EMS Operations

EMS Operations

THE NORTHRIDGE EARTHQUAKE

Within a minute after the Northridge Earthquake struck, the City of Los Angeles Fire Department went into the Earthquake Mode, a preplanned degraded dispatch implemented to conserve resources. Instead of sending usual assignments of companies, including rescue ambulances, a single unit is dispatched, thereby making scarce resources available to handle the expected additional flood of calls for service. Four floors under City Hall, constituting the Emergency Operations Center (HOC), were made functional. Generator failures caused the computer system at the Department’s dispatch center to fail, necessitating “Manual-Mode” dispatching. Fortunately, no 911 calls were lost.

Hundreds were injured as a result of the Northridge Earthquake, and hospitals scrambled to handle the onslaught. Eighteen hospitals temporarily closed their doors, unable to function as emergency centers. They, themselves, had become casualties in need of aid.

The City of Los Angeles Fire Department operates 52 paramedic rescue ambulances, 1 1 paramedic engine companies, and 13 EMT I rescue ambulances; and 102 fire stations have semiautomatic defibrillator capability. Two thousand four hundred firefighters, up through the rank of captain, are certified as emergency medical technicians. Paramedics come under the jurisdiction of the Bureau of Emergency Medical Services, commanded by the chief paramedic. Medical control in the field setting is conducted by 18 platoon-duty EMS district captains. The city is divided into six EMS geographical districts on three platoons, which oversee the EMS activities on a day-to-day basis. Medical control is the primary job duty of the district captains.

At the time the quake struck, the regularly scheduled six platoons were augmented by personnel held over from the previous platoon shift. Ambulances from areas not affected by the earthquake were brought in to facilitate rotation and provide relief.

VALLEY COMMAND

As the EMS Bureau commander, l went to my assigned department vehicle and attempted to monitor radio traffic, but it was virtually impossible. Static was pronounced; and with the exception of a few words, legible communication was nil.

I responded to Fire Station 88, where I expected Department Command to be organizing. On arrival, 1 assumed command of the EMS Branch of Valley Command. The Medical Branch was physically set up adjacent to the department’s Command Vehicle at Fire Station 88, just west of the station; tables and chairs were available. EMS operations were headquartered here; the only other EMS center established was the Medical Group at the Meadows Apartments complex.

Fourteen ambulances were staged at Valley Command. Seven EMS captains, including EMS Assistant Bureau Commander Dave Thompson, made up the Medical Branch at Valley Incident Command.

• Captain Harry Rich, commander, EMS District 1, “C” Platoon, visited various hospitals to obtain specific and accurate information. His first-hand information, while bleak, was much needed.
• Captain Allen Norman, commander, EMS District 6. “B” Platoon, assisted early on with Medical Branch operations and oversaw communications with the L.A. County EOC, dispatched resources from the Medical Branch, and was responsible for
• developing Casualty Collection Points, should they be required.
• Captain Larry Mayer, commander, EMS District 6, “A” Platoon, supervised the fire department and private ambulance resources assigned to the Medical Branch. He remained at Fire Station 88 throughout the day and night and ultimately was designated as the Medical Group Commander after 1 left Valley Command.
• Captain James P. Denney, the EMS Bureau’s staff assistant, maintained a dispatch log of still alarms originating at Medical Command. In addition, he monitored and updated San Fernando Valley Hospital status with specific liaison with the Department of Health Services.

Captain Robert Linnell, commander, EMS I, “A” Platoon, was responsible for obtaining emergency room status, including damage control. He attempted to obtain first-hand knowledge of damage by first calling emergency rooms on the telephone, where possible, to determine evacuation needs and perform assessments.

MEADOWS MEDICAL GROUP

While en route to Valley Command, Thompson was rerouted to the Northridge Meadows Apartments to supervise EMS activities and to establish a Medical Group. Captain Wade Jones, commander. EMS District 3, “B” Platoon, assisted Thompson at what was to become a tragedy in itself- the death of 16 people due to a collapse. One of the first requests 1 received at Medical Branch was from Thompson for a department chaplain. As it happened. Father Christian (“Father Chris”) van Liefde had just driven up to Command to volunteer his services where needed. He was disptached immediately.

