If anyone needs 200 urinals in a hurry, Jan Koegler is on it.
Koegler and John Eaglesham spend their days planning for every aspect of the medical system’s response to a local disaster, as heads of Santa Barbara County Emergency Medical Services.
The county Public Health Department’s EMS manages the medical system’s response to mass-casualty incidents, large-scale disasters and evacuations of vulnerable populations such as assisted-living or skilled-nursing facility residents, as it did during Santa Barbara’s Jesusita Fire in 2009.
| Emergency Preparedness 2017 | Complete Series Index |
The county Office of Emergency Management has an Emergency Operations Center at 4408 Cathedral Oaks Road, and EMS has its departmental emergency operations center in the auditorium of the building at 300 San Antonio Road.
Planning for every contingency, Koegler and Eaglesham have an alternative location in case of earthquake — because the old building may not be standing after a big one.
Once the Emergency Operations Center is running, EMS checks in with local health-care providers to determine their status and field requests for supplies or staff, which can be sent up the chain to the county EOC.
“Partnerships are set up ahead of time, so everybody knows everybody,” said Eaglesham, director of Emergency Medical Services. “In a disaster, you just start making phone calls.”
Through the disaster health-care coalition, Koegler works on regular drills and response plans with hospitals, clinics, skilled-nursing facilities, assisted-living, home- and hospice-care agencies, dialysis providers and others, so when an emergency hits, the health-care system has a coordinated response.
“Fortunately, or unfortunately, we’ve been through enough fires and evacuations that we’ve gotten better at it, because of our hazards,” said Koegler, program manager for the Public Health Department’s emergency preparedness.
The coalition started about 10 years ago, and agencies conduct a hazard-vulnerability analysis that they incorporate into their own plans.
Possible hazards include wildfires, earthquakes, flooding, tsunamis, hazardous materials incidents, nuclear power plant incidents, dam failure and communicable disease incidents.
EMS Medical Shelters, Field Treatment Sites
Not everyone who is evacuated during a disaster can stay in a so-called general population American Red Cross shelter on a cot, but they don’t need a hospital bed — so EMS opens medical shelters for vulnerable populations such as seniors and disabled residents.
During the Jesusita Fire evacuation, about 80 skilled-nursing facility patients were evacuated and placed all over the county, including Santa Barbara Cottage Hospital, Goleta Valley Cottage Hospital and the Comprehensive Care Center at Lompoc Valley Medical Center.
“They moved three times in 12 hours,” Koegler said.
The county has been working with long-term care facilities so the evacuation plan is not to have to go to a hospital in the future.
There are EMS caches of medical supplies and staff trainings in Lompoc, Santa Barbara and Santa Maria in case one area is cut off — a likely scenario that happened with the 2005 La Conchita mudslide, floods and wildfires causing closures of Highway 101, the main route through the county.
After a large disaster such as an earthquake, many people would likely be in Red Cross shelters, medical shelters and camping outside to avoid damaged buildings, Koegler said.
Building inspectors would evaluate structures, but the process could take days or weeks, so EMS also plans for potential health consequences of tent cities.
“Is there water there, is there sewage there, do we need to get port-a-potties out to neighborhoods, is there an infectious disease outbreak happening?” Koegler asked.
EMS would mobilize field treatment sites where people are already gathering, to help those with minor injuries and keep people from inundating local emergency departments, Eaglesham said.
He said they could set up something at Oak Park in Santa Barbara, for example, if people are going to the area of Cottage Hospital anyway.
The logistics for a field treatment site are extensive, with plans for bathrooms, security and translators to communicate with non-English speakers.
A lot of that help would come from the many disaster response volunteer groups in the county, which include VOAD (Voluntary Organizations Active in Disaster), Medical Reserve Corps, the American Red Cross of Central California-Pacific Coast Chapter, the Amateur Radio Emergency Service, the Community Emergency Response Team (CERT) program, and Listos, a disaster preparedness program tailored to Spanish-speaking communities.
The plan, in the case of earthquake, would be to evaluate health-care facilities and funnel that information to the EOC, and then tackle the emergency medical services side with medical shelters and evacuation shelters.
