Jan 232015

My first thought after I saw Why Would You Build a Hospital in a Tsunami Zone was “who would knowingly build a critical facility in a inundation zone?”  As I read more, my opinion changed. It makes sense for the community. I was, however, struck by the adversarial tone between the community and the state, and the lost opportunity to develop a “promising practice” for jurisdictions that face tough choices between current needs and looming, future disasters.

Emergency on the Horizon
January 26, 2015 is the 315th anniversary of the last Cascadia earthquake and tsunami.  Geologists tell us we’re living on borrowed time until another major event occurs. What might this event look like?  If this scenario developed by the Cascadia Region Earthquake Workgroup is any indication, it will be devastating:

It’s 8:16 on a chilly, wet morning in early spring. You’ve just arrived at work and are pouring a cup of coffee when you become aware of a low rumbling noise. Within seconds, the rumbling becomes a roar, the floor beneath you heaves, and the building begins to pitch and shake so violently that you’re thrown to the floor. The roaring is joined by a cacophony of crashing as windows shatter and every unsecured object in the room—from the desk chair to the coffee pot—is sent flying. Shaken loose by the shuddering and jolting of the building, dust and ceiling particles drift down like snow. Then the lights flicker and go out. Remembering to “drop, cover, and hold,” you crawl under the nearest table, hold on tight, and tell yourself that the shaking should last only a few seconds more . . . but it goes on and on.

If you live along the coastline, you have approximately 20-30 minutes to seek high ground.  Scientists estimate that waves from a 9.0 subduction earthquake off the coast of Oregon could reach between 60 and 100 feet above sea level.  Local topography will play a role in how much tidal surge an area receives. But if your community has seen tidal rises in previous tsunamis, you’ll certainly see this with a Cascadia event.

Based on the picture of impending catastrophic disaster, readers might suspect the state is correct in suggesting the hospital not build a hospital in the tsunami inundation zone. But I don’t think they are in this case.  Let me explain.

Current Needs vs. Predicted Risk
The current hospital is in drastic need of repairs and updating. It’s so bad that the fire marshal gave them until mid-2016 to build a replacement building or face closing the doors due to safety concerns.  In 2013, the community voted to support building a new one by passing a bond measure.  Planning and designing is complete and the new facility is scheduled to open in 2016. Both the hospital and community seems to have done their due diligence in looking for alternative locations, but there don’t appear to be viable site solutions based on their needs and resources.

After the local work was done, the state entered the discussion and suggested the siting of the new hospital represents a failure. I disagree.  It’s true that a Cascadia event will occur in the future and will represent a catastrophic disaster for the west coast of the United States and Canada, and that the new hospital will sit only 50 feet above sea level. It’s likely that one or multiple floors of the new facility will be flooded by a Cascadia event tsunami.  However, it’s also true that community members seek and obtain their medical care from Curry General Hospital every day.  To suggest the community is better without any hospital now because it may become uninhabitable in the future, makes no sense.

Assessing Daily Needs
Besides the daily impact a local hospital has on the health of community members, it is also a key economic and societal driver in the area.  On average, the clinic and urgent care facility sees 2,000 patients per month.  The new hospital will have 18 in-patient beds.

Did the state really weigh the impact to the health and safety of the whole community on a daily basis multiplied over the number of years until a possible Cascadia event occurs?  Does the state really mean the site represents such an immediate danger to suggest it was wrong of the hospital to move ahead? Did the state step up with a solution other than “don’t build it there?”

There may have been discussions I’m not aware of, but this points out the need for inclusive planning to take place at a community level to let community stakeholders decide what’s best for them.  kobebldg

Make Alternate Plans
I understand the new hospital may have up to 18 patients and maybe three times that number of staff at risk when the next Cascadia earthquake hits.  They have designed the hospital so that inpatients and most staff would be on upper floors which may offer some protection against tsunami flooding.  However, they could also develop and practice patient evacuation plans during times of low patient census — there will only be 20-30 minutes for the task. Training is key.

Gold Beach or Curry County could also explore a sister-county agreement with an Oregon county not expected to be impacted by a Cascadia event. That way someone will be prepared to come to their immediate assistance.   This was a lesson learned by some prefectures in Japan after the 1995 Kobe earthquake and again after the 2011 Tohoku earthquake.  Rather than wait for help to come, they had pre-planned where assistance would come from and what it would entail.