The Medical Group consisted of Jones, who was held over from the previous day’s platoon; Captain Steve Johnson. EMS District 3, “C” Platoon; Rescues 27, 39, 81, 93, 827, 818 (reserve); and a private ambulance. Dr. Gregory L. Palmer, LAFD’s medical director, was also on scene. Ultimately. 14 patients were seen and released at the Meadows Group treatment area, located in the parking lot of the post office directly across the street from the Meadows Apartments. Seven patients were transported to area hospitals; three of them had been extricated from first-floor apartments by fire suppression personnel.

HOSPITALS AFFECTED

Six Valley hospitals-Holy Cross Hospital, Olive View Medical Center, Northridge Hospital Medical Center. Granada Hills Community Hospital. Kaiser Hospital Panorama City, and West Hills Regional Medical Center-were closed as a result of “Internal Disaster,” a category that adequately described the condition of the emergency department. Although most hospitals wanted to remain open, many found it physically impossible to do so in view of flooding, haz-mat incidents resulting from chemical spills, and structural damage. In addition, electrical failures rendered equipment inadequate/nonoperative. An EMS mess existed. Normal communication with base hospitals was nonexistent.

In Los Angeles County. 2.5(H) beds were lost as a result of the earthquake. Most hospitals closed as the result of ruptured water lines, disrupted oxygen lines, and nonworking elevators (due to power failure). At the height of activity, only 136 critical beds were available county wide-a frightening reality. Eighteen hospitals were temporarily closed.

The following hospitals required patient evacuation: Olive View Medical Center, Holy Cross Hospital. Northridge Hospital Medical Center, Granada Hills Community Hospital. L.A. County/USC Medical Center Pediatric Pavilion, Veteran’s Administration Medical Center, and St. John’s Hospital. Evacuation to areas outside the earthquake-involved sections was accomplished by hospital staff members and private ambulances.

COMMUNICATION FAILURE PROTOCOLS

At 1030 hours, the Medical Branch determined that all ALS units operating in the San Fernando Valley would implement Communication Failure Protocols. These protocols, which suspend on-line medical control, are implemented when voice/ direct communication between paramedics and base hospitals cannot be established or maintained and when delaying treatment may jeopardize the patient. They permit paramedics, after performing a thorough I assessment, to initiate appropriate treat| merit, such as administering medications or solutions. The Failure Protocols were ! implemented since Northridge and Holy ! Cross hospitals’ base stations were tionop: erational as a result of internal disasters. ! The department’s use of Communication j Failure Protocols was announced on all | rescue ambulance channels numerous | times and was reaffirmed later by depart| ment teletype and EMS district captains, j LAFD had used Communication Failure Protocols regionally during the 1992 civil disturbances without a single problem. Numerous hospitals appreciated their use, and subsequent newspaper articles chronicled their use. The Department of Health ! Services was notified of their implcmenta| tion shortly thereafter and concurred with I their use. The Department of Health SerI vices declared that hospitals could not go ; on diversion status to paramedic traffic | except in the case of “internal disaster.” ! This action made it easier to move patients I to various hospitals.

Amateur radio operators. Communicaj tion with hospitals was reestablished | through the implementation of an amateur| radio system and physical inspections conj ducted by two assigned captains. Captain i Kevin R. Nida organized the HAM radio ; operators (Amateur Radio Emergency Serj vices) known as ARES and then responded j to Valley Medical Branch. A HAM radio i operator was sent to as many hospitals as i possible, thereby maintaining direct con; tact to maximize reliable and accurate ; information. Amateur radio operators were ! the link at Olive View Medical Center, I Northridge Medical Center. Holy Cross Hospital. Granada Hills Hospital, and j UCL.A Medical Center. Nida remained in charge of the ARES communication van at Fire Station 88, supervising the amateur radio operation. This link between the Medical Branch and hospitals proved to be invaluable and facilitated radio traffic between the Medical Branch and the Los Angeles County Emergency Operations Center (EOC).