The process wouldn’t be as smooth in reality as it is on paper and in drills, Koegler noted.
“In an earthquake, there is going to be a delay,” she said.
“Can you get into a building? Are your radios working? You can send a runner to see what the status is. The process of responding could be slow, and we need all the partners to be really aware of that, to be prepared to be on their own and take care of their own until there are resources to help them.”
That’s why everyone involved in disaster planning will emphasize personal preparedness — providing for yourself and your family for three to five days.
Everyone should have personal supplies of food, water (one gallon per person, per day), a week’s worth of medications, extra clothing, copies of important documents and more. Click here for a guide to building an emergency supply kit.
People on oxygen should have bottle backups and emergency power in case of outages, and EMS officials noted that most bottle vendors aren’t local. Hospitals can’t fill oxygen bottles, either.
It’s important to understand potable water is not one of the supplies EMS has stored and cached all over the county.
“We don’t have water,” Koegler said. “We have water for our department operation center, but we don’t have water for our field operations.
“We have some cases but not days’ worth. Not at all. So that would be a resource request.”
How Hospitals Prepare for Large-Scale Emergencies
California hospitals are required to have several days of water and food on hand, as well as supplies and generators as a backup power system.
“It’s going to be those granola bars for a couple days, folks, but nobody’s going to die without food,” said Jim White, safety officer for Lompoc Valley Medical Center.
The center’s generator can run four days before it requires fuel, he added.
Santa Barbara Cottage Hospital can mobilize the emergency department for more than three trauma cases at a time (like a car accident) or the entire hospital for a “code triage,” which can mean activating the incident command, engineering, logistics and nutrition teams, to name a few.
During a mass-casualty incident such as a plane crash, which agencies practiced in airport drills last year, patients are triaged at the scene as immediate, delayed or minor injury cases.
Hospitals have “surge tents” and equipment to handle extra capacity and use a variety of communications systems to call staff in when needed.
Cottage Health, which includes Santa Barbara, Goleta and Santa Ynez hospitals, encourages its employees to have personal preparedness plans.
“They have their home plans together for child care and what not, because obviously we want them to work,” said Susanna Shaw, Cottage Health’s director of environmental safety and security.
Many Cottage Health employees live out of the area, so they also prepare for the possibility of being stuck away from home, she said.
Lompoc Valley Medical Center has plans for a day-care center during emergencies so staff can come into work with peace of mind, White said.
Shaw said Santa Barbara Cottage Hospital, at 400 W. Pueblo St., which is still undergoing construction, is earthquake-safe up to a magnitude 7.0.
Hospitals have “red outlets” that indicate the electrical sockets are connected to emergency backup power. During a major outage, generators will keep the hospital’s red outlets going, powering emergency rooms, critical care, IT infrastructure and emergency lighting.
The hospital maintains a three-day inventory of supplies and has agreements with its food vendors to feed its patients and employees, including a stock of “wonderfully tasty MREs,” Shaw said.
“It’s always been the key when we have disasters in the past, relationship building,” she said of hospital vendors. “The ones you use on a day-to-day basis are the ones who come through.”
Hospitals are not meant to be a refuge for the entire community during a disaster, Shaw said.
“To keep scarce supplies, we will go on lockdown in our lobbies to make sure we don’t have a huge influx of community members just coming here for safe haven,” she said.
“We don’t have the food and water to maintain the whole community. We need to maintain our resources for our patients, their dedicated family member and employees.”
Santa Barbara Cottage Hospital did lock down during the Jesusita Fire, securing entry points to keep people out. The fire happened around the same time the hospital changed its rules to restrict visitors after an infant-abduction case in early 2009.
“It was a huge shift in the community that we’re not 24-hour, open door,” Shaw said. “We are 24-hour access but restricted to those family members or those seeking medical care.
“We all have to take our own preparedness seriously.”
Hospitals plan to support themselves for several days, and new accreditation standards push for 96 hours of self-sufficiency, a higher level than before, Shaw said.
“With the state, it has always been 72 hours, but after disasters nationwide and Hurricane Katrina, now even FEMA pushed it out,” she said.
