V O L U M E 4 , I S S U E 6 J U N E 2 0 1 5 MMRC News · When relief workers finally entered...
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INSIDE THIS ISSUE: MMRC News 1 Message from the Program Manager 2 Mission Statement 3 Disaster Medical Care 4 Classes & Events 4 MMRC Core Competencies 5 Management Team 6 Branch Director Reports 6 JUNE 2015 VOLUME 4, ISSUE 6 Kate Garay, RN, MSN, FNP PROGRAM MANAGER 1600 Los Gamos Drive Suite 220 San Rafael, CA 94903 PHONE: O 415.473.2721 C 415.497.8298 EMAIL: [email protected] OFFICE HOURS: 9am to 5pm Appointments advised MMRC News NEWS >>PAGE 3 Lack of Command, Fatalies Invesgated in Five Days at Memorial By Lorea Rogers When relief workers finally entered Memorial Medical Center in Uptown New Orleans aſter the devastaon of Hurricane Katrina, they found to their horror 45 bodies, lying scaered around the facility, in the chapel, in abandoned rooms, and in corridors. The death toll at Memorial was more than at any comparable facility in the city. Subsequent autopsies yielded “homicide” as the cause of death for nine of the deceased, prompng an invesga- on of exactly what had happened aſter floodwaters marooned the hospital for five horrific days. The story of that ordeal and the subsequent invesgaon is told in the Pulitzer Prize-winning book, Five Days at Memorial, by Sheri Fink, a physician and re- porter for The New York Times. The book is divided into two parts. The first describes the desperate days when the hospital, with its 2,000 inhabitants, including more than 200 paents and some 600 medical staff plus families, volunteers and their pets, were all stranded by floodwaters without hope of early res- cue. The power grid was defunct. The generators gave low levels of power before eventually flickering out. The toilets overflowed, filling the hospital with an intolerable stench. Water was of uncertain quality. Paents lay sweltering and dehydrated in over 100-degree heat. Shots were heard outside the building, looters were spoed, and two stabbing vicms showed up at the ER for treatment. Through these fearful and chaoc condions, medical staff and family members struggled heroically to care for the paents. Dr. Fink tells this part of the story with great understanding and compassion. At the same me, she details all the ways that the hospital was woefully unprepared for the disaster. Memorial’s 297-page disaster plan contained plans for a volcano erupon (impossible in New Orleans) but not a flood (highly likely). It had no evacuaon plan. Memorial’s parent company, Tenet, had no staff trained in disaster management; it had not contracted with any helicopter company to evacuate paents should the need arise. Memorial’s helipad had not been used or maintained in years so it was not clear that it was usable. The only access to the helipad was through elevators that ceased to work when the electricity failed. When helicopters finally arrived, a hole had to be created in a wall for paents to be carried through on blankets into the parking garage where a pick-up truck transported them to the helipad.
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Transcript of V O L U M E 4 , I S S U E 6 J U N E 2 0 1 5 MMRC News · When relief workers finally entered...