The use of Failure Protocols was discontinued at 1633 hours on January 24, seven days later. Paramedic units began to utilize their assigned base stations consistent with Reference No. 808, Base Hospital Contact. Although Northridge and Holy Cross hospitals returned to normal base station operation, Holy Cross remained closed to ambulance traffic. One by one, the hospitals came back on line; the complete system was reestablished over a period of weeks.

The communication breakdown did not negatively affect EMS dispatch. All calls were answered, and two lives were saved by implementing the Failure Protocols.

DISASTER MEDICAL ASSISTANCE TEAMS

Disaster Medical Assistance Teams (DMATs), provided by the Federal Emergency Management Agency, arrived several days after the earthquake. Part of the national disaster medical system, the units are composed of physicians, nurses, and emergency medical technicians. Ten teams responded: four were used in rotation. They w’ere installed in hospital parking lots, parks, and county-operated health centers in the San Fernando Valley, where tents had been erected for victims displaced by the earthquake. The four teams-designated CA-l through CA-4. referring to California and the numbered team-originated from Seattle. San Francisco. San Bernardino, and Mexico. They were under the direction of Dr. Joe Iser, a federal physician, U.S. Public Health.

The DM AT teams had from 25 to 41 members. These MASH-like units have functioned in the worst of scenarios, from hurricanes Hugo in the Virgin Islands to Iniki in Hawaii. They established units complete with generators and were fully self-sufficient: they did not rely on local resources.

Medically, the teams can handle anything from colds and flus to chicken pox and cardiac emergencies; they can refill lost medications, since one of the team members is a pharmacist.

Most of the patients served by the DMATs had been living in various parks and shelters since the earthquake occurred. Some were pregnant; others had lacerations and bruises. One child had chicken pox; another had a fever and sore throat.

The DMATs also responded to the acute care facilities at Northridge Hospital Medical Center and Granada Hills Community Hospital. All DMATs were demobilized on Sunday, January 30.

MOBILE HEALTH VEHICLES

In addition to the DMATs, 12 mobile health clinic vans, coordinated by the County Department of Health Services, were placed in service; they provided minor medical care needs to individuals in approximately 30 parks. Mobile health vehicles from Kaiser Permanente, Martin Luther King/Drew Health Center, and Mental Health Services also were placed into service.

STATUS REPORT

EMS personnel suffered only minor injuries, such as sprains and strains.

On January 25, 1994, a week after the most devastating earthquake in Southern California history, the Southern California Hospital Council released the following countywide statistics:

• 4,167 EMS incidents;
• 928 patients evacuated from dam-
• aged hospitals;
• 805 beds available (136 critical; 669 noncritical);
• 7,757 patients treated and released from emergency rooms;
• 1,496 patients admitted to hospitals;
• 61 fatalities; and
• 9,309 patients seen.

At $2 billion dollars and two lives a second, the Northridge Earthquake was the most devastating and costly earthquake in terms of lives and property. Results, however, could have been worse were it not for the efforts of LAFD Chief Engineer and General Manager Donald O. Manning, who maintained department command of this disaster and was directly responsible for implementing the fire department’s Disaster Preparedness Section following the 1987 Whittier Narrows Earthquake.

The Disaster Preparedness Section Community Program, initiated in 1988 by Manning and Councilman Hal Bcrnson, trains volunteers in groups of 50 to become members of Community Emergency Response Teams (CERTS), which arc dispersed throughout the city. CERTS members arc trained in basic disaster response. including fire suppression, rescue, and first aid. More than 10.000 citizens, more than half of them living in the San Fernando Valley, have been trained to date. Many volunteers were thankful for the training they received; some recognized that it saved their lives and those of family members.

LESSONS LEARNED

• A backup system for hospital communications is needed.
• In a major emergency, part of the fire department response should be to have EMS district captains physically drive through to hospitals and report back to Medical Command.
• Whenever possible, a management level representative from the Medical Alert Center should lx* present as a liaison at the fire department command post.
• Consideration should lx given to transferring the dispatching of medical resources from the Dispatch Center to Medical Branch Operations.
• Early logistical planning is needed if Casualty Collection Points are implemented.