DATE WITH DISASTER

[Music] this is a hospital it has a disaster plan so does this one and this one and so did this one [Music] the cold facts of a disaster are that no hospital of any size or type of service or geographic location can safely say that the plan it has for what it will do in the next disaster will be adequate new bergen new jersey chicago [Music] gulfport mississippi new york city los angeles every community can and very probably will someday come face to face with its own date with disaster the police department has advised that a major portion of the san fernando valley is to be evacuated between these boundaries [Music] this community had a recent date with disaster but before that date the steps had been started toward a multi-hospital disaster plan in every community someone has to take the initiative the mayor or a red cross director the local medical association or a single hospital administrator in this community it was a doctor a pediatrician director of outpatient services for children's hospital of los angeles he wrote a letter to the administrator and medical staff disaster chairman at four neighboring hospitals you are urgently requested to attend a meeting of representatives from blue cross children's kaiser cedars and hollywood presbyterian hospitals to discuss matters of serious and mutual concern regarding preparations for the management of mass casualties that might result from any environmental community disaster the meeting has been scheduled with the expectation that all five institutions will send a senior administrator and the disaster committee chairman so the topics of both administrative and medical concern may be identified and appropriate follow-up action initiated one of the reasons we're here together is i think to discuss our mutual concerns over disaster planning perhaps have some tie-in or some arrangement where we can supply each other with personnel supplies um well i'd like to hear some of your concerns that you have so that we don't work independently of one another well i would say he would need community support acting as a group with other agencies having input to this whole problem now blue cross is represented because of our working relationships with them and they have a large organized administrative backup which i think we could put to use jay what about this kind of supportive action i think that we can lend you to the whole project this is where we can benefit most personnel the dialogue has been established regular one-hour meetings of the committee are held monthly and both the files and the committee grow as problems are identified communications control center and command post inventory security and traffic control this is what we must concentrate on communications the doctor said and control center the line of authority gap between government which has the authority and voluntary agencies which have the capacity will have to be bridged and representatives of other community agencies are marshalled to help solve them thus the resources of much of southern california become committed to a multi-hospital disaster response we could use an assist on as well as some of the record keeping of the movement of patients through the whole program would be very beneficial to us this is the grassy eye rule between ourselves our various institutions certainly communications is our main problem we can't do anything we can't communicate with one another one thing that's been we need to know is situations with the other hospitals so that we can either ask for help or lend assistance when necessary i think that's true yes well we also have to have some means of getting messages in and out of the hospital especially if the telephone lines are jammed or down because of any kind of disaster situation yeah i think the list of things that we might need to communicate is almost endless if you're going to keep your hospitals functioning effectively what about communications with the police department i believe the communications with us would be helpful but it appears to me that what you need is an inter hospital communication system amongst themselves i feel that you should have a system into which we can link where we can talk to one another primarily for medical problems and then if we need your support you can link into this yes sir that's correct yeah so what we're talking about probably is a basic inter-hospital network uh with communication somehow with law enforcement with fire rescue ambulance this kind of thing and even involve red cross and other resources that are around well it seems to me that if we're talking about hospitals and an inner system and a network of this nature this is bigger than us we need help from hospital associations on that allen i know the hospital a network specifically designed for hospitals was built around a piece of radio equipment hardly more complicated than a telephone operating this disaster radio is a very simple procedure you just use it like a telephone except that when you use it you must press this little lever would you like to try and talk to council control yes just tell them it's children's hospital do they answer me no you just tell them who you are and you're talking to council control all right children's hospital and right speaking tell them you're making a test and how do they breed you try this is council control go ahead children's hospital thank you i'm making a test how do you read me we read your unit loud and clear over now you sign off see roger roger and that's about it the radio network doesn't lie idle it is at work every day expediting inter-hospital communications on scores of routine emergencies for hospitals that can make this available please respond this is valley presbyterian hospital to cedars we can supply that item we will make the necessary arrangements with your hospital and the highway patrol kql84 clear los angeles air traffic matches that of most big cities but unlike other cities in los angeles when the airport reports a potential emergency the hospitals through their communications network can be expediently mustered to standby positions alert prepared valley hospital this is an alert we have been notified that a passenger plane is approaching international airport with the landing gear malfunction will the following hospitals stand by in the emergency mode the southern california