We interrupt this program….Emergency Preparedness 101: first installment

Robert Mitchell, M.D.

Robert Mitchell, M.D.

We interrupt this program….

Remember when this pronouncement meant something to listeners or viewers? Like many of you in the 12th Man, I found myself glued to Super Bowl Champion Seahawk parade coverage. Listening to a jubilant Dori Monson, Brock and Danny on Seattle sports radio, I was hit by a real-world reminder. Dori became serious, changed his tone of voice announcing he had been asked by city officials to request parade revelers to “stop using their cellphones” because 911 calls were not getting through. This piqued my interest!

Why, you may ask?

Struck by the lightning bolt of 9/11, I became interested in emergency preparedness. Now board certified in Disaster Medicine, I work on emergency planning with Snohomish County Fire District 1 and Swedish Edmonds. As Seattle officials pleaded for citizens to reduce cell traffic, I was immediately reminded of the recent American College of Emergency Physicians revelation of the failing grade and rank of #50 for Washington State in healthcare disaster preparedness. This call for cellphone stoppage indicated to me emergency planning for this event fell short.

Surprising?

Fire, paramedics and hospital personnel know they are not equipped to take on a major emergency and steps must be taken: we need back-up, shared and exercised communication tools for when the cell towers go out or are over-taxed, like during the Seahawks parade; we need to credential responders; we need reliable patient tracking and family reunification systems, management of volunteers, and training and coordination of healthcare providers and responders to name only a few.

Let’s walk through a recent minor emergency; Nov. 21, 2013, a three-alarm fire and subsequent hospital-wide power outage at Swedish Edmonds. No one was injured and hospital services came back on line fairly rapidly thanks to the diligence of hospital personnel working round the clock together with Fire/EMS crews. That said, many of the same weaknesses in communications, tracking, command protocols, emergency response plans, hospital emergency preparedness became evident.

THIRTEEN YEARS since 9/11 and millions of dollars later spent nationally, why are we still unprepared for emergencies?

To help answer some of this, I had lunch with retired Army Lt. Gen. Russell Honore when in New Orleans last month while attending a disaster preparedness conference. You may recall he was the nightly face on CNN, heading the response effort to Katrina in 2005. While in conversation, I asked his definition of resilience. He did not respond with the standard dictionary language of “the ability to return to normal.” Instead, touching his chest he said, “Resilience comes from within. It does not come from the outside.”

He further clarified that an individual, an organization, even a community must have the wherewithal to be self-reliant. You cannot wait for outside agency or government rescue. He believes the tendency Americans have to depend on outsider help stems from the reliance on tools such as a smartphone. “Whenever anyone encounters any kind of challenge or hurdle, they no longer problem-solve independently. They reach for a laptop or Google to solve their every problem…or wait for the government to solve it for them.”

Those of us trained in emergency preparedness know the government will not be able to help for at least a week during a major emergency, and every community and family should be prepared for that.

Alarmingly absent from the disaster preparedness discussion are the Snohomish County Medical Society and the Washington State Medical Association. Neither organization offers any acknowledgement of the need for hospital or provider preparation in their publications or meetings, as if the risks do not exist or because they do not see disaster response as a healthcare issue, even in the aftermath of Hurricane Katrina. Suggested required reading for these organizations is ‘Five Days at Memorial’, by Sheri Fink, about the avoidable hospital chaos post-Katrina.

Catastrophic emergencies rumble forth like a runaway train without brakes, plowing through one community after another, including Boston’s marathon bombing, West, Texas’s fertilizer plant explosion, Pennsylvania train derailment, the Midwest’s tornadoes, eastern seaboard Hurricane Sandy, blizzards and power failures. Bad things happen and will continue to happen. What can we, here in quiet little Edmonds, do to be ready and more resilient?

Each installment I will give a tip to improve your family’s resilience and a tip to move our community toward an “A” in emergency preparedness.

