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Wildfires: Review community communications, train for quick evacuations

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January 1, 2019

In November, California suffered its deadliest wildfire in history, the Camp Fire. This single fire killed dozens of people, destroyed 10,500 homes, and burned an area the size of Chicago. Two weeks after the initial blaze began, the casualty toll stood at 85 deaths and more than 200 still missing.

During these fires, healthcare workers stepped up to take care of patients before escaping the flames themselves. Hospital workers evacuated patients in ambulances, police cars and personal vehicles as the fire swept through the Paradise, California, community within hours, according to media reports.
Stories included problems not only with fire damaging structures and vehicles, but smoke and ash clogging mechanical engines and creating blinding conditions for evacuees.

Even when such fires burn out, the reprieve is expected to be short. As climate change raises temperatures and brings more droughts to the West Coast, wildfires are expected to become more frequent and dangerous.

San Diego County has been spared from this year’s fires, says Sharon Carlson, RN, director of Emergency Preparedness at Sharp HealthCare. But that’s not to say they aren’t familiar with wildfire.

In 2007, San Diego County had a huge wildfire that forced several hospitals, nursing homes and behavioral health hospitals to evacuate. Sharp Healthcare was one of the hospital systems to take in some of those patients at that time. And the area suffered from a devastating wildfire in 2003, the Cedar Fire.

Carlson spoke recently about lessons learned from Sharp's previous brushes with wildfire, and how her healthcare system prepares for the next one.

This Q&A has been lightly edited for clarity.

Q: What problems did Sharp Healthcare face during those fires?

Carlson: Truthfully, for our hospitals evacuation hasn’t been an issue [during wildfires]. It’s been smoke.
Smoke gets into your hospital and you have work with your engineering department and air handlers to make sure the filters are changed and the environment safe for people to breathe. I think that is some of the stuff that Northern California is dealing with right now. The communities that are devastated by the wildfires are now surrounded by smoke. So they’re dealing with increased asthma [and other respiratory problems.]

We’re a little bit better protected [from flames] here because our hospitals aren’t rural. We’re in a [metropolitan area] … There’s buildings all around, and just by virtue of the fact that the building is made out of the materials it’s made of, it’s pretty fireproof. It’d have to be like it was in Paradise, California [location of the Camp Fire] where it was surrounding them and burning right through to their hospital because it’s not a big city.

Our risk for that happening is less than theirs—not that it can’t happen.

Q: What did you learn from previous wildfires? How did you modify your emergency plan as a result?

Carlson: We learned after the Cedar Fire that we didn’t communicate well with all the community, citizens, and hospitals and that we needed to make some improvements. So San Diego has been working on better response to everything since 2003.

That takes us to 2018 and now we have communications platform, a strong disaster coalition that consists of hospitals, clinics, nursing homes, public agencies, and emergency medical services. We meet once a month.

What we’re looking at in those meetings is how are we doing on our planning, lets share some best practices, and let's develop new processes if need be. For example, the coalition has two sub-committees that are working on best practices identification for a couple of responses. Mine happens to be evacuation.

Q: What is your committee working on now?

Carlson: We are reviewing our current evacuation plans and identifying best practices. Then we share those tools with all the other hospitals and healthcare entities to make sure that people are on the same page.

We have a program in San Diego called TRAIN [Triage by Resource Allocation for IN-patient matrix]—a way to identify what kind of transportation your patient needs to be evacuated. For instance, if it’s someone in the ICU who has a ventilator to help them breathe and IVs and tubes coming everywhere, they aren’t going to be able to get out of bed and walk to a school bus to be evacuated.  (For more on TRAIN, see p. 8.)

We color code our patients on a regular basis so if it’s 3 a.m. and you have to evacuate, we can say “ok I have 10 red patients.” That immediately tells the people we work with on transportation that they’re going to need specialized ambulances [or whatever kind of transportation we need.]

We also have an arrangement with local public health that if a hospital has to evacuate we will share the TRAIN colors with them (15 reds, 13 blues for example) and they’ll arrange the transportation and we’ll wait to hear from them.

Now that doesn’t mean we won’t go right away if we have to. If we have to go right away, we will. But we like to think that we can stay on top of it and nobody has to leave without a plan.