network links 128 hospitals metropolitan and rural forty four thousand square miles divided into areas within which the hospitals communicate valley doctors hospital we have 29 medical surgical beds each area has one regional control hospital responsible for coordinating hospital disaster communications and providing a link to other areas and related community emergency services if disaster strikes all hospitals are alerted simultaneously and the hospital association mobile unit at the scene provides on-site communications to and from the mobilized medical resources while the regional hospital tracks information on casualty flow blood supply and emergency room capacities individual hospitals monitor the situation and request outside help the moment they anticipate the need for future sets by ambulance uh [Music] with a major medical center a prototype system has worked out to assure the timely arrival of skilled medical sorting teams at any disaster site get together some medical triage teams and we've come to you as a large medical center uh to see about the formulation of these teams now dr gaster you have around the clock coverage yes you could put together a team at a moment's notice yeah some of these gentlemen are paramedics well now i think the the scheme that we're developing here is if this represents our large urbanized area and we should have a a disaster in a certain segment such as this it becomes very apparent that the local hospitals uh need to man their own facilities and they need support from medical centers in other parts of the city and this is our this is our concept of the leap frog where medical triage teams in any one of these large medical centers could be brought by helicopter or other transport into the disaster site and act as the front line medical triage group and of course teams could come from any one of these centers as required and it would be their job to sort out these victims and dispatch them to the local hospitals which hopefully would be staffed by their own doctors so their efforts not diluted by having to go out into their own community now with your triage team we've got this uh radio mobile radio and uh jim let's take a look at that five watt radio and this is really our link from the state of the disaster to the hospital preparations get underway for a full-scale multi-hospital disaster exercise 120 days before the event itself resembling a sizable military operation the exercise is given an appropriate code name explo selection of a staging area and arrangements for volunteer casualties and makeup teams are assigned to committee members and as the countdown continues warm-up tests are aimed at perfecting a flexible response this is the hospital council and a test exercise of the central los angeles area will each hospital initiate its green capacity inventory form and report back within ten minutes on all items listed under number four blood supply this is council control standing by hospital acknowledging your request here the hospitals are testing one of the keys to this multi-hospital disaster plan the emergency capacity inventory through repeated practice hospitals on the network can now rapidly gather and exchange information on any item of hospital service or supply as the day of explo approaches hospital public relations departments will increase the flow of information about the coming event to the news media and graphic material will be designed printed and distributed long before the countdown ends essential to a flexible hospital response in a disaster is coordination of ambulance services first to agree and offer their full cooperation are the local governmental and private ambulance agencies up sunset boulevard down to the emergency entrances of the hospitals and then circle back and pick up more casualties for this exercise we're going to observe normal traffic regulations and normal normal speeds okay it's a lot easier and a lot safer really plans for the explo exercise must include early selection of a staging area fenced for control and large enough to accommodate activities during progressive stages of the exercise a multi-hospital exercise brings the community together by marshaling the available human resources explo day will see the assimilation of many volunteers with a variety of talents and background employees of local businesses schools of nursing church groups service clubs boy scouts girl scouts and campfire girls having previously received information brochures and submitted sign consent forms these participants will register and receive a final set of instructions to apply makeup on explo day five employee volunteers from each of the four participating hospitals will already have been trained in the art of moulage during three one-hour sessions these volunteers will have been coached to play their parts so that medical hospital and rescue personnel will be stimulated to react as they would to a real disaster realism in the makeup of casualties will pay off it will be instrumental in generating a serious response to the exercise well this is our final briefing session and we're right on schedule so far 14 days from the time of our disaster exercise and i want to bring up firstly a discussion of our traffic control and uh police support sergeant johnson have you made the arrangements for us for these teams and so on uh yes doctor i have we are going to have two black and white vehicles assigned to the front of children's hospital to transport the triage teams the medical triage team that's coming from arbor general that's correct and how many of your civil air patrol personnel are going to be involved 125 on standby at all times for actual disaster as well good thank you very much what about the red cross well we're prepared to provide a first aid coverage at the staging area these will be trained disaster nurses first aid personnel to be concerned with anybody who may be injured at the staging area this would be a real thing a real thing an actual operation and in addition to that we're prepared to provide a canteen feeding operation for all of the participants with coffee and donuts and uh juices and that sort of thing you got lots of coffee this year a lot of coffee this year i understand we ran out right now last year and that was a disaster and it was brought up as number one on the critique now about critique teams commander broussard