When major earthquakes hit Southern California earlier this month, it was a reminder to residents about the persistent threat of a catastrophic quake in that region.
But it was also a prompt for all hospitals located near the fault lines to brush up on their own disaster preparedness procedures.
Among the hospitals that were tested was Ridgecrest Regional Hospital, a facility located in a small city about 150 miles north of Los Angeles near the epicenter of the July 4 quake. Hospital officials announced a partial shutdown of the Ridgecrest facility for several days. They suspended triage as they waded through the emergency. Although a full closure of the hospital was not necessary and remains a rare occurrence, moving patients or even closing down one wing can cost a hospital money and cost the public valuable resources.
So what are hospital staff and administrators in earthquake areas of the country doing to stay ahead of the game in 2019?
Two California hospitals and one pediatric hospital in Seattle discuss how they are diversifying their communication tools, outfitting buildings with technology and running preparedness scenarios in order to implement the best possible outcome following an earthquake.
No earthquake season
An earthquake is unique from other natural disasters, because there is no such thing as earthquake season, officials pointed out. Therefore, hospitals in these areas need to be prepared at all times.
“Healthcare organizations in seismically active areas must prepare differently as building codes are usually much more stringent and there is little to no warming to prepare for the earthquake,” William Dunne, administrative director of emergency preparedness, safety and security services for UCLA Health, told FierceHealthcare. “In California, the Office of Statewide Health Planning and Development monitors the construction, renovation and seismic safety of hospitals and skilled nursing facilities. State engagement allows for strict code enforcement to engage seismic risk mitigation.”
For example, California hospitals follow the Hospital Facilities Seismic Safety Act, requiring all hospitals be built or retrofitted to withstand major earthquakes following the big 1994 Northridge quake
During any emergency, hospital staff is tasked with using data supplied through technology, information from community, county or state resources and the individual facility’s disaster plan to make quick decisions and take decisive actions that ensure patient safety. As with any disaster or emergency, communication—and redundancy—is key to successfully navigating through an earthquake.
At UCLA Health, multiple methods are used including traditional phone, VoIP, HAM Radio, cellular phones, high- and low-band radios with dedicated frequencies, satellite phones/data transmission, alphanumeric pagers, public address systems, email, web-based desktop notification banners and reverse 911 technologies.
Similarly, Cheryl Osborne, emergency management manager for Torrance Memorial Medical Center (TMMC) in Southern California, says that TMMC has multiple communication methods. For example, in the loss of networks for phones, the hospital has the ability to utilize “copper land-line” phones that do not rely on a network (much like your house phone) to communicate within the hospital.
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“We have also purchased separate cell phones that would be distributed to critical areas of the hospital to communicate via text messages as appropriate,” Osborne said.
In addition, TMMC has a radio room which can serve as an operations center for amateur radio operators to send and receive messages from community partners and to notify local agencies of any critical needs.
For monitoring quakes, Dunne reports that UCLA Health uses Shake Alert via the U.S. Geological Survey and the City of Los Angeles. This resource provides potential early warning notifications for activity in the Los Angeles area.
“We are currently looking at opportunities to integrate this into mass notification and building infrastructure capacities,” Dunne said.
There is an increasing number of technological tools being introduced to hospitals to assist in earthquake management. For example, Kinemetrics makes a product called OasisPlus that combines seismometers, software and structural data before, during and after a quake. The information, available in real time, can be shared among hospital staff via app and web to ensure check-ins and communication throughout an emergency procedure.
Thus far, OasisPlus has rolled out at naval hospitals in Washington and California and recently announced a partnership with its first private facility, Seattle Children’s Hospital.
“Not all earthquakes require extreme response or full evacuation, and many times the ability to keep patients under care in place—especially those in ICU settings—can lead to better overall outcomes,” Ogie Kuraica, president and CEO of Kinemetrics, said in a statement.
Kinemetrics’ OasisPlus solution is comprised of four major components: first, sensing technology deployed in the structure that acquires essential data during shaking.
Second, performance-based engineering analyses turns measurement data into actionable information such as the probability of certain levels of damage at specific locations.
Third, the command console includes real-time information from sensors, alert levels for impact expected in differing parts of the building, occupant check-ins, injury and hazard reports, safety checks and building safety tagging. A detailed SAFE Report is automatically sent out to designated lists of recipients (leadership, response team, structural engineering firm, etc.).
Finally, iOS and Android mobile apps can provide real-time, on-the-ground information and check-in, report injuries or hazards and receive instructions via the app.