#1: Personal preparedness empowerment: Even when cellphone voice capability fails due to over-taxed towers, text messaging can still get through. The key to personally seeking help all the way to the larger overall coordination of response and accurate messaging to the public is communication. Communication fails, the response fails.

Bonus tip: Be sure your loved ones know an out-of-town/state (OOT/s) contact to use as a shared check-in point in case all phone systems are down due to over-usage. Long-distance lines will remain available despite local system overload. My family knows to check with my friend Charlie in Pennsylvania if it should ever be necessary to find each other in a catastrophic disaster….Please don’t call Charlie. Set up your own OOT contact.

More to come…stay tuned.

-By Robert Mitchell, M.D.

Dr. Robert Mitchell, an Edmonds resident for 30 years, is board certified in Disaster Medicine and OB/GYN and maintains an avid interest in disaster response planning volunteering all his time. He has worked with Joint Base Lewis McChord, hospitals, law enforcement and the fire service in disaster response planning and exercises. Additionally, he is the medical director for the SnoCO Fire District 1 Disaster Medicine Project, a collaborative effort aimed at improving community resilience to disaster. Dr. Mitchell attends the Region 1 Healthcare Coalition that serves the 10 hospitals in the 5 counties north of Seattle as well as the Emergency Management committee at Swedish Edmonds Hospital and is an instructor in Basic and Advanced Disaster Life Support.

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8 Comments

  1. Good time to get on top of this, particularily with the recent F grade. When I lived in Seattle a number of years ago, we set up a major emergency preparedness program (with original information, maps, etc. from the Seattle Emergency Preparedness people, two info meetings with them also, notes on supplies to set aside, etc. ) right on our own Block Watch block in conjunction with our Block Watch meetings.

    It turned out to be quite simple. Everybody enthusiastically wanted to be a part of this. Everybody in each house was given a responsibility should a major event happen. We were fortunate to have a couple of doctors and nurses on our block, so one of their houses became the triage area where people that were hurt could go to for help (medical supplies kept at those houses, bandages, etc). A few people were chosen to transport people and had simple equipment at their houses for that. We had two people that would go house to house and do a count of people/animals in each house and post on the window. Two athletic people had the job of walking or riding a bicycle (if possible) to where the short wave radio station had been set up for our neighborhood to get or give information regarding our area and injuries/casualties. damages, etc. to the city….Three people were chosen to do a simple assessment of damages for each house……So everybody on the whole block had a different job to do in regards to helping during an event. Everybody also got a list of all the things they should set aside (outside of their house somewhere) for such an event, water, wind-up radio, flashlights, batteries, etc. …..even information about keeping a pair of shoes always by your bed in case an event happens in the middle of the night and you have to walk through broken window glass in your home…..

    Anyway, this was ALL very SIMPLE and easy to set up, block by block, on a very local level. I think this could easily be done in Edmonds with all the Block Watch people/neighbors.

  2. Tere,

    First, thank you for your insightful contribution to the discussion! Your explanation of Neighborhood Watch programs is perfect, exactly the level of participation that needs to occur at the “cul-de-sac”, “front porch”, “over the fence” level. This is how you keep your families and neighborhoods involved and informed.

    It also happens to segue right into my next article, “It really DOES take a village”. I’m not sure that was Mrs. Clinton’s intent in her statement, but the reality is that WE as neighbors need to recover some of the “yesteryear” where communities knew one another; churches and schools were involved. We can’t hide from or prevent all of the harshness of emergencies; we can embrace them as opportunities to get to know one another. I still remember the closeness that occurred nationally in the aftermath of 9/11…even way out here, 3000 miles away.

    Thank you very much, Tere!
    Dr. M

  3. Thank you for the article Dr. Mitchell. My husband and I also reacted to the request to stop using cell phones because of the overload. We have become a nation of must send pictures too that definitely causes overload. Also a great idea to incorporate this with Block Watch and getting to know our neighbors.