tell us where we are well the navy uh will be standing by to help in critique along with uh the representation from fort mcarthur approximately uh 15 people involved in the critiquing the entire system now your team consists of various kinds of people of various kinds of experience yes sir i will be the senior surgeon involved we have the one army nurse along with air force nurses and multiple military enlisted personnel who have triaged and been with triage the patients and the administrative aspects will be critiqued too dr messer you represent the county medical association what's in store for us the county medical society which has about uh ten thousand members has been alerted and we have appointed several of the members into very important vantage points in the different districts on the on the field the triage and the different hospitals now the police department is going to show us what the uh police department will be doing on the day of the exercise ron thank you doctor i have a chart here that uh as you can see the exercise has been divided into six major activities each one of these have a time sequence beginning at 0 800 the players report to the moulage area and that will carry through 900 the cpx play begins at about 8 40. at 9 15 transportation the injured commences and will terminate about 11 30 hospitalization shortly thereafter then the casualty information center operated by the police department will begin shortly after exercise play and concludes uh long after the hospitalization and transportation has ended doctor we have taken each one of these areas and included them in an operations plan and it's reproduced in this booklet expo 71 on the cover california hospital from one place this is the last city fire department this is california test hospital there has been an airplane crash in the vicinity of common star king junior high school there are numerous casualties at the school and a nearby apartment fire rescue units are on the way please alert all hospitals roger this is california hospital to all central area hospitals this is a test exercise the fire department has reported a plane crash in the vicinity of thomas starr king junior high school there are numerous casualties in the school and nearby apartment houses will the following hospitals immediately initiate their green disaster capacity inventories theaters of lebanon children's hospital hollywood presbyterian kaiser foundation this is california hospital standing by as the scenario unfolds regional control contacts hospitals near the scene and over 300 casualty volunteers are moved in waves of 60 and 70 from a holding area to the disaster site will you notify harbor general to go to on emergency mode we will be communicating directly from the mobile unit over spearheaded by rescue teams trained in casualty work the fire department is the first agency to arrive exactly as would have happened if this had been a real date with disaster medical sorting triaging begins at once followed immediately by first aid [Music] a standardized disaster tag records the first glance field data upon which succeeding medical judgments may be based thus initiating a chain of information from the disaster site to the hospital bed good morning i'm chief miller from the l.a city fire department we've commenced first aid on the victims here we've estimated close to 300 okay we have the hospital mobile unit here now now what assistance are we able to give you at this point we're going to need the medical sorting team out here to assist us in the sorting of the victims okay let me radio for that right away medical liaison this is mobile one the california hospital california hospital medical center over yes california hospital we urgently need the medical sorting team from harvard general hospital would you initiate that right away over california uh we're gonna need a lot of help in dispatching these ambulances out of here can you help with that yes i can coordinate fire department this is mobile unit to california hospital yes we will need a capacity inventory of the hospitals in this vicinity right away over [Applause] [Music] for your medical sorting team to go to the scene of the plane crash at thomas stark king junior high school over this is harbor general acknowledging your request the medical sorting team will be dispatched to the site immediately harbor general hospital standing by dr gaster would you please call surgery and get them to alert the triage team larry give central supply a call would you please and find out when they can get the supplies up to the heliport bob will call the blood bank and find out how much blood is on hand and how much is available for dispatch to the scene of the disaster larry we're staying at the blood bank report now we have uh on hand 25 units of apos while the medical sorting team prepares for its departure the most serious casualties triaged by the fire department are already arriving at nearby hospitals leapfrogging in by helicopter from outside the disaster area the medical sorting team arrives from harbor general hospital this rooftop heliport is in fact the nearest place to the disaster site that a helicopter can safely land on the street below police cruisers stand by waiting to whisk the team of medics off to the disaster site [Music] an experienced critic one of many assigned to the exercise will later provide an evaluation from which the multi-hospital plan can be corrected and improved upon trained in the art of field triage the triage officer takes control of the medical sorting identifying priorities for care and evacuation and coordinating the activities of all available manpower resuscitative and stabilizing tasks are assigned to members of the team and carried out instantly the acute emergency victim is given transportation top priority but whenever possible the walking casualties fill extra spaces or help take care of the more critically injured [Music] this is kaiser we are no longer able to effectively handle burn cases at this time over the continued arrival of emergency vehicles places an ever-increasing demand on the hospital's resources practicing physicians summoned by their hospitals respond immediately assuming leadership roles they direct the essential resorting and care of the incoming casualties and while all the victims of a disaster exercise are being managed the real work