“I think they’re realizing it’s not easy for them to deploy resources and get them there for you, and are advocating a bit longer (to be self-sufficient).”
During a mass-casualty “surge event,” the Lompoc Valley Medical Center works with the county, city and the Lompoc Fire Department to set up a triage environment to take the “more ambulatory patients” and allow the hospital to deal with the severe cases, White said.
“In our preparations, some of the most important elements in preparedness and practice are to allow our staff to do things they normally wouldn’t do,” he said. “For example, in a mass-casualty incident, maintenance people could be helping to do things, so that’s what we drill on, putting people outside their comfort zone.”
Elective surgeries are canceled and patients who could be discharged are sent home, if they have homes to go to, he said.
LVMC, at 1515 E. Ocean Ave., has nearby facilities that can take patients, including its Comprehensive Care Center and Champion Center, an addiction and treatment site.
The most recent mobilization scare — and threat of evacuating the hospital — came during the Miguelito Canyon Fire in 2014.
“When that fire reached the crest of the mountains to the south of Lompoc, we considered … it was still a ways away but we started to consider evacuating the hospital,” White recalled. “We wanted to be ahead of the game, not thinking about it when the fire was coming down the hill.
“We looked at where we’d go and worked with schools, transportation. We were lucky that winds shifted and the fire went south, so nothing happened.”
State Senate Bill 1953 required new earthquake-safety standards for hospitals, and Lompoc voters approved a bond to fund the new hospital, which was built in 2010.
“If the earth were to shake, it’s probably the strongest earthquake building in the valley,” White said.
Hospitals have vulnerability assessments to determine the likelihood of particular disasters, and a Bradbury Dam breach up the Santa Ynez River at Lake Cachuma is on Lompoc’s list of possible hazards.
White said the hospital worked with the county and the Federal Emergency Management Agency to select a safe place for the new facility.
“If Cachuma was full and Bradbury breached, and water came rushing down, it would take an hour or hour and a half to get to Lompoc,” he said. “So we placed the hospital where, even with that, the highest inundation of water, the hospital would still not be wet.”
In a localized disaster, Lompoc would ask Marian Regional Medical Center in Santa Maria or another hospital for supplies and help, and do the same if they asked, White said.
Hospitals also have agreements set up with their vendors to get equipment and supplies delivered and can “go out borrowing and buying,” he added.
A unique threat to Marian Regional Medical Center would be an incident at the Diablo Canyon Nuclear Power Plant in Avila Beach — although the plant is in the process of shutting down.
Marian, at 1400 E. Church St. in Santa Maria, is part of San Francisco-based Dignity Health, which means it can request staff and supplies from sister locations nearby — such as Arroyo Grande Community Hospital — or even the corporate level during an emergency, said Lisa Abeloe, the trauma program manager and disaster preparedness expert.
Incident command has the highest ranking person at the hospital take charge, and employees do drills at all times of the day so different people become accustomed to the role, Abeloe said.
“In all of our planning, it’s really important to be adaptable to any type of situation that may come up and really be there for the community,” she said.
“We all work very closely with the disaster health-care coalition. We share each others’ policies, capabilities. It’s really encouraging that if something were to happen we’d definitely be able to help each other out.”
Critical Role of Communication
Communication is how EMS and health-care facilities organize their disaster response, and they train intensely on the subject.
“Communication is one of the hardest but most important things during a live event or exercise,” White said.
EMS has Internet and phone communications in addition to its satellite phones and 800-megahertz radios that can reach anywhere in the county. The satellite phone does not work as advertised on Jurassic Park — it doesn’t always get a signal, Koegler and Eaglesham noted.
“We have monthly drills, so in a disaster people will know they have at least three or four redundant ways of communicating,” Eaglesham said.
Then there are the Amateur Radio Emergency Services folks: They know to deploy to the EMS emergency operation center during a communication outage, and they’ll be dispatched to hospitals and clinic sites so EMS can get facility status updates, Eaglesham said.
“Those people, they’re all volunteers but they’re going to save us in a disaster,” he said. “If it’s really, really bad, they’re going to be very important.”
| Emergency Preparedness 2017 | Complete Series Index |
— Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.