In a simulation room at APL, the unthinkable is becoming real: A chemical tank explodes at Bayview Medical Center, contaminating a vital portion of the facility; a nuclear "dirty bomb" is detonated in downtown Baltimore, a scenario ripped right from the the summer's big-screen release The Sum of All Fears.
The architects and witnesses to these "desktop" calamities are a group of university and hospital administrators and APL staff singularly focused on one overriding question, the one that has echoed in the ear of James Zeller, a member of the university's Committee on Crisis Management and chair of the its Crisis Response Team for the past two and a half years: How would Hopkins respond to a major crisis?
The six-member CRT, formed in the spring of 1999, was created to manage the response to a crisis that would be outside the ability of an individual school or functional unit to handle, such as an outbreak of meningitis or a laboratory fire that destroys a campus building. The thinking went that Hopkins needed a controlled and coordinated response to a bottom-up crisis event, one that began within a school but needed a broader response.
But what happens in a top-down crisis, one that starts, perhaps, with events outside Johns Hopkins but immediately affects the university?
According to Zeller, the events of Sept. 11 have pushed crisis management planning at Hopkins into a whole new arena, creating an entirely new set of questions:
In a case where city, state and/or federal assistance is needed, who takes control of the situation? What role will Hopkins play in the management of a local disaster? How can the institution help to minimize the loss of human life and physical property following a critical event?
"We are looking at more top-down things now, events that we never even considered when we did our original risk assessments," said Zeller, associate provost for budgets and planning. "Three or four years ago, we were not thinking about dirty bombs, we were not thinking about anthrax, we were not thinking about smallpox. One of the major things that has changed in the past year is the explosion of risks that we are looking at."
In the wake of Sept. 11, a presidential steering committee created a mass-casualties task force on the medical campus. Not long after the task force began meeting, the anthrax outbreak occurred.
According to Edgar Roulhac, chair of the Committee on Crisis Management, it was the anthrax outbreak that served to expose both a strength and a weakness at Hopkins. The profusion of expertise the divisions displayed regarding bioterrorism attacks, both on the medical front and in policy planning, was unparalleled; the weakness, Roulhac said, was the absence of any single entity across the entire Johns Hopkins enterprise that could both plan for and coordinate the response to such a critical event.
To fill this void, out of the mass-casualties task force arose the Office of Critical Event Preparedness and Response. The new office, officially established on July 1, will be directed by Gabe Kelen, professor and director of Emergency Medicine at the School of Medicine.
CEPAR's main charge is to coordinate the enterprisewide response to a critical event--such as a major explosion or a smallpox outbreak--that is outside the capability of the CRT.
"Just as the CRT comes into play when the individual divisions just can't deal with an event, CEPAR deals with the even more unthinkable," Zeller said. "CRT cannot begin to handle this type of event because [the situation] is just so massive and requires health expertise and linkages to outside."
In the coming months, CEPAR will begin to develop response plans, policies and training programs for the entire Hopkins enterprise. The office, to be housed at 201 N. Charles St., will be staffed by two full-time employees "with significant resources added" from Emergency Medicine, APL and The Johns Hopkins Hospital.
James Scheulen, an administrator in Emergency Medicine and a member of both CEPAR and CRT, said that the new office will have an unprecedented authority in its ability to call upon any and all Hopkins entities, whether it be SAIS, the School of Medicine or Johns Hopkins Community Physicians.
"CEPAR is concerned with how best to utilize the expertise and manpower across the entire Hopkins enterprise in responding to an external event, such as a dirty bomb or smallpox outbreak," said Scheulen, who is also director of medical transportation at the hospital. "We also need to make sure our response is coordinated with any local, state or federal response to the same event."
Scheulen said that CEPAR and the CRT have had and will continue to have regular contact with those in external crisis response organizations, including the Federal Emergency Management Agency and the Maryland Emergency Management Agency.
While CEPAR represents a significant change in Hopkins' crisis response effort, it's not the only one.
Since Sept. 11, Zeller said, the main focus of his group has been to make sure that all divisions and operational units are self-sufficient so there is less of a need for CRT to intervene. To that end, divisions and units have been rolled into larger groups so as to consolidate expertise. For example, schools and centers on or near the Homewood campus now belong to the Greater Homewood subgroup, while the university divisions located in Washington, D.C., have been paired up with nearby Georgetown and George Mason universities.
"The CRT may not be able to get on I-95 to deal with a problem in D.C. in the case of an event; their response has to be self-contained," Zeller said.
In addition to the grouping, individual crisis management plans have been re-evaluated. Stored in a locked file cabinet are nearly two dozen plans--some of them long-standing and others quite recent--representing Hopkins entities ranging from the divisions on the Homewood and East Baltimore campuses to the Hopkins-Nanjing Center for Chinese and American Studies in China.
"These plans are reviewed annually and during the Committee on Crisis Management meetings. Throughout the year, we discuss ways in which to make the plans more effective and comprehensive," Zeller said. "We also continue to look at new risks that come to our attention and make sure that the plans accommodate newly identified potential events like the international tension issue between India and Pakistan."
To date, the CRT has been called into action about a half-dozen times. Zeller said that in each instance--whether it was a case of meningitis or an IT crisis--the CRT "parachuted in" expertise rather than activating the entire group. With larger threats on the horizon, Zeller said, that is the way the system should work.
"The fewer times the CRT is called in, that means we are doing our job because we are doing it up front," he said.
Roulhac said the massive ongoing crisis management effort at Hopkins should serve as a model for not only other higher education institutions but city, state and federal institutions as well.
"There are not a lot of institutions that have the breadth, depth and bulk of what we have in terms of intellectual capital," Roulhac said. "So we are going to do all we can to make sure that this capital stays on the Earth."
Roulhac added that while the past 10 months have been a whirlwind of activity for those working to safeguard Johns Hopkins, much more work lies ahead.
"This is an enormous issue in terms of planning and coordination. It is just so big that we are still learning," he said. "We have but one grain of sand in our hand taken from the shores of a mighty sea yet to be explored."