Silver lining in explosion disasterBy Bil Paul
With the massive explosion and fireball that consumed more than three-dozen homes and killed eight people in a quiet San Bruno neighborhood almost two months behind us, the effectiveness of emergency responses that day are still being looked at.
The first responders primarily tried to put out the gas-fed fire, which started raging out of control just after 6 p.m. on Sept. 9.
Residents needing medical treatment were ferried to nearby hospitals by ambulance, friends or other residents, and some even drove themselves. Fortunately, there are three hospitals within a five-mile radius -- Kaiser Permanente in South San Francisco, Seton Medical Center in Daly City and Mills-Peninsula in Burlingame.
The closest is Kaiser, which I expect received the most patients. I was particularly interested in this medical center, since I'd worked there some years ago. So I interviewed physician-in-chief Dr. Michelle Caughey and Environmental Health and Safety Manager Jim Wadkins about their experiences that night. Both were off-duty when the disaster struck but returned soon after.
While I worked there, the hospital took part in an annual San Francisco International Airport plane crash drill. Because the hospital is under a takeoff route from the airport, preparing for a major jet crash is the right thing to do. Volunteers were used to simulate victims, and all of the various local and county emergency responders played their various roles. Over the past several years, I was told, the hospitals have been left out of these annual drills, which isn't right. I see that a drill at the airport on Sept. 22 dealt with a security threat rather than a plane crash. Chances of a plane crash are much greater than a terrorist attack.
Because of Kaiser's experience with airplane crash drills and its emergency plans, it could swing into action on the night of the disaster. When the first patients began to filter in and the hospital began to learn the extent of the emergency, a "code triage" was called, which pulls together extra personnel and sets up an area with many gurneys on which to place patients in a holding pattern. There, doctors determine which victims need immediate help and which can wait.
This staging space was in the emergency room area. Doctors (surgeons, cardiologists, critical care specialists and anesthesiologists) who didn't normally work in the ER department came over to help out, and some patients were also handled by the minor injury clinic, which hadn't yet closed for the day. Several doctors from other nearby Kaiser hospitals also drove over to volunteer.
"(At first) it was unclear how many casualties we might expect," Caughey said. By the time the night was over, the hospital had taken in 31 San Bruno patients. Of those, four serious burn cases were transferred to other hospitals with specialized burn units. Caughey and Wadkins worked into the wee hours of the morning managing care and operations, not leaving until it was determined that no further patients would arrive.
Another aspect of the hospital's responsibilities was managing the many calls from people asking about patients and their status.
I asked what the hospital had learned from the experience. "You learn from every disaster," Wadkins said. "One of the things we always work on here is communication. You can never improve communication enough, whether it's communicating with our partners in the county emergency organization, or communicating with our staff here. We always learn things we can do better."
This tragedy, as awful as it was, could have a positive outcome if it helped emergency responders better prepare for a large plane crash. Boeing 747 jets that take off overhead can carry as many as 500 or 600 passengers. If one of those jets crashes, the number of burn and other victims could really stretch nearby hospitals' capabilities beyond their limits.
I think it needs to be worked out how to better apportion patients to the various hospitals, which can be quite difficult when patients are driving or being driven to the hospitals.
Copyright ©2010 Palo Alto Daily News. Published 10/28/2010.