I N S I D E T H I S I S S U E :
MMRC News 1
Message from the
Program Manager
2
Mission Statement 3
Disaster Medical Care 4
Classes & Events 4
MMRC Core Competencies 5
Management Team 6
Branch Director Reports 6
J U N E 2 0 1 5 V O L U M E 4 , I S S U E 6
Kate Garay, RN, MSN, FNP PROGRAM MANAGER 1600 Los Gamos Drive Suite 220 San Rafael, CA 94903 PHONE: O 415.473.2721 C 415.497.8298 EMAIL: [email protected] OFFICE HOURS: 9am to 5pm Appointments advised
MMRC News
NEWS >>PAGE 3
Lack of Command, Fatalities Investigated in Five Days at Memorial
By Loretta Rogers When relief workers finally entered Memorial Medical Center in Uptown New Orleans after the devastation of Hurricane Katrina, they found to their horror 45 bodies, lying scattered around the facility, in the chapel, in abandoned rooms, and in corridors. The death toll at Memorial was more than at any comparable facility in the city. Subsequent autopsies yielded “homicide” as the cause of death for nine of the deceased, prompting an investiga-tion of exactly what had happened after floodwaters marooned the hospital for five horrific days. The story of that ordeal and the subsequent investigation is told in the Pulitzer Prize-winning book, Five Days at Memorial, by Sheri Fink, a physician and re-porter for The New York Times. The book is divided into two parts. The first describes the desperate days when the hospital, with its 2,000 inhabitants, including more than 200 patients and some 600 medical staff plus families, volunteers and their pets, were all stranded by floodwaters without hope of early res-cue. The power grid was defunct. The generators gave low levels of power before eventually flickering out. The toilets overflowed, filling the hospital with an intolerable stench. Water was of uncertain quality. Patients lay sweltering and dehydrated in over 100-degree heat. Shots were heard outside the building, looters were spotted, and two stabbing victims showed up at the ER for treatment. Through these fearful and chaotic conditions, medical staff and family members struggled heroically to care for the patients. Dr. Fink tells this part of the story with great understanding and compassion. At the same time, she details all the ways that the hospital was woefully unprepared for the
disaster. Memorial’s 297-page disaster plan contained plans for a volcano eruption (impossible
in New Orleans) but not a flood (highly likely). It had no evacuation plan. Memorial’s parent
company, Tenet, had no staff trained in disaster management; it had not contracted with any
helicopter company to evacuate patients should the need arise. Memorial’s helipad had not
been used or maintained in years so it was not clear that it was usable. The only access to the
helipad was through elevators that ceased to work when the electricity failed. When helicopters
finally arrived, a hole had to be created in a wall for patients to be carried through on blankets
into the parking garage where a pick-up truck transported them to the helipad.
Message from the Program Manager P A G E 2 T o T h e C o r p s N e w s l e t t e r
June, 2015 In this issue, Loretta Rogers does a great job of summarizing Sheri Fink’s investigative report of the Katrina disaster in Five Days at Memorial. The book is a disturbing portrait of a healthcare disaster response gone awry. I have been inspired by this story to think about how our MMRC disaster response operations might face similar challenges, and I’ve been especially curious about how we might strengthen our capabilities to make tough, medical ethics decisions during a period of crisis.
The decision to euthanize patients at Memorial Hospital in New Orleans after Katrina was made by doctors and nurses outside of the incident command structure set up by hospital administrators. Patients—some of whom were conscious—received le-thal doses of anesthetics without their consent. Family members were asked to leave the bedsides of their loved ones, evacu-ated from the hospital, and didn’t learn about the death of their family members until months later. There was no open dis-cussion at the command staff level about the possibility of euthanasia. Remarkably, the role of the chaplain at the hospital was marginalized. This individual could have helped the command staff consider their ethical decisions in an open venue, where careful, compassionate discussion could have been facilitated. I asked the chaplains and mental health teams to think about these kinds of challenges with me. I asked them to imagine a catastrophic scenario, where MMRC members are providing medical treatment in a neighborhood spontaneous treatment site or a field treatment site for an extended period. We talked about how the unpredictable circumstances and lack of re-sources would raise stress levels and challenge individuals’ decision-making skills. Both chaplains and mental health team members agreed they would have common functions in these circumstances, such as providing comfort, grief counseling, and emotional support to patients, families, and providers. Then we talked about the circumstances at Memorial in New Orleans. Had a command staff role been established for the chaplain, he would have had the opportunity to speak directly with the response operations leaders about the possibility of euthanasia, and perhaps would have helped guide the group to take different actions. At the MMRC meeting, chaplains and mental health members agreed a command staff role of “Behavioral Health Officer” could be part of the incident command structure for our disaster response operations. Dr. Tom Cromwell, MMRC’s Southern Marin Branch Director, spoke about his experiences in the Katrina disaster response and the role of their Federal DMAT (Disaster Medical Assistance Team) chaplain who watched for individuals exhibiting high stress, pulled them out of opera-tions, and gently encouraged and counseled them. This is an individual counseling function critical to a good disaster response operation, and can be performed by mental health or spiritual care professionals. The role of a Behavioral Health Officer at the command staff level would be responsible to the medical operations incident commander (IC), advisor to the IC, and mon-itor stress levels and decision-making capabilities of the entire staff. Thank you to the chaplains and mental health team leaders who participated in these discussions. I feel confident the Behav-
ioral Health Officer command staff role, filled by a skilled spiritual care or mental health leader, would be a significant contri-
bution to a successful MMRC disaster medical response operation.