And because [Sharp Healthcare] is a big system, we have a lot of our own vehicles. Not ambulances—but patient care vans and pickup trucks, cars, shuttlebuses and things we use every day for transportation.

We’ve written those into the plan and we have someone who oversees that and ensures that at the end of the day those vehicles are filled with gas and those drivers have agreed to take calls. That way if something happens at 2 a.m. and we need to move people or stuff or supplies or staff, we can activate those ourselves and move patient A to hospital A.

And because we have multiple hospitals before I request patients to go elsewhere we try to [relocate] them in our own healthcare system.

Q: Circling back to improving communications, how do you communicate with other facilities and entities during a disaster now?

Carlson: We use a communication platform called WebEOC [for incident management] and that program allows us to communicate during a disaster. That’s how we get news on the current [2018] fire.
In fact, we just finished a [pandemic] disaster drill an hour ago and we used it during the drill to communicate with other hospitals, other healthcare entities, and county authorities. We all communicate on this platform. Hospitals and clinics have their own [status] board, and utilities in town have a board so if there’s a gas line failure or something.

If I knew there was a wildfire, I’d immediately looked to WebEOC to see, where is the incident, how close is it to my hospital, what are the fire experts saying about how it’s spreading, and what we need to do here.

Q: Any other lessons you’ve learned from prior wildfire experiences?

Carlson: One of the things we learned is to classify disaster victims now.
We have category called “Worried/Well.” We now know that people who are worried, [for example] they have diabetes or heart disease or they’re older and live alone and don’t have as many resources, they decide when they know something is happening they’ll just go to the hospital because it’s safe there.

What we’ve learned is that we have to do a medical exam assessment to make sure there isn’t a current medical issue. But then we realize who these people are and can work with our county to determine where the shelters are and get transportation to move them to a shelter if they’re unable to stay at their home. But what we don’t want to do is absorb them all in-between our walls because they’re taking up space we might need for sick or injured patients.

That’s one thing we’ve learned, and San Diego county authorities have helped us plan for that.

Q: How is preparing for a wildfire different than preparing for other types of disaster?

Carlson: Preparedness isn’t different. The way we prepare for any disaster is that we identify our risk factors first, then we rank those risks based on our geography and location. We do a Hazards Vulnerability Analysis (HVA)—we look at San Diego county and say, “What are the common risk factors here?”

And we know in San Diego wildfire and earthquake are always at the top. We live in a state where there’s earthquakes and where, it feels like, wildfires are becoming an everyday occurrence.

All our hospitals sit in very metropolitan area. San Diego County is very spread out and we have hospitals all over the county. However, my hospitals [Sharp Healthcare] and most hospitals are not in wooded, rural areas. They’re in cities. I have one hospital that sits across from a big mall, one near a freeway.

So our risk for our hospital actually being overrun with fire is lower than an area like Paradise, CA or Northern California where it’s smaller, rural communities with a lot more brush, shrubs, and trees.
It doesn’t mean we’re completely immune and we know that. So what we’ve done is beef up all of our communication processes—how we identify when there’s been a wildfire, etc. That ties into our fire plan of how do we evacuate, when do we evacuate, what do we use, how do we transport patients?—we plan for all of that.

Q: Any other advice you give on wildfire emergency preparedness?

Carlson: In San Diego County there is, on an ongoing basis, a lot of education to our citizens about being prepared for a wildfire. And there are simple things that you can do. One, you have to keep some defensible space around your house.

For example, I happen to live in an unincorporated area of San Diego. I own about an acre of land and I have trees and whatnot. We’re always clearing brush to keep a defensible space around our house. So that education goes out.

Two, we educate our employees on personal disaster preparedness. By which I mean, do you have a disaster plan in your own home? Do you have extra water, flashlights, non-perishable food, and batteries? Are you sure that at the end of your day you have gas in your car in case you have to evacuate in the night?

I used to be one of those people who used to drive home on fumes and be like “oh, I’ll get it tomorrow.” But what if it’s 3 a.m. and you have to leave?

We do a lot of education with our staff on being responsible, having a fire plan or disaster plan at your home and to make sure that our employees have access to [information] that not only list our healthcare policies, but give them information on what they need to be prepared in their own home.

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