Manhunt Medicine

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Alice Hyde Medical Center in Northern New York was thrown into action when two convicted murderers escaped from a nearby maximum security prison.

The Clinton Correctional Facility is a maximum security prison in far upstate New York, 30 miles from the Canadian border and 15 miles from where I live. On June 9th, two inmate Clinton inmates made national news by successfully staging an escape that involved hacksawing through a steel wall and ended with a yellow Post-It note scrawled with “Have a nice day” and a smiley face.

I work at Alice Hyde Medical Center in Malone, New York, 38 miles from Clinton Correctional, and as time wore on and more officers poured into town searching for the inmates, the media response intensified. When more than 1000 law enforcement personnel were searching the area, we realized that there was a potential for a media storm if the escapees came to our facility, and a potential for a mass casualty incident (MCI) should a fire fight occur.

Alice Hyde went into planning mode. As the ED medical director, I did have some experience planning for an MCI – I’d spent a year at Mcmurdo Station in Antarctica – but nothing prepared me for this. We would potentially be caring for patients who were the subject of the largest manhunt in New York state history. Our contingencies considered not just one or two prisoners with traumatic or exposure injuries, but any number of law enforcement personnel with injuries as well. We also needed to control any media response and prevent internal security leaks such as an employee posting to social media. In addition to the usual HIPPA concerns, there was a concern for the prisoners’ security as well.

We started meeting together with all hospital departments present. Since we are a small rural hospital without a security department, Facilities was in charge of setting a perimeter and rules for passage were established. Our EMS director fostered close communication with the Certified Emergency Response Team (CERT) director so that we would have immediate notification of any transports to the ED. The communications director emailed all employees to remind them of their privacy responsibilities, and the surgery and ED teams coordinated to be able to provide emergency trauma or non traumatic care in the ED, PACU, or Ambulatory Care Units. Resources were analyzed and staff were advised of our potential patient care options. The risk of running a trauma outside of the ED where the staff were unfamiliar with the location of supplies was weighed against the potential benefit of having a more easily secured patient care area. Lastly, we reviewed hospital policies and bylaws to ensure that, should we invoke our contingency plans in response to an emergency, later scrutiny would not reveal that we were in violation.

The nurse manager and I advised staff on each shift daily that the final decision of where to treat patients lay with the ED physician in conjunction with the ED charge RN. We notified our consultants on call of our plan, and we decided that the hospital would go into Internal Disaster mode if a prisoner or law enforcement personnel were brought in with an injury. With the calling of an internal disaster, additional ICU and physician staff would automatically report to the ED for assistance managing existing and new ED patients as well as any manhunt victims. During planning I even found out that there is a red button in the ED, which, when pushed, causes every door in the hospital to close and lock!

The ED stayed on high alert as the manhunt continued and intensified after the first escaped prisoner was shot and killed. Patient visits increased as law enforcement personnel, working very long days and searching through extremely difficult terrain, came into the ED with injuries and illnesses. Finally, four days later in the afternoon of a sunny Sunday in Malone, David Sweat, the second prisoner, was shot and transported to the Alice Hyde Emergency Department.

A code Orange, Internal Disaster, was called, as the word of the shooting spread through town at lightning speed. Sweat was shot in a field, in full view of several homes, and social media lit up instantly. But as the local crowds approached the ED, the swift response and excellent coordination between law enforcement and our hospital staff immediately secured the roads to the ED. Screens were set up in the ambulance bay to protect the arrival of the patient from prying eyes and cameras. The charge nurse and ED physician discharged non-emergent patients and admitted patients were swept to the floor. Our internal medicine physicians responded to assist with medical screening exams, specialists including surgery and ortho arrived immediately, and the charge nurse gave specified assignments to each nurse.

Law enforcement personnel exceeded medical personnel by a huge margin, but remained helpful and at a respectful distance as the “golden hour” of trauma care was provided. For me, it was an ethereal experience, for we had been told for three weeks how dangerous the escapees were and had seen their faces on TV and in the papers so much that it was something like seeing a mythological creature. My lifestyle had been curtailed by fear of this man – I had felt frightened walking my dogs at night and had not gone hiking for nearly a month because of repeated warnings that he was “armed and considered extremely dangerous.” Yet here he was, as any other patient would be, in pain and possibly frightened himself.

Fortunately, we are blessed with excellent consultants and ancillary services, and Mr. Sweat’s care was as good as that given at any of the major academic centers where I have worked. We all had a heighted sense of concern for the medical record, as we were aware that his care was likely to enjoy particularly intense scrutiny. Weather conditions conspired against us, but Mr. Sweat was safely transported to Albany Medical Center, our closest level 1 trauma center in New York (with a nearly 3 hour transport time). As always in a rural hospital, we weighed the risks and benefits of immediate transfer versus more diagnostic and therapeutic care in our ED, and I believe that the right balance was achieved.

I am extremely grateful to the law enforcement personnel who endured difficult conditions in the area surrounding Malone and for their successful protection of our community. I am also very proud of my hospital’s organization and planning, and I know that the care we put into anticipating that moment helped it manifest in a way that provided excellent care for Mr. Sweat and for the other ED patients (wouldn’t you know it, a motor vehicle accident with multiple victims happened at the same time), as well as ensuring the security of the patient’s subsequent transfer. We were asked to not make a statement to the press to keep the situation as quiet as possible, so this is my props to the medical team at Alice Hyde, a community hospital that routinely delivers top notch trauma care—mostly out of the limelight, but occasionally right in the middle of it!

ABOUT THE AUTHOR

Keri Gardner, MD, MPH, FACEP is the Emergency Department Medical Director at Alice Hyde Medical Center in Malone, NY and the Chief Medical Officer for NES Health.

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