During the Cold War there was the "Red Phone," which actually was black in color, but it linked the presidents of the United States and the Soviet Union 24 hours a day, seven days a week.

All either side had to do, in case of emergency, was pick up the receiver and a telephone at the other end of the line would ring.

Butler Memorial Hospital and the Butler County Emergency Management Center have a similar telephone, but these organizations actually like each other and want to work together for the good of Butler County residents.

Mark Edwards, the hospital's risk manager, and John Spryn, the hospital's emergency management specialist, said when there is a major fire or other disaster, such as the extensive flooding in September, the county's dispatch center stays in touch with the hospital via this emergency telephone.

"It directly links us with the 911 center so that we can remain updated on what is going on where in the county. We can also tell the center about conditions here at the hospital," Spryn explained.

While the hospital's emergency department is always prepared for the everyday disasters of car wrecks, flu season and Friday night fights, it is the unknown disasters for which emergency personnel, including the hospital staff, train together.

"Bio-terrorism is the thing we are preparing for," Spryn said.

Its tough preparing for an unknown, undefinable, unthinkable attack, but that's what Edwards and Spryn have been working on since Sept. 11, 2001.

"We have always trained for train wrecks in the train yard (just below the hospital near the Route 38/68/422 intersection)," Edwards explained.

If there was train accident, fumes from the accident could get into the hospital.

"The hospital's ventilation systems pull air in from the outside," Edwards said.

"Every fall, when people burn leaves in the neighborhood, you can sometimes smell the smoke inside the building, so bio-terrorism is something we are working on here," he added.Spryn said the stability of the utility systems that keep the hospital functioning are of major concern if there is a major disaster. That is something they have always maintained to perform in case of emergency."We have the generators in place to keep water moving, the heating and air condition systems working, the elevators, telephones and computers up and running," he said.In the case of the electrical blackout that hit much of the Northeastern United States during the summer of 2003, Spryn said if Butler County had lost power, "doctors in the operating rooms wouldn't have even known it." He pointed out the hospital's generators are designed to provide continuous service for operating rooms, critical care units and the emergency department."We would be fine for a number of hours, but if an emergency would last for an extended period of time, we could have a problem," Edwards said.In the event of a disaster or emergency, Spryn said, the hospital's biggest problem would be people fleeing the area of the disaster to the hospital."For some reason, when there is a disaster, healthy people run to the emergency room," Edwards said.He noted this topic is discussed during the monthly meetings of the Metro Medical Response System, which brings personnel from Pittsburgh area hospitals together to discuss emergency preparation.For example, Edwards said that shortly after the 2001 terrorist attacks in New York City and Arlington, Va., there were several faux, but high profile anthrax attacks. A woman in Butler County found a white powder in her laptop computer and immediately came to the hospital emergency room."It turned out a battery had exploded in her computer," Edwards said. But that's what people do in those situations - they come to the emergency department."Educating the public about how to use hospitals' emergency departments and who should go there is a priority action this year for the hospital and the metro response system, Spryn said."When these emergencies happen, 60 to 80 percent of the people who come to the emergency department are the walking well, so we need to educate people that coming to the hospital is not in their best interest or the interest of the hospital," Spryn said.

<B>Who uses it</B>The ages of patients who showed up at Butler Memorial Hospital's emergency department from Jan. 1 to Dec. 31, 2004 were:0 to 15 years - 6,20016 to 62 years - 21,439Older than 62 years - 8,500Total visits - 36,139

2001-02 - 36,0512002-03 - 36,3402003-04 - 37,162

December through March is the busiest period with the flu seasonThe summer months are the second busiest period with outside activitiesMonday and Thursday evenings on the 3 to 11 p.m. shift are the busiest days.

Here are the top 20 reasons patients give for going to the emergency department.1. Chest pain2. Abdominal pain3. Cough4. Pain in limb5. Lower leg sprain6. Fever7. Backache8. Open finger wound9. Sore throat10. Shortness of breath11. Respiratory abnormality12. Headache13. Dizziness14. Earache15. Joint pain in shoulder16. Rash17. Nausea with vomiting18. Toothache19. Head injury20. Lethargy

Here are the top 20 diagnosis after examination in the emergency department.1. Bronchitis2. Open finger wound3. Neck sprain4. Chest pains5. Urinary tract infection6. Ankle sprain7. Pneumonia8. Abdominal pain9. Contusions10. Back sprain11. Sinus infections12. Ear infections13. Viral infections14. Inflammation of the throat15. Gastroenteritis or inflammation of the bowels or stomach16. Sprain of legs or knees17. Headache18. Asthma19. Fever20. Kidney stone

44 nurses10 doctors13 medicsSource: Butler Memorial Hospital