CBS affiliate, WUSA9, to develop stories about OEF/OIF veterans participating in inauguration activities.

There was a very collegial spirit among the staff spending Inauguration Day together. They shared the pride of having an important mission – taking care of veterans who had traveled across the country to be in this place, at this time. There was a sense of being a part of history. A large group gathered in the atrium at about noon time and together in silence they stood to honor President Barack Obama and Vice-President Joseph Biden as they took their oaths of office. Even those in wheelchairs struggled to their feet. Some stifled cries and wiped away tears. Then they quietly dispersed to report back to their duty stations.