It was a weekday morning like any other at United Hospital in St. Paul. Then the wounded began staggering in. A dirty bomb had gone off at a big event nearby.

Medical personnel scrambled to set up decontamination showers in an ambulance garage. Others donned head-to-toe hazardous materials protection suits. Pagers beeped madly as doctors and nurses rushed to help victims.

Luckily, none of it was real. It was just the latest drill by metro hospitals in more than a year of preparation for medical calamities in advance of the Republican National Convention, which comes to the Twin Cities Sept. 1 to 4.

In many ways, Minneapolis and St. Paul have never been more prepared. Like most U.S. cities, the Sept. 11, 2001, terrorist attacks were a wake-up call that spurred significant disaster planning. Then there was the Aug. 1 collapse of the Interstate 35W bridge, when emergency services and hospitals won kudos for their prompt responses.

"Compared to [emergency preparedness] 20 years ago," said Rick Huston, director of operations at Regions Hospital in St. Paul, "it's like night and day."

Unlike hotels, bars and restaurants, hospitals aren't exactly publicizing these services or dangling deals for convention attendees.

But they're doing just as much to gear up for an expected surge in clients because of the sheer number of visitors headed to the Twin Cities. These could be people coming into urgent care with something as simple as a sprained ankle, tear-gassed protesters, or -- in a worst-case scenario -- victims of a full-blown terrorist attack.

"We're prepared and ready to go if needed," said David Miller, vice president of operations at United Hospital, "though we're feeling sure we're not going to be needed very much."

Lessons from Katrina, 9/11

On a recent day, Rick Gammell sat in a darkened room before four computer monitors at the east metro emergency services control center at Regions Hospital (the west metro equivalent is at Hennepin County Medical Center).

The Web-based system tracks patients and hospital bed availability around the metro area. In a medical emergency, it becomes the nerve center for metro hospitals, pinpointing the locations of victims and alerting hospitals to glitches in the system. It was tested during the Hugo tornado in May and now operates around the clock.

Gammell took a call about a female patient being transferred from an east metro nursing home to a south metro hospital. He posted information about a CT scanner that was down momentarily.

The MnTrac command centers are an outgrowth of the Metropolitan Hospital Compact, formed several years ago when Twin Cities hospitals decided to coordinate planning and jointly buy emergency supplies. After Sept. 11, 2001, federal regulators required hospitals to hold drills to test different scenarios. That happens now whether there's a big convention coming to town or not.

After Hurricane Katrina in August 2005, regulators added more requirements. Hospitals must now be self-sufficient for 96 hours after an event occurs, with enough food, medical supplies, linens and generators to care for patients.

Two years ago, the Metropolitan Hospital Compact bought special filtration masks that keep out even tiny particles. Last year, it was ham radios to use in case phone networks go down and Geiger counters to detect radioactivity. That year, metro hospitals drilled for a major biological disaster -- a feigned plague outbreak at the Metrodome.

This year, the compact is buying a big semitrailer truck to convert into an emergency department on wheels that will arrive before the GOP convention.

At the command center, Gammell will get a little more company. During the convention, the number of operators will go from two to three during the day and from one to two at night.

"We're hoping for a peaceful week and planning for a not-peaceful week," Gammell said.

The devil's in the details

Hospitals may be better prepared than ever, but that doesn't mean the recent drills went without a hitch.

Over two days, May 9 and June 26, all area hospitals took part in mock scenarios in which a bomb went off at an event.

"It went really slick," said Katherine Grimm, director of emergency preparedness for Healtheast, which owns St. Joseph's Hospital in St. Paul. But she added: "The devil is in the details."

For example, after medical personnel were suited up, they found they couldn't be heard. That showed Grimm that the hospital needed better signs, so workers could simply point to signs that read, for example, "Shower Here."

At North Memorial Medical Center in Robbinsdale, staff members realized that they needed to place Geiger counters closer to the decontamination facility for quicker retrieval, said Kris Kaus, the center's emergency management coordinator.

As several hospitals found, pagers can get overloaded in the heat of the moment.

"There were so many people paging it was hard to read all the messages coming over the pagers," said Miller of United Hospital. United is now prepared to switch to two-way radios in an emergency.

Some of the chaos was intentional.

"It's an opportunity to make sure we're prepared," said Dr. John Hick, head of emergency preparedness for Hennepin County Medical Center. "Not because we expect something to happen ... but if it does ... we're not testing it in the heat of an incident."

At North Memorial, actors in the June drill first played victims, then pretended to be frantic family members showing up at the hospital. They were whisked away in a shuttle bus to a makeshift family center a block away, where hospital staff consulted MnTrac to help them locate their kin.

In an attempt to get a metro-wide, systemic view of emerging health problems, the Minnesota Department of Health has asked hospitals to ask every patient if they are part of the convention and to report in three or four times a day to see whether there are patterns with the maladies.

United and St. Joseph's hospitals are a couple of blocks from the Xcel Energy Center in St. Paul, where the Republicans are gathering. Regions Hospital is a mile and a half away. But there are numerous gatherings planned around the Twin Cities, so all 29 metro hospitals have joined the preparations.

They've made plans to staff up and have tested communications systems. They've updated staff phone lists and made sure that employees have maps of alternative routes in case roads are closed.

Toting up the capacity of the convention center, the number of media people involved and the number of anticipated protesters, Huston, the Regions operations director, reckons 50,000 to 100,000 people will descend on the Twin Cities for the event.

For Regions, that could translate to a 30 to 40 percent bump -- or 45 to 60 additional patients a day. It has plans to open a second, makeshift emergency room if needed.

"All the hospitals are taking this very seriously," said Carol Risdal, safety officer at the University of Minnesota Medical Center, Fairview. "We in the Twin Cities are going to be in the spotlight. We don't want to fail."

Staff writer Maura Lerner contributed to this report. Chen May Yee • 612-673-7434