Abstract
I
Now, in 2016, we have experienced several emergencies in the region, notably some of the largest wildfires in Washington State's history. Our healthcare coalition assets have grown to include 5 25-bed alternative care facility trailers and 2 registration supply trailers. We have deployed these trailers to assist regional partners on 4 different occasions and have conducted tabletop exercises and functional exercises in each of our 5 counties.
Because of our early efforts to define what it meant to be part of a healthcare coalition, our partners thoroughly understand their response roles; they send requested work teams to events anywhere in the region. They anticipate what partners might need during a response and are eager to help in any way they can. These coalition partnerships have grown visibly over the years, leading to a can-do attitude in our regional healthcare coalition response system. Even in the face of challenges such as staff turnover, our new members are quickly brought into the group and easily learn their roles.
The strength of these partnerships was put to the test in summer 2015, when multiple large-scale wildfires erupted across Washington State. During this emergency, the Regional Disaster Medical Coordination Center (DMCC) was activated for the first time. At the height of the crisis, we activated WaTrac patient bed tracking regionally at hospitals not affected by the fires; this provided hospital capacity updates every 4 hours, allowing us to anticipate patient transfers from affected hospitals and see open-bed options at a glance.
Coalition partners that were affected stayed in constant communication, holding situation report update calls twice daily. Situation reports were intense and covered fire information, staffing numbers, patient counts, and hospital operations. Although we managed our first DMCC experience well, there is no doubt we can do better next time.
We also gained greater insight into the unique needs of vulnerable populations as a result of our wildfire response—particularly those of seniors. Many area nursing homes and assisted living facilities requested evacuation for their residents as the fire threat increased. And while everyone was safely evacuated, it was important to remember that seniors can be a fragile population, with special needs. The typical cots from Red Cross or our alternative care facility supply trailers are not very comfortable and were difficult for this population to use. We learned that to keep this population not only safe but comfortable, evacuation from senior living facilities ought to include removal to other senior facilities first (unless, of course, you are anticipating a very short-term need—8 hours at most). Shelters should always be a “last resort” for almost all of this population.
Moreover, many seniors came with their pets—a challenge for which we are still exploring solutions. Other residents had needs beyond what a shelter could provide; many were hospice patients or had memory problems that were aggravated by the move away from familiar surroundings. Our future response planning will recommend hospitalizing some people who need close care—a move that would not only ensure their comfort and safety, but reduce needed resources in most emergencies. We also found that including senior living facility staff on the response team is the best way to share information about the residents in the temporary senior facility or alternative care facility. This has become a staffing best practice moving forward.
Overcoming communication challenges and determining what our best practices should be moving forward was a major component of the wildfire response. One of the major lessons learned this summer is the importance of including all regional county-level hospitals in the daily situation report call—not just those affected by the emergency event. Their available resources and fresh ideas were able to boost the healthcare coalition's capacity, especially during the ongoing responses.
But communication during emergency responses goes further than just making sure everyone's talking. Communication infrastructure itself needs to be maintained. Your power is out, your internet is out, and there's no television or telephone. Maybe the wildfires burned through the cell towers. What would we have done in that situation? Do you have a satellite phone? Was it plugged in to power? Is it on the generator? Is it charged, if on battery? Does anyone know you have one? Does anyone know where it is? Is it locked up in someone's office? All these things happened during our real-life wildfire response. The backup satellite phone was useless.
We know for the future that we should train more people on how to use the satellite phone equipment, and we have developed guidelines on keeping it in an accessible location and in running order. Training your response supervisors on the emergency equipment before an event improves the outcome. That way, the next time all communications are out, you might have the opportunity to use the satellite phone.
Our hospitals experienced a number of issues, including loss of local radio channels for updated information, power, communications, internet, television, sewer, water, and, in some areas, staffing shortages. But because of years of planning and partnership, these crises didn't affect the quality of care. The hospitals were able to stay open and serve their community, operating with everything they had successfully put in place for just these kinds of emergencies.
In 2007, when we first established the healthcare coalition, it was all about improving how we communicate with each other and establishing memorandums of understanding to make our CEOs happy. Today, it's all about building working relationships before emergencies happen to ensure our community becomes more resilient. The 2015 wildfire season proved that, because of our coalition, we were able to do just that.
In 2016, in Region 7, all regional emergency responders know who the healthcare coalition partners are. We know what it means to be part of a coalition, and we know what needs to be done to respond to emergencies successfully as a team. We work together and train together—and keep our communities safe together.