of the hospital continues unimpeded by the make-believe activities services for the really sick are assured by plans drawn up weeks before the re-evaluation of a patient's condition takes place at every available opportunity for his condition may suddenly change from the emergency entrance on into the hospital lobby up elevators and through hallways to operating rooms and wars the explo casualty traffic flows urgently requests 24 units please respond if you can provide [Music] this is children's hospital of los angeles a week with every hospital listening in response to an urgent request can be immediate we'll send it to you on the next ambulance developer over roger we acknowledge that this is mobile one clear little benefit can come from the learning experience of an exercise unless it is followed by a documented evaluation i'd like to turn the podium over to commander broussard of the military critique team nick would you tell us officially what you've found in this program thank you dr clinton i am going to pick on you only a little bit maybe enlighten a few of you that i saw in action at the disaster site and i'm not personally after you okay this is an overall comment i know it's hard for doctors to play the emergency and play surgeon and play this and play that so we'll have to have some improvement along this line and if you figure that you're going to be anything less than adequate then you're working at about the right range because you can just not locate 20 nurses or 30 nurses in 20 minutes and this becomes a problem we should stress more of the resuscitation as the disaster site before they ever move because you're going to have about a 30 mortality rate on these people and the time to get them is at the triage site so one doctor should quickly run through the area to see who's there what's there how bad of the casualties and he may want to direct this medical triage team to take care of this one this one this one and this one then the rest we'll look at in the next three or four minutes maybe we need to move the ambulance dispatch officer over another hundred feet because the fire chief was so loud with the bull horn he just put him down completely every time he began hollering about a stretcher here a stretcher there there was a fire chief directing his 25 farmer he needs a bullhorn at the scene of the disaster uh to allow a stretchy bear to uh have a sinkable episode to think well that's all well and good because this is going to happen to you there's 18 year old kids who are calling around a man all of a sudden he's going to die and these kids have never seen death before and they are going to drop now you have not only a dead person but you have two passed out cap people to take care of panic you haven't seen until you have a massive disaster panic disaster february 9 earthquake 2300 injured swamp hospital emergency rooms four hospitals destroyed eleven hundred patients to be evacuated the major medical centers organized their triage teams from children's hospital the triage trunk and medical sorting team are airlifted to the scene supplies in the disaster area are running short blood sutures incubators five hospitals have no water others only a muddy trickle council to all southern california hospitals on the radio network please stand by for urgent message the van norman reservoir dam is breaking chlorine gas is also escaping hospitals in within the boundary areas are asked to begin to transfer patients immediately in this building 84 victims lie trapped this was a date with disaster [Music] triage medical sorting teams leapfrogged in from outside the disaster area apply life-saving measures to the victims extricated from the debris this is mobile 1 the valley presbyterian hospital this time it's for real we need replacements for the medical sorting teams up at san fernando vets for both four o'clock and midnight tonight can you arrange a matter of life or death and so is the need for hospital network communications at the scene from ucla children and uh well now we got an opportunity here to discuss our recent experiences in the earthquake and see what we can do to improve our reaction to a community disaster we must learn how to develop and improve our inter-hospital transportation resources we had some frightful experience on the heliport on the rooftop teleport we had gravel and soot flying around we had an awful lot of noise we couldn't communicate with our command posts and so on i think we really concluded that the rooftop heliport is a very dangerous thing as well as a good thing there's no doubt that in this earthquake experience the use of the helicopter and for things other than patient every hospital needs to either have a heliport if possible or at least an area where they know that they can be cleared for helicopter landing bringing supplies bringing key personnel to disaster areas i think that's where we develop further i think the main problem still is the coordination of our various radio networks the thing again it comes right back to our whole radio network but every hospital is not going to have a radio i don't think we're saying it relies entirely upon radio i think everything a runner is important yelling out the window to somebody down in the street is important telephone is important radio is important the advantages of our radio network is one i'm talking now i could be talking to 144 hospitals all at the same time so we're only saying that if all these other things are cut off for one reason or another then you're left really with only one resource a radiation if it's working or you have one well we had 128 of them working during the earthquake and that's pretty darn good when a million people didn't have a telecommunications transportation medical triage a few of the problems encountered by this group in their search for a satisfactory multi-hospital disaster preparedness model a tested and tried plan with some solutions and some more problems for a disaster plan is never and can never be complete and so the cycle must repeat itself from the startup dialogue to testing and critiquing the plan disaster preparedness is not postponable disasters do happen no community is immune someday yours may have its date with disaster [Music] coming through control go ahead please the hospital to valley presbyterian over especially acknowledges hospital council over [Music] you