Kate
MMRC Mission Statement
The Marin Medical Reserve Corps Mission is to augment Marin County’s public health and disas-ter medical response. Our mission is to: Educate and train citizens and MMRC volunteers in Disaster Preparedness and Disaster Medi-
cal Response Deploy MMRC volunteers and resources in the event of a disaster or public health emergency Deploy MMRC volunteers for public health in non-emergency situations Build relationships and partnerships throughout our county to promote community
resilience.
T o T h e C o r p s N e w s l e t t e r P A G E 3
MMRC News
As the evacuation of the hospital finally got underway via boats and helicopters, it became clear to staff that some patients would be very difficult if not impossible to move under these circumstances. Many were near death. At this point, talk of euthanasia began to circulate among some doctors, nurs-es and administrators. No formal discussion or agreement was ever reached on this course of action, and certainly patients and their families were never consulted. However, massive doses of opioids and anti-anxiety drugs were ordered from the pharmacy and a well-regarded surgeon, Dr. Anna Pou (pronounced Poe), was seen carrying trays of pre-filled syringes into the ward of the sickest patients, who soon died. She and two ICU nurses, Lori Budo and Cheri Landry, were later arrested on murder charges.
The second part of the book contains an account of the investigation that led to these arrests and the ultimate verdict of the grand jury not to indict. The story reveals the limits of current investigative tools. This was not like a CSI television show. Inves-tigators found it hard to get fingerprints. Eyewitness stories frequently contradicted each other and no one had actually seen Dr. Pou administer the lethal drugs. Autopsies were problematic as the bodies had decomposed in hot weather for over a week be-fore they were recovered. There was no way to take a blood sample to check for lethal levels of drugs, so pathologists had to look for traces of drugs in hardier tissues such as brain, liver and kidneys. In addition to these physical challenges, investigators and State Attorney General Charles Foti, had to deal with public opinion sympathetic to the medical staff, myriads of lawyers representing various individuals and interests, plus political pressures. In general, Dr. Pou’s colleagues strongly supported her and public rallies were held on her behalf. Dr. Pou garnered national atten-tion by appearing on shows such as 60 Minutes. In all of this, the truth of what happened in those five days got harder and hard-er to determine. And yet, clearly, there were many important lessons to be learned; hence, Dr. Fink’s decision to write this book. In an epilogue, Dr. Fink recounts how she went to New York during Hurricane Sandy to see how hurricane medical response had evolved, if at all, since Katrina. She was dismayed. Clearly, many staff had never considered what to do in case of a failure of their disaster plan, loss of power, or other likely contingencies. One physician at Bellevue was suddenly presented with a terrible decision: in the event of a power outage, there would be exactly six outlets available to her 56 ICU patients; she had to decide which six would get the electricity. Various protocols have been drawn up for rationing scarce resources in disaster circumstanc-es, but none have proven to save more lives, and all are very difficult to implement when you are the physician refusing treat-ment. This book is a must-read for any person concerned with disaster medical preparedness and response. It provides invaluable les-
sons on the necessity of broad disaster preparation and the consequences when it is lacking.