  4. i recommend taking a CERT class, community emergency response team – http://esca1.com/upcoming-cert-classes/

    there’s also the communications part of esca…

    the official site is http://www.fema.gov/community-emergency-response-teams

    get involved

  5. Victor,

    Thanks for weighing in on this very important “cul-de-sac” conversation!

    You said it. CERT training IS OUTSTANDING. An excellent combination of hands-on and classroom training, CERT is a wonderful opportunity to, as you say, get involved and team-build with your friends, family, church groups, organizations, neighborhood watch, colleagues from work…you name it.

    If you don’t have the time in your daily grind to fit this in, you can go on-line after the Olympics wind down and take Core Disaster Life Support (CDLS) offered by the National Disaster Life Support Foundation. Cost $15.

    This link takes you right there:
    http://register.ndlsf.org/course/search.php?search=coursesearcheCDLS

    The value of the CDLS course is to provide participants from diverse professions, disciplines, and backgrounds with a common understanding of emergency response actions. It will appeal to a broad range of audiences, including medical first responders, health professionals, health service providers, public health workers, health support personnel, and anyone interested in learning about disaster response.

    Upon completion of the CDLS course, you will be able to describe actions that can be taken to enhance your personal and community preparedness and resilience for emergencies. Great for the Neighborhood Watch!

    Thanks, Victor. Your contribution is appreciated!!

    Dr. M

  6. Dr. M,

    Several years ago, after watching the debacle of Hurricane Katrina, I woke up and realized that our Government was incapable of protecting the population when disasters were predictable a few days out. At this point I had an awareness but didn’t really take steps towards a preparedness lifestyle. Then one day I heard a discussion in Which Newt Gingrich discussed the book “One Second After” by William R. Forstchen. So I picked up a copy and thus began my dive into the world of Emergency Preparedness.

    I came to realize that our society has become highly dependent on both technology, just in time delivery systems, and the specialization of trade that has made independent self sufficient living a thing of the past. One need only to look at Walmart shelves a few hours after an announced hurricane or winter advisory to see the risks and results of the low levels of inventories stores nowadays carry. I began to assess the risks facing my family of short term, medium term and long term threats.

    Having lived through an Ice Storm in Eastern Washington where the power was out for over a week in some areas and having a lot of training as a youth in camping, I felt somewhat prepared for most short term events. A major wind storm, ice storm, major flooding are real events that impact our area that might require 2, 3 days or a week of independent living. FEMA, the Red Cross, state and local emergency management agencies have been advertising for many years the 3 day kits but it is surprising how many people are not even ready for this type of event.

    Two medium to large scale events in our region that have significant probabilities would be an earthquake on one of the major regional fault lines like the South Whibey Island Fault line, Seattle Fault Line, or the ten or so other regional fault lines. An even bigger threat is a 9.0 earthquake on the Cascadia subduction zone fault line that has a historical pattern of major quakes every three hundred years or so that could create significant tsunami waves as well as crippling infrastructure throughout the region. Additionally, we do sit along the Ring of Fire and have several active volcanoes in the state of Washington that could Erupt aka Mt. St Helens 1980.

    My observation is that this area does not seem as well prepared as California for significant quakes although our risks are not much different.

    The risks that seem to have the least amount of statistical risks, are major man made disasters such as an EMP, or major economic disruption due to currency collapse, aka Argentina, Venezuela, or political instability aka Ukraine, Syria etc.These risks exist but have far less day to day potential than a major earthquake.

    The experts now suggest people prepare for up to 2 weeks of independent living. To me this is the very least that one should do. If many of the major bridges along the I-5 corridor was collapsed , the Puget Sound ports closed, and the regional rail network cut off simultaneously due to, it would take months, if not years to return to normal.

    In any crisis, the thin veil of civil behavior would be at risk and potentially a significant percentage of local first responders would desert their posts in favor of taking care of their own families.

