Rain poured on the fire-scarred mountainside, sending cascades of water, mud, massive boulders and uprooted trees toward the ocean — without regard for what, or who, was in the path.
It might sound like the start of a drill, but it became reality Jan. 9 for Santa Barbara Cottage Hospital staff who routinely train for treating people in mass casualty incidents, including disasters.
“I think the (key to) routine disaster planning is that you can’t necessarily design for every single possible scenario,” Steven Fellows, Cottage Health’s executive vice president and chief operating officer, told Noozhawk.
“However, you design for situations, and you then adjust what you do to that specific situation.”
After a busy Monday in the Emergency Department — it was the height of influenza season, after all — Tuesday began with a 4:45 a.m. call to Dr. Brett Wilson, Cottage Hospital’s director of emergency medicine, after responders started bringing in the first victims from the deadly Montecito flash flooding and debris flows.
Emergency management personnel reported receiving hundreds of 9-1-1 calls for help in the early morning hours.
“I think the most complicated and difficult part of a disaster scenario is one, the unknown, so you don’t really know how many victims you potentially are actually going to get,” Wilson said. “They don’t all come in by the same path.”
Some patients arrived by ambulance, others via private vehicles. A few were delivered by the Santa Barbara County Air Support Unit rescue helicopter operating so urgently that the pilot bypassed normal procedures of shutting down engines.
“In terms of disaster preparedness, we’re required to be ready for any kind of event,” Wilson said, adding that the hospital staff goes through several drills annually.
“At that point, it was time to activate our plan.”
Treating Patients Soaked in ‘Cesspool of Mud’
The Cottage Health disaster preparedness plan envisions all sorts of emergencies and resources required for any situation, such as a chemical spill at UC Santa Barbara with patients needing decontamination, or a plane crash with burn victims.
For the debris flows, medical staff saw patients with hypothermia and general blunt trauma injuries such as broken bones.
“As you can imagine, these poor people are getting hit by cannon balls,” Wilson said of the high-velocity boulders that swept through neighborhoods. “It’s unbelievable these people even survived, to be honest with you, the ones we got.”
The list of injuries included two burn victims rescued from a house fire sparked by a broken gas line.
One burn patient was transferred to the Grossman Burn Center in West Hills, with the other cared for at Cottage Hospital.
With freezing cold weather and some people trapped for hours, doctors and nurses worked to carefully free patients from mud that cloaked them head to toe and to warm them up while treating trauma.
“That was the next challenge,” Wilson said. “You have to delicately get these people out of their cold, hypothermic exposure and treat their trauma, and treat whatever else because you’ve got kids, you’ve got elderly and everybody in between.
“They’ve got their own cadre of medical issues on top of being dragged through the streets of Montecito for X number of miles until somebody rescued them. That was really the challenge.”
Previous disaster drills let doctors know what resources they had, such as showers in the event of chemical containment.
“That’s the beauty of the training,” Wilson said, noting that the mud had mixed septic, ash, poison oak and other unknown substances.
“It was a cesspool of mud, so from our perspective it was just as toxic as getting something off a train car. We tried to hose them down as best we could, and we have resources to do that.”
Between its Santa Barbara and Goleta Valley hospitals, the Cottage Health system saw 28 patients related to the Montecito disaster.
“We’re thankful that everybody who came in as a patient was discharged, which was pretty miraculous for a few of those,” Wilson said.
The timing of the disaster meant extending the night shift crew — all staff members were willing to stay — as the day shift crew arrived. From physicians to support staff, those who heard about the incident showed up to help.
“I think the thing that I was most proud of was the way in which everyone in the hospital just automatically responded to the need,” Fellows said. “It was a beautiful orchestration of well-defined, well-trained staff who just instinctively knew what to do.”
Cottage Hospital also recognizes that the trauma isn’t over for many people in the community, with its How We Heal series offering trauma and anxiety support groups for free during the next year. For more information or to register, call 805.569.7501 or email howweheal@sbch.org.