FROM PAGE 1
T o T h e C o r p s N e w s l e t t e r P A G E 4
Upcoming Classes and Events
Disaster Medical Care class Debuts
MMRC in the Community
Date/Time Location Class Contact CEU
July 7 1300-1600 AND July 9 0900-1200
1600 Los Gamos, Suite 220 First Aid for Disaster Response, Train the Trainer Intensive, both sessions required
Kate Garay: [email protected] 6 hours (for BOTH sessions)
July 25 0900-1300
TBD First Aid for Disaster Response Vivian Cohen : [email protected] or 415.246.7070 4 hours
August 8 0900 to 1300
Fairfax Women’s Club 46 Park, Fairfax
First Aid for Disaster Response Judy Greenwald: [email protected] 4 hours
September 12 0900 to 1300
Ross School First Aid for Disaster Response For Ross residents and RPOA
Judy Greenwald: [email protected] 4 hours
September 26 0930-1230
TBD Point of Dispensing (POD) training by county Public Health Preparedness and Public Health Nursing staff. Lecture only. Training will support MMRC volunteers in staffing county flu clinics this fall. Venue announcements for the flu clinics are pending
Vivian Cohen : [email protected] or 415.246.7070 3 hours
October 16, 17 TBD
TBD Disaster Behavioral Health Ann Eichhorn: [email protected] TBD
October 31 0900-1300
Novato Community Hospital MMRC trailers
Field Treatment Ops Beta drill and train-ing
Vivian Cohen : [email protected] or 415.246.7070 4 hours
A MMRC Disaster Medical Care class was launched June 20, with 10 MMRC members practicing the SALT (Sort, Assess, Life-Saving Interventions, Treat and Transport) triage protocol for a multiple casualty event. SALT, which is recommended by the CDC, the American College of Surgeons, and many other national professional organizations, guides providers to immediately sort injured patients and start life-saving interventions. In SALT triage, patients are sorted into
“immediate,” “delayed,” and “minimal/minor” categories to rapidly move the most critical to higher levels of medical care. With the successful launch of the class, MMRC will take what
was learned, improve the design, and offer another class in the
fall for MMRC members who want to be on the MMRC Disaster
Medical Response team. If interested, please contact Marty
Frankel, interim Operations Chief, at
[email protected]. Please include your preferences
for days of the week and times to schedule classes.
By Kate Garay
Marin Disaster Readiness Conference
Marin Interagency Disaster Coalition (MIDC) holds annual meetings to bring together government, the private sector, non-profit, and community based groups organized for disaster pre-paredness. This year the focus was on disaster recovery, the period after the immediate impact of the disaster, which is di-vided into short-term (up to 48 hours) and long-term (weeks and months). Several sessions were focused on volunteer or-ganizations, including those prepared to act during a disaster
and those focused on disaster recovery. Experts on financing recovery for individuals and organi-zations also spoke and there was a session on the role of faith communities in recovery. A re-view of lessons learned in various disasters, in-cluding Sandy, Loma Prieta, and the more recent southern Napa earthquake, was led by respond-ers to those catastrophes.
By Peggy Woodring
John Bruckbauer, San Rafael Emergency Management Coordi-nator
Patti O’Connor (kneeling) with Peggy Wooding (left) and Katherine Shotwell (right)
The Office of the U.S. Surgeon General released the Medical Reserve Corps Core Competencies requirements. Core Competencies requirements rep-resent the baseline level of knowledge and skills that all MRC volunteers should have, regardless of their roles within the MRC unit.
The first competency is personal/family preparedness. The specific competency is to describe the proce-dures necessary for the MRC member to protect health, safety, and overall
well-being of themselves, their fami-lies, the team, and the community. Suggested trainings for the MMRC team members are GET READY Marin and Marin County CERT.
The GET READY Emergency Disaster Preparedness Program is a free two-hour training course that includes a take-home manual. At the conclusion you will know what to do before, dur-ing and after a regional disaster. Sign up for the GET READY Marin at www.getreadymarin.org.
CERT, Community Emergency Re-sponse Team, is about readiness, peo-ple helping people, rescuer safety, and doing the greatest good for the great-est number. Marin County CERT is 15 hours of FUN and costs $45. You will receive a student manual, backpack, helmet with chin strap, vest and gog-gles. Secure your seat and sign up to-day at www.marincountycert.org.
C E R T… What you NEED to know!
