I chose a disaster that is older than the assignment requested since it is one that I personally have experienced and felt compelled to reopen and examine…the San Francisco earthquake of 1989.
The SF earthquake was called the Loma Prieta Earthquake, with a magnitude of 7.1 and occurred on October 17, 1989 for a long thirty seconds. Amazingly, although it was one of the biggest earthquakes ever recorded in a populated American city, the casualty list was among the smallest and in all and causing more than 5 billion dollars in damage. Overall, 3,757 people were injured and treated at 51 local hospitals, and of those there was a 23% hospital admittance. 63 died; 60 of which died from major trauma from automobile crush injuries on-site. A majority of these casualties were from a fallen freeway and therefore did not receive hospital care.
Socioeconomically, culturally and environmentally, the SF Bay area which was hit is extremely diverse. The earthquake affected approximately 4 million people in six different regions. One common denominator in the healthcare system in all regions, at the time, was the healthcare system’s main focus on the AIDS “epidemic”, which was at its height of spread and treatment. Alt
hough all major healthcare facilities had disaster plans, not all stated after the earthquake that their plans went smoothly… or happened at all (Martchenke, 1994).
Some of the healthcare facilities benefited from more advanced and sophisticated communication, transportation systems, staffing assignments, facility preparedness and/or plain advantage of location. Infrastructure affected both healthcare providers and those in need alike; breakdown in transportation, lack of electricity and availability of transport routes decided who could give help or get help if having a medical need. According to one major study, the three top negative issues that the healthcare system encountered were: breakdown of communication systems, lack of proper transport and confusion among triage protocol. The last factor mentioned, triage protocol, referred to nurses and providers specifically. According to the textbook Disaster Medicine by David Hogan, only 70% of SF earthquake ER physicians and nurses stated that they were trained in disaster preparedness triage…and when the earthquake occurred only 50% utilized triage tagging outlined in the protocol. Principal reasons for not following protocol? Those who were interview stated that they did not believe that the tagging system for triage would be fast enough or effective. On a positive note, 90-94% of hospital administrators reported after the disaster that supplies were adequate, and that additional staff and volunteers had come to the hospital to assist. The bigger question I have is that if they hadn’t, would their needs have been met? The only relateable statistic I could find was a report that stated that 5%-10% of nurses that worked during the aftermath are quoted to saying nursing staff was inadequate (Tierney, 1991).
It is interesting to be doing research on this event in the current moment. My findings now are filling in a picture to complete my past perspective, when I was working at a healthcare office. According to my research and official reports, the overall consensus is that there was “adequate” healthcare available after the event, as reported in a study conducted by the San Francisco Emergency Medical Services Agency, the Disaster Research Center, California Emergency Medical Services Authority and the Federal Emergency Management Agency (Palofox, 1993).
I was managing an alternative healthcare office at the time, which included a nurse practitioner, chiropractor, massage therapist and acupuncturist. I had just left the office that day and was heading towards the bus stop when the earthquake hit. I was then witness to undulating sidewalks, rolling buildings and motor vehicles that were teetering back and forth. I myself felt as though I had suffered a bout of vertigo, as my legs gave out and I found myself falling to my knees. It wasn’t until the shaking stopped that I realized what had happened…a massive earthquake. Panic and mayhem ensued, as people began running around and traffic stopped in its tracks. Although my office was closed for the following two days, we reopened and offered free services to anyone in need for the following two weeks. As patients flooded in for appointments with various complaints, we found one major common denominator- that every person required additional time…not for modalities but moreso to talk. There arose an obvious psychsocial aspect to our care and just lending an open ear seemed to help patients immensely.
I think about the earthquake all these years later, and my own personal thoughts and feelings that I took away from the experience, and it is easy to surmise that PTSD was prevalent. It was difficult to avoid anxiety and depression back then. The disaster affected everyone, and knowing the terrible pictures you saw on tv were real and happening just down the block, made everyone scared. Even I had problems sleeping and worried constantly with every post-tremor. Everyone was tense both physically and emotionally.
Could this happen again? Will there be another earthquake in that region? Currently the United States Geological Survey states assigns 2-in-3 odds that one or more destructive earthquakes (magnitude 6.7 or larger) will strike the Bay Area in the next 30 years (USGS, 2011). This could affect another 4 million people…
If there are any other lessons to be learned from the SF earthquake from a healthcare perspective, I imagine it would be for the hospitals to take a closer look at why their response and supplies were deemed “adequate” and not “good” or “excellent”. Since extra staff/volunteers were (luckily) present to assist, it would be good to take a closer look at minimal staffing needs in the case of another disaster, and not to rely too much on walk-in assistance. Re-examining the resistance regarding use of triage protocol would also be a good idea. It seems that staff anxiety regarding speed took over better judgment of sticking with a proven protocol. Improvements in the communication/emergency systems also requires improvement, as it was stated by most all hospital administrators that it was not quite clear who was in charge and held empirical authority on communication dissemination (Pointer et al, 1994). Lastly, implementing more healthcare during and after, that addresses PTSD and psychsocial conditions, would be of great service to victims and those affected.
I learned some lessons too. It was soon after the earthquake that I studied to become a licensed ham radio operator, and participated in emergency disaster drills run by the City of San Francisco. Cell phones were not prevalent back then, so having a radio was the closest thing to having one and being able to make contact with another person or emergency services if telephone service was out. I also made sure that I had an emergency kit of supplies at home and took my first CPR class.
These days I feel more prepared regarding disasters, and I hope that the SF Bay Area is as well. Their healthcare facilities now have had experience and over twenty years to prepare for the next disaster. Numerous studies and recommendations have been examined in preparation. In addition, the Bay Area Earthquake Alliance was formed that incorporates over 180 organizations and agencies that assist in analyzing data and in making additional recommendations to healthcare facilities. The USGS has also partnered with local agencies to make recommendations that affect infrastructure, which ultimately will improve transportation corridors to healthcare facilities.
Now that I am studying nursing, I can appreciate even more all the efforts made in the healthcare community in the SF Bay Area. I applaud all of the healthcare workers that provided care during the earthquake and do wish all the best to my former home!
REFERENCES:
Hogan, D. (2007). Disaster Medicine (Vol. 1). Lippincot, Williams and Wilson, 116-118.
Martchenke, J. (1994). Hospital disaster operations during the 1989 Loma Prieta earthquake. Prehospital Disaster Med, 9(3), 146-153.
Palofox, J. (1993). The 1989 Loma Prieta earthquake: Issues in medical control. Prehospital Disaster Med, 8(4), 291-297.
Pointer, J., Michaelis, J., Saunders, C., Martchenke, J., Barton, C., Palafox, J., Calabro, J. (1994). The 1989 Loma Prieta earthquake: Impact on Hospital Patient Care. Annals of Emergency Medicine, 1228-1233.
Tierney, K. (1991). Emergency medical care aspects of the Loma Prieta earthquake. University of Delaware Disaster Research Center Publication, (161), 9-14.
USGS (2011, February 1). Retrieved November 29, 2015, from http://www.usgs.gov/blogs/features/usgs_top_story/progress-toward-a-safer-future-since-the-1989-loma-prieta-earthquake/
The collapsed Oakland Cypress Freeway.
60 people died on-site; civilians and professional medical providers rushed to the scene,
saving many other lives before first responders arrived.
An apartment building 6 blocks from my home.
Amazingly there were no casualties.
The SF Loma Prieta Earthquake
