April 1999 Bulletin

St. Louis hospitals meet challenge of Pope's visit

Medical community organizes for demands from throngs, community

By Sandra Lee Breisch

When Pope John Paul II arrived in St. Louis, Mo. on Jan. 26, 1999, nearly 100,000 people awaited his presence inside the Trans World Dome and Cervantes Convention Center. The media touted it as the "largest crowd ever gathered at one time inside the facility," and "one of the largest indoor gatherings every held in the United States."

So, just how far in advance did the medical community in this town gear up for such an event?

"About three months ahead of time," says Timothy G. Buchman, MD, PhD, Chief, Burn, Trauma, Surgical Critical Care Section, Washington University School of Medicine at Washington University Medical Center. He said the city anticipated "between 500,000 to a million visitors" during the Pope's stay.

Because Barnes-Jewish Hospital, St. Louis Children's Hospital and the Washington University School of Medicine "developed an outstanding framework for the provisions of medical services and facilitating interactions among hospitals, there also was was no interruption of essential medical services for the community," notes Dr. Buchman.

Planning for such an event "isn't merely a question of extra staff, but how to effectively employ resources during an interval when the whole community is different," says Dr. Buchman. "It's redeployment. We didn't hire new nurses, we didn't lie-in for a month-long siege. We looked at how the operation ran and asked ourselves, 'In a situation where the hospital might be isolated from people and resources for a period of time, how would we go about meeting that challenge?'"

"We needed to make sure we had supplies and resources and to adapt to a different environment of a visiting head of state, other visiting dignitaries and the possibility that medical services might be required."

To give some dimension to the scope of this effort, Dr. Buchman says that Washington University School of Medicine "scaled up" to accommodate 1,000 emergency room visits a day, instead of the usual 200 emergency room visits. "The way we did that was by shifting appointment days for many of our clinic patients and taking over the adjacent outpatient clinic areas as potential patient care areas," he explains.

"We redesigned our patient administration and discharge structure. We created a command center that would allow us to keep track of beds and personnel available on a minute-to-minute basis. Part of it was computerized, but some of it had to do with understanding the flow of patients and that requires humans to anticipate."

"Everything ran very smoothly," explains Joseph Borrelli, MD, chief of orthopaedic trauma at the Washington University School of Medicine. "The number of cases we had was not overwhelming because we took the precaution of rescheduling clinic appointments for the two days the Pope was here. This allowed us to utilize our four senior residents for a stay in the two emergency rooms to provide adequate coverage."

Dr. Buchman also cited the joint efforts of the city and outlying towns. "We had an opportunity to bring together managers from all over our medical city who normally don't get together." They also set up "an informal communications link" with medical colleagues in Denver, Colo. who handled the Papal visit in 1995. Other factors working in their favor were the hospitals' experiences with handling large crowds at their annual health fairs.

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