Important Websites Marin County = http://www.marincounty.org
DHV = https://www.healthcarevolunteers.ca.gov/
Link to IS22 = http://training.fema.gov/EMIWeb/IS/is22.asp
Link to IS100 = http://training.fema.gov/EMIWeb/IS/is100b.asp
Link to IS700 = http://training.fema.gov/EMIWeb/is/is700a.asp All MMRC members are required to complete these courses and report completion to Loretta Rogers at [email protected]
T o T h e C o r p s N e w s l e t t e r P A G E 5
Marin Medical Reserve Corps Core Competencies
You must complete all 18 hours of the program to obtain certification!
Upcoming CERT classes: 2015 Registration website: www.readymarin.org/cert/
Month Location Date Times
August Novato Thurs 8/6 Thurs 8/13 Sat 8/15
5:30pm—8:30pm 5:30pm—8:30pm 8:00am—5:00pm
September San Rafael Sat 9/12 Sat 9.19
8:30am—5:30pm 8:30am—5:30pm
October Nicasio Sat 10/3 Sat 10/10
8:30am—5:30pm 8:30am—5:30pm
October Mill Valley Sat 10/17 Sat 10/24
8:30am—5:30pm 8:30am—5:30pm
www.mrc.train.org
https://www.bauasitep.org
NORTH MARIN BRANCH Director: Sharon Grabovac [email protected] From the ridge line separating Marinwood/Lucas Valley to the North SAN RAFAEL BRANCH Director: Peggy Woodring - [email protected] From the ridge line separating Lucas Valley/Marinwood to ridge that separates Terra Linda from San Rafael, includes Los Ranchitos, Santa Venetia, and all of San Rafael. SOUTH CENTRAL MARIN BRANCH Director: Judy Greenwald - [email protected] Includes ridge that separates San Rafael from Greenbrae/Kentfield south to Corte Madera Creek, includes Ross, Kentfield, San Anselmo, Fairfax, San Quentin. SOUTHERN MARIN BRANCH Director: Tom Cromwell - [email protected] South of Corte Madera creek to Pacific Ocean, includes Corte Madera, Larkspur, Tiburon, Belvedere, Mill Valley, Marin City, Sausalito, Muir Woods, Stinson Beach, Bolinas.
WEST MARIN BRANCH Director: Marty Frankel - [email protected] Includes Woodacre, San Geronimo Valley, Nicasio, Marshall, Pt Reyes Station, Tomales, Inverness, Pt Reyes National Sea-shore, Dillon Beach. Program Manager: Kate Garay - [email protected] Operations Lead: Ann Eichhorn - [email protected] Administrative Section Chief - Vivian [email protected] Logistics Chief: Rick Moses - [email protected] Chief Training Officer - Stu Tanenberg- [email protected]
T o T h e C o r p s N e w s l e t t e r P A G E 6
Branch reports
Management Teams
San Rafael Branch : Marty Brenneis organized a disaster drill for neighbors in the Spinnaker Point neighborhood in May, using the Clubhouse area as the base for Incident Com-mand and Spontaneous Treatment site. Kevin Hagerty is a board member of the Point San Pedro Coalition and is active in organizing their neighborhoods for disaster response readi-ness. Next meeting of the San Rafael Leadership Team will
be Tuesday, September 8, 6:30pm to 8:30pm at 3210 Kerner Blvd, San Rafael.
Southern Marin Branch: has scheduled meetings every other month, on the 3rd Thursday, beginning August 20 from 5:00pm to 6:00pm. Location will vary, contact Tom Cromwell for information.
Report Your Volunteer Hours - You Count! All volunteer hours are recorded and re-ported throughout the year. Send an email to Loretta Rogers at [email protected] with the event/ training, date and number of hours immediately after earning.
When you break out your time spent into categories, it gives a clear picture of how balanced we are between the categories of Activation, Administrative work, Com-mittee meetings, Exercises, Foundation work, Outreach (public education), Train-
ing and Work Parties. This information is vital in that it allows MMRC to plan and manage the organization. A report is generated every six months.
NEW!
To The Corps will be taking a summer hiatus during July and August, the next MMRC newsletter will appear in September. Happy Summer! Your Editorial Board: Mira Schwirtz, Loretta Rogers, Kate Garay, Ann Eichhorn and Diane Ayers
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