Coping with Highway 101 Closure
Cottage Hospital’s challenges didn’t end after the influx of patients slowed.
The flooding and mud flows surged onto Highway 101, burying a large swath of the freeway for almost two weeks. The closure blocked normal commuter traffic between Santa Barbara and Ventura County, and even Carpinteria, forcing implementation of another section of the disaster plan.
From its own incident command, which didn’t stop meeting until the highway reopened Jan. 21, Santa Barbara Cottage Hospital managed staffing issues, resource requirements, employee transportation, housing accommodations and more while also communicating with Santa Barbara County emergency management representatives.
About 25 percent of the nursing staff lives east of the highway closure, so hospital administrators focused on making sure Cottage had the staff needed to care for patients.
“We had to find a way to get the employees from the other side of the road closure to the hospitals — both Santa Barbara and Goleta,” Fellows said.
At a news conference, Cottage Health president and CEO Ronald Werft mentioned to California Highway Patrol Capt. Cindy Pontes the struggles of getting staff to Santa Barbara from the other side of the closure. That comment prompted a caravan of vehicles escorted by CHP officers to Cottage from Carpinteria, taking a winding route on back roads and surface streets.
“We did that for two weeks,” Fellows said.
Despite the stressful times, he said, one CHP officer delivered a joke daily to staff.
“As corny as the jokes were, he had a joke for the staff every morning, and every day he thanked the staff for the privilege of being able to escort them to work,” Fellows said.
Santa Barbara Airbus helped transport employees from the Santa Barbara Harbor — after Island Packers and Condor Express ferried employees by boat between Ventura and Santa Barbara, set up through memorandums of understanding in anticipation of the need during a disaster.
Other employees traveled by train between Ventura County and Santa Barbara. For the first two days, employees arrived via a chartered Gulfstream jet that traveled between the Oxnard and Santa Barbara airports.
“We worked with our staff, and we actually were almost a mini travel agency,” Fellows recalled.
One employee at the Cottage Outpatient Surgery Center was so determined to get to work that she walked through the mud after her vehicle got stuck in the debris flow on Jan. 9.
At one point, Cottage housed up to 220 employees a night all over the South Coast. Some slept in an empty patient care unit at the Goleta Valley hospital. Some stayed in hotels and motels. About 50 others stayed in fellow employees’ homes.
The hospital used Survey Monkey to help identify those in need of housing or transportation during the emergency.
“We knew when every mode of transportation was coming or going throughout that two-week period,” Fellows said, adding that sea sick-susceptible employees were provided ground transportation.
Months after the disaster, the numbers are staggering for logistical measures. There were 4,000 transports by train, plane, van and boat. Nights of housing for staff topped 900.
In addition, most supplies, food, medicine, diesel for generators and more come via Highway 1 from Southern California, requiring a detour to access Santa Barbara from the north.
“We’re very in tune of how vulnerable we are because of our geography,” Wilson said.
Cottage has emergency response plans and equipment in place at the Santa Barbara and Goleta campuses since outside aid can take at least 96 hours. Emergency generators can run 24/7 for five days without refueling. Diesel providers are lined up to bring fuel and water tanks on site — two 40,000-gallon tanks will supply 96 hours’ worth of water.
“We can run the entire hospital operation pretty much independently for easily four days,” Fellows said.
A debriefing after Highway 101 reopened brought few recommendations for improvements, he noted.
One question asked what the hospital would have done if Highway 101 closed in both directions and a wreck closed Highway 154.
“The answer was, we would have done exactly what we did,” Fellows said.
Throughout his hospital administration career, Fellows has seen colleagues respond to assorted disasters. He founded himself reflecting on that while watching Cottage staff in the aftermath of the Montecito catastrophe.
“It was probably one of the most amazing experiences of my life, just seeing how everyone knew what to do,” he said.
“I’ve been through floods, earthquakes, tornadoes and fires, and this was probably one of the most challenging to go through.”
— Noozhawk North County editor Janene Scully can be reached at jscully@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.