    So my recommendation to our neighbors is to remember is to :

    1. Assess your personal risks: Do you have a loved one who is medication dependent, or dependent on the power grid for a medical device. Do you know where your utility shut off valves are. do you know several ways to escape your neighborhood if necessary say due to a train derailment with hazardous chemicals.

    2. Develop a plan in coordination with your family members. Where will you go if an earthquake hits,…

    3. Priorities having:backup(reserve) Water, Shelter, Food, fuel, medicine, security, tools etc in place. A saying I found help full is that “Three is two, two is one, and one is none”

    If you had to survive fore more than two or three days could you find and purify your own water. For example, I have bottled water for several days, I have my hot water tank as a reserve, chlorine bleach as a chemical purifier, iodine tablets, a ceramic backpacking filter, and boiling as methods for purifying water. I know of multiple freshwater sources within a mile of my house. Now take this model and work it out with Food….. Shelter(Heat) ……

    I wish everyone well as you consider your personal preparedness strategies.

    David

  7. CERT training is excellent. I completed mine on February 8th. I also recommend Skywarn Stormspotter Training. One eye to the sky and an ear to the ground are always helpful regardless of where you live.

    David mentioned water and his suggestions are excellent. In addition to those he mentioned, consider a portable filter, such as a LifeFilter. I own it, have used it and recommend it. I’m planning to install rain barrels next. Never underestimate your need for water.

    Food is next – and protein bars are great – but as emergency sources, such as in a 72 hour bag. I think it is better to pack your own supplies rather than buying a huge lot of meals prepared by a company. If you can, dehydrate your own fruit, etc. Pack your own nuts – buy in bulk, sure, but don’t buy a bunch of prepackaged meals that you may not even like. Don’t forget your pets, either. They like to eat, too.

    More than anything – plan every step of your own survival and don’t depend on anyone else. You can’t count on anyone else. Maybe someone else will be there, but you don’t know that. Do you want to tell your hungry kids that you have no food because you didn’t take the time to think ahead?

    Not me. My kids deserve better than that.

  8. David,

    Hats off to you!

    If I had to pick the “calendar” guy for emergency preparedness, you are that guy! Thank you for your excellent summary, list/tips and advice regarding personal preparedness.

    You are so right that few in our midst are really ready to “dig in” in the event of any significant emergency and to live under austere conditions whether as individuals, households, businesses, hospitals or schools.

    I live the same daily grind as everybody. As the sun goes down, I feel my energy draining, trying just to keep up with doctors’ appointments, work, the kids, my aging relatives, the bills, my gutters, on and on in my own hamster-wheel life. Who has the time, money and priority to actually do what you have done in your house with your family? ……. Darn few of us.

    Attending the “state of the city” address today as a spectator and 30-year resident of Edmonds, as I listened I closed my eyes. I could actually see just what Carolyn and the mayor were brushing before me on the Edmonds canvas…scenic, vibrant, active, growing, healthy, walkable, safe, beautiful, thriving…all appropriately wrapped in the context of cooperation and relationship-building.

    Then, the number of trains passing daily was mentioned…30-35 jumping to 104…WOW! 3X the number as today! Another much darker image burst into view behind my still-closed eyes.

    I, too, often sit in my car impatiently waiting to go to Anthony’s Homeport or Arnies or the park as a seemingly ENDLESS train rumbles by. I get the inconvenience.

    However, this increase in trains adds a whole other level of hazard beyond coal dust to the “vacation-land” of the Edmonds we love. A bridge or tunnel won’t fix this or lessen the number of trains. Think about it. Prepared?

    David, I believe the very same successful, “collaborative” approach to economic, social and fiscal progress so eloquently laid out in today’s mayoral address is the same approach our neighborhoods, schools, churches, businesses, hospitals and yes households must use to be prepared as well.

    Thanks for taking the time to share your thoughts and ideas about this important topic.

    Dr M

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