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Unprecedented wildfires forced California hospitals to reinvent emergency plans on the fly


April 1, 2018

Unprecedented wildfires in California forced hospitals to not only test their emergency plans, but to reinvent them on the fly.

Hospitals generally have pretty good emergency plans (and the smart ones know that includes knowing when and how to evacuate patients quickly). Prudent safety officials should test their evacuation plan often and keep it in the top desk shelf, just in case. Not only is it smart, but accreditors require it. Don’t let a Joint Commission surveyor hear that you don’t have an evacuation plan, especially if you operate in an area prone to wildfires and without help and additional resources nearby.

It’s one thing to have the plan available, but yet another to put it into action. Hospitals in general aim to stay operational during an emergency, but what do you do when you literally look on the horizon and see one of the biggest wildfires in California’s history coming right for your facility?

It happened in August 2014 to the Mayers Memorial Hospital Burney Annex in Burney, California, when the so-called Eiler fire bore down on the hospital. That blaze, combined with other fires that year, burned more than 117,000 acres and quadrupled in size almost overnight, causing what some termed a “fire tornado.”

The firestorm, which came within five miles of the hospital, started raining ash and sparks onto the surrounding area and forced the evacuation of at least 40 patients from the long-term care hospital to Mercy Medical Center in Redding, about 65 miles away. From there, the patients were placed in nearby healthcare facilities until the danger receded, according to a report in the Redding Record Searchlight.

On October 10, 2017, at least two hospitals were forced to evacuate patients when wildfires in northern California got too close. Kaiser Permanente transported about 130 patients from Santa Rosa Medical Center to Kaiser Permanente San Rafael and other area hospitals. The Santa Rosa hospital was not damaged, but it did close temporarily, cancelling scheduled appointments and surgeries. Sutter Santa Rosa Regional Hospital also evacuated 70 patients to other area hospitals.

“The firestorm which erupted … has devastated our community, destroying hundreds of homes, including the homes of many of our employees and medical staff,” according to a statement released by Sutter Santa Rosa Regional Hospital. “Many of our physicians and employees called with offers to assist, even as their own homes were threatened. We are extremely grateful for the incredible acts of courage of our employees, clinicians and first responders in managing the crisis.”

With the recent breakout of a series of monster wildfires in the Los Angeles area, the California Hospital Association (CHA) has devoted a section of its website to helping hospitals prepare for wildfires with several tools and lots of advice for remaining operational and knowing when it’s time to evacuate.

“Hospital plans for full or partial evacuation should incorporate pre-planning and address the incident command and management structure established for its operational area (community),” according to the website.

“In advance of an event, hospitals should understand and incorporate local plans and protocols that are in place to support evacuation and should establish Memoranda of Understanding (MOUs) with other hospitals, as necessary, for transfer and mutual aid during an emergency.”

So when is it time to evacuate?
Again, hospitals generally don’t plan to evacuate unless there is no other option or they can’t stay operational for long; in fact, The Joint Commission and CMS require facilities to prove they are ready to stay open for 96 hours in the event of a major catastrophe. But as events in California have shown, that decision could be disastrous in the face of huge fires.

According to the CHA, there is no one algorithm or formula for knowing when to evacuate vs. sheltering in place, and that’s where a hospital’s plans take over.

A well-planned hospital has also done a well-researched hazard vulnerability assessment (HVA), which takes into consideration the many disasters that could befall a facility. If you’re prone to a wildfire and don’t know it, you’re probably going to be looking for a new job. Among some of the considerations that CHA recommends are the following:

When potential or actual evacuation is first contemplated, the hospital should alert the local emergency medical services agency (LEMSA), Emergency Operations Center (EOC), and/or Medical Health Operational Area Coordinator in accordance with the protocols established for emergency notification in the area. Especially in the event of a quick evacuation, you’re going to need all the help you can get. Get the word out, fast.

The LEMSA or EOC may assist the hospital with identifying and coordinating placement and transport of patients and other support while the hospital is preparing for and staging evacuation of patients in accordance with local plans and protocols. If the LEMSA or EOC are unable to provide assistance, the hospital is responsible for identification of receiving facilities and securing the consent of those facilities for transfer.

The hospital should have established protocols for evacuation, including medications, supplies, equipment, medical record summaries, and patient tracking. In other words, make friends with other hospitals in the area and have a pre-arranged mutual aid relationship in case you need to move your patients.

Because attending physicians may not be available for all patients involved in an immediate evacuation, it is anticipated that hospital-based physicians (e.g., emergency department physicians, hospitalists, the medical director) will coordinate with the sending and receiving hospitals. Medical record summaries should accompany each patient, and the patient’s attending physician should be notified of the location of the patient. Again, this should be in your plans. Contact numbers for all staff, on call and otherwise, should be on automatic dial. Some hospitals are turning to the cloud to keep track of patient information in case hard copies are not available.

Your wildfire game plan
Safety and emergency preparation experts, especially in areas of the West that have long suffered droughts and high temperatures, have long experience to thank for well-executed evacuation plans in the event of a major wildfire. Take some notes.

Your evacuation plan should be second nature. With most natural disasters such as hurricanes or blizzards, hospitals have plenty of warning and can stagger their emergency response. A fire is a different animal. A sudden change in wind direction can blow sparks right in your direction and send a wildfire quickly heading to your doorstep.

When Sutter Health’s Santa Rosa Regional Hospital evacuated in October 2017, the staff waited until the last minute until the hospital was forced to run on emergency power and all its utilities were down.

“Literally the fire was raging all around the hospital,” says Lisa Amador, director of North Bay strategy and business development at Sutter. “Firefighters were defending the hospital right up to the door. It was a firestorm around the hospital. The patients were here in the hospital, and we had a full staff.”

Don’t let that happen to you. Make sure that if your hospital is located in a potential fire zone, an emergency drill for evacuating with little notice is high on your priority list at least once every year.

Prepare for mental health of workers and patients. In the event that a fire forces the fast evacuation of a hospital, things will happen quickly and staff will be expected to spend extended amounts of time tending to patients, often away from their own families. You need to prepare not only for their care and well-being, but for their mental health.

Deadly wildfires in northern California in October left many people battling new levels of stress, anxiety, and depression, and experts say that the number of mental health issues could be unprecedented.

“It’s been six weeks since the fires -- the impact on the community has been incredible, and it’s not going to just go away,” Maryellen Curran, a clinical psychologist and the mental health director for Santa Rosa Community Health, told the Press-Democrat of Santa Rosa.

Curran said the demand for mental health has been on the rise in recent weeks, with many patients exhibiting signs of enduring grief, depression, irritability, anger, and sleep disturbance. The level of these symptoms depends “on the exposure they had to the immediacy of the fires,” she said.

Your staff members are among these people who will be directly affected, especially if they have homes or family in the area. Many hospitals have plans in place to turn conference rooms or entire wings of a building into a makeshift hotel in the event of a blizzard or other disaster. If you anticipate the possibility of having to evacuate your building entirely (again, this should be in your HVA), it’s a good idea to have a mobile option in mind such as a trailer or the ability to set up shelters in off-site facilities.

Make friends with your neighbors. Healthcare facilities don’t need to be, and shouldn’t be, expected to operate in a vacuum. You’re all in this together. Therefore, there should be a pre-established agreement to work together with facilities that need a helping hand.

Some facilities have agreements to take in extra patients in the event that another hospital in their area gets evacuated. If physicians, nurses, or other staff members can’t get into work, it’s not unheard of for hospitals to partner with fellow facilities to share staff under emergency circumstances.

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