Select Disaster Staging Areas
The state should recognize the daily economic, societal, and medical benefits that will come from a new Curry County hospital.  They should also recognize that Curry County may not have a hospital after a catastrophic event. So why not develop an interim solution to helping survivors?

I suspect that within Curry County there are state buildings or forest land which sits on higher ground that would not be prone to landslides.  Why not help the county stockpile or pre-stage supplies within shipping containers to help survivors until more substantial help can arrive?

There are solutions to be found.  We just need to open our eyes and look for them.

images The whole topic of where to site something brought me back to one day at the mouth of the Columbia River.  I had been doing ground validation work of our tsunami inundation maps with an Oregon geologist.  We stood at the lookout tower at Fort Stevens State Park, taking in the view of the beach and Pacific Ocean in front of us, the community behind us.  The geologist said “this will all be under water some day”. Then he went on to say, “I’d build a house right here today if I could, it’s beautiful.”

I’m curious to your opinions on the situation currently underway in Gold Beach, and what your recommendations would be.

Jan 122015

When people are put under stress they fall back on one of two things; experience or training.  Make 2015 the year that your organization offers current, relevant and engaging training for your personnel.

Below is a partial list of programs to help you keep your staff safe, improve performance and enhance efficiency withing your organization.

Improving Survival in Active Shooter Situations

Personal Protective Equipment: Train-the-Trainer

Hospital Emergency Response Teams

Medical Response to CBRNE Events

Managing the Critical Patient

ICS 300

ICS 400

Updated and Advanced Hospital Incident Command System – HICS

Customized ICS Development Consultation

Initial Incident Action Plan Library Development Seminar

Strategies and Tactics for Reducing Disease Transmission 

Highly Pathogenic Disease – PPE Confidence Building Course

Medical Consequences of  a New Madrid Earthquake

Consequence Planning Seminar and Exercise for a Cascadia Event Tsunami 

Discussion-based and Operations-based Exercises



Dec 222014

In a perfect world police are there to handle criminal acts, fire fighters available to perform rescues, and EMS personnel close at hand to apply life-saving interventions.  Unfortunately, that is not always the world we live in.

We need to have the conversation on how best to address the “planned” response to the aftermath of a violent criminal act.  The data tells us it could occur anywhere — at work, out in public, a recreational facility, sporting event, place of worship or healthcare facility. Unless it occurs at a police, fire, or EMS station, the first people on scene will be members of the community. Why don’t we train them so their reaction is not random but based on tasks designed to positively influence survival?

There are a number of mitigation strategies organizations and facilities should undertake in cooperation with their local police and emergency management agencies.  This can include training their staff in how to respond to this type of situation — a program similar to people learning CPR.  Lets call it community-based hemorrhage control for lack of a better term. Science tells us that the people whose lives are saved at the next attack will be by someone who can apply a tourniquet within minutes of injury.

Consider this case study from the Boston Marathon bombing.   A 34-year-old man was brought to an emergency department at a hospital suffering from multiple traumatic injuries which included a complete amputation of his leg below his right knee.  A tourniquet had been applied to the right upper leg by prehospital providers but was not adequately tightened to control the bleeding.  At the hospital the tourniquet was tightened, and a second, military-style tourniquet was added which stopped the bleeding.

Tourniquets work and the risk of complications from aggressive and unnecessary use is outweighed by the risk of not controlling bleeding in situations like these.  The public is trained in CPR. We see Automated External Defibrillators (AEDs) in most large buildings and venues, all designed to help save lives from heart attacks.  Granted, more people die of sudden cardiac arrest than bleeding to death from a gunshot wound or blast injury from an Improvised explosive Devices (IEDs, but there is a need for this training.

I’m advocating all citizens learn how to improve survival in active shooter situations and to use hemorrhage control kits that are placed in venues alongside AEDs.  image-prod-502

Like it or not, members of the public will be first on scene of the next sick attack by a gunman or the detonation of an IED. Why not offer training designed to change the outcomes of the wounded? Naturally there is risk to any type of action in the face of this type of attack and education is the best way to give them the ability to make the best risk-reward decision.

I look forward to your comments and discussions in how we prepare to handle these emergencies.