Derek Skolnik, senior project manager at Kinemetrics, says that the system was created to provide the hospital decisions-makers with all of the necessary information to support their thought processes when it comes to structural integrity. While the data were previously available, OasisOne has put that information into a digestible dashboard for the people in charge.
“Our solution works great,” he said. “In most situations an earthquake is scary, and things shake a lot, but everything is okay. We give that assurance.”
Decision-making after a quake
Once they have received all of the necessary information immediately following a quake, there are several people on a hospital staff tasked with making emergency decisions.
UCLA Health has a 24-hour on-site supervisor as well as on-call administrators. These individuals are identified to activate the emergency operations plan and become the initial incident commander within the framework of the National Incident Management System. “We have policies and procedure which would guide the decision around evacuation,” Dunne said. “Due to our significant building standards related to seismic mitigation, a full facility evacuation due to an earthquake would likely mean broader regional catastrophic failures of infrastructure.”
Dunne says the ultimate goal for the hospital is to never stop operations. The community counts on hospitals to support and keep operating through disasters.
“In the event of a catastrophic incident leading to the potential need for evacuation, there is always the difficult decision about being able to maintain lifesaving care for the patient if they stay in the disrupted environment and whether moving the patient is a greater risk,” Dunne said. “We need to train and empower our clinicians to make these decisions. Medicine is always based on the standard of ‘Primum non nocere’ or ‘first, to do no harm.’”
Similarly, Osborne states that hospitals should be prepared to “shelter in place” during an earthquake.
Osborne notes that there are great challenges in making arrangements for sending staff with the patients to other hospitals and then having staff work in an unfamiliar environment while trying to maintain the same level of care.
Per the policy at TMMC, after an assessment by the facility’s engineering team, the hospital administrator, along with the advice from the local fire department, will make the decision to evacuate if all buildings are no longer safe for patient care. This would be done in communication with the local health department and the Los Angeles County Emergency Medical Services collaboration for obtaining transportation and transfers to like-to-like facilities.
Post-evacuation, the hospital would first assure the safety of all its buildings and receive an official “OK” to reenter the buildings. Then the process of recovery and repopulation of its staff, followed by the patients, would occur. The hospital would work with the receiving facility to make arrangement to reestablish the patient care back to TMMC as appropriate.
Practice makes perfect
Required by law, each hospital has a mandatory emergency preparedness plan and annual drills.
All hospitals are required by the state government, federal government and accrediting organizations to have robust disaster preparedness plans, according to Mary Massey, vice president of disaster preparedness for the California Hospital Association (CHA), a state trade association with a focus on public policy and expertise in areas such as behavioral health, long-term care, nursing facilities and emergency disaster response.
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“During normal times, our job is providing education tools and resources that help them [hospitals] to respond to the different emergencies,” Massey said of CHA. When there is an emergency, Massey—a trained ER trauma nurse—serves on a team to help the individual facility use its unique Emergency Operational Manuel to make important decisions.
Massey’s team at CHA also helps train hospital employees in different roles for earthquake responses. For example, each situation has a designated incident commander, usually an on-call administrator, and a house supervisor as well. And all of these in-house coordinators need to eventually communicate with regional ones. (There are six designated regions in California.)
Dunne notes that UCLA frequently conducts exercises around earthquake preparedness including participation in the annual Great Shakeout in Southern California. The hospital practices skills so teams can focus on patient and visitor safety as well as their own.
In addition, the facility practices unit evacuations, tests mass casualty surge capacity and trials infrastructure through simulated IT outages.
“We also have a huge focus on personal preparedness,” said Dunne. “We recognize that if our faculty and staff are not prepared at home, that they may not be able to respond to work or if they are already here, that they may not have a complete focus on the mission if they are uncertain/unprepared at home.”
TMMC has a dedicated emergency manager position that leads the hospital’s emergency preparedness activities. This person leads the emergency management committee (made up of multidisciplinary group members), which meets monthly to evaluate and review ongoing preparedness activities, unplanned emergency events, policies and plans for two annual hospitalwide drills that test the current policies in place and evaluate the effectiveness of the program.
Taking the necessary steps
Dunne advises that all hospitals in an earthquake-prone area make preparedness, risk mitigation and resilience part of their culture. This includes developing relationships with public safety, public works and the community at the local and state level to understand their plans and capacities, and vice versa.
On the infrastructure side, hospitals need to continually be assessing for single points of failure in utilities, communications and IT capabilities.
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Finally, Dunne advises facilities to invest in self-sufficiency as much as possible, because in an emergency, external resources are beyond the hospital’s control.
“Ultimately, the more staff trained and understanding the ‘all-hazards’ readiness process, the better prepared the facility is to respond for any type of disaster or emergency in the community,” Osborne said.