Palo Alto is a far cry from the Third World, but in a disaster it will face many of the same challenges that often plague impoverished countries: communication failures; impassable roads; masses of sick and injured victims; and psychic shock, city disaster officials said.
Notwithstanding the city's robust emergency-services program and Stanford Health Care's first-class trauma center, Palo Alto is still missing a critical component that could affect the aftermath of a catastrophe: readily available, trained medical staff, local disaster officials say.
But the five-year-old Palo Alto Medical Reserve Corps (MRC) could put a dent in the problem. Local doctors, nurses and other health professionals have set up a volunteer medical unit that will set up at Cubberley Community Center in a disaster to provide first aid and triage. Their role could be significant, taking on the less sick and injured and freeing up hospitals and clinics for more serious cases, according to Nathan Rainey, emergency services coordinator for Palo Alto's Office of Emergency Services.
"There needs to be a relief valve to relieve the pressure on the hospitals. ... We think the MRC is one of those relief valves," he said.
The Medical Reserve Corps is one branch of the City of Palo Alto's Emergency Services Volunteers program. Its members would offer a higher level of assessment and care, bridging the gap between the Band Aids-and-splints first aid that the Community Emergency Response Teams (CERT) members could provide and the high-level skills of a hospital team.
The Corps was started in 2011 as the Palo Alto Emergency Medical Unit, co-chaired by residents Geri Spieler, a former emergency room interventional radiographer, and Bonnie Berg, a registered nurse. They recognized there was a critical gap in disaster services, they said.
Rainey characterized the founding of the Corps as an attempt to answer a fundamental question: "When we're in a large, regional event and everybody is holding onto their own resources and they get tapped out, what do we do?"
Spieler and Berg created protocols for the medical unit from scratch. With the help of retired emergency room nurse Marty Douglas, they established a supplies trailer full of stethoscopes, bandages, splints, antiseptic, tape and equipment enough to last two days. The unit holds trainings and drills for different disaster scenarios (including a mock-earthquake, called "Quakeville," at Cubberley), and they attended a regional training session that involved people posing as victims, complete with fake blood, lacerations and burns. They also keep skills sharp by manning first-aid tents during community events such as the Palo Alto May Fete Parade, the Moonlight Run and the July 4 Chili Cook-off.
A year ago, the unit joined the national Medical Reserve Corps a network of 200,000 volunteers who are organized in 987 local units to improve the health and safety of their communities. They prepare for and respond to wildfires, hurricanes, tornadoes, blizzards, floods and earthquakes and public health emergencies, such as disease outbreaks, according to the organization's website. They also provide first aid at large public events, health screenings and other health-related activities.
Membership allows Palo Alto's unit to access webinars, regional disaster drills, grant funding and 2,000 courses leading to advanced certifications.
Palo Alto's Corps took an additional significant step in March when Dr. Stephen Fisk, an adult critical care physician at Kaiser Foundation Hospital in Santa Clara, became a co-chair with Spieler. Berg and Douglas now are in charge of the medical supplies .
Fisk has experience in wilderness medicine and is certified in the fundamentals of disaster management with the Society of Critical Care Medicine. He will help organize and stage drills.
"Dr. Fisk brings a high level of medical experience in disaster preparedness," Spieler said.
Fisk said he joined the Corps because he wanted to give something back to the community.
"I realized in many ways it's woefully unprepared for a major disaster. There is no hospital in Santa Clara County that has sufficient surge capability to accept everybody in a major disaster," he said. "Even though Stanford responded wonderfully to the Asiana (Airlines) crash, this was still a small fraction of the number of casualties that one would have in a major disaster," he said.
Fisk estimated that hospitals could double their capacity in an extreme disaster.
"Beyond that, there would be a significant degradation in care. However, it's just a guess. The choke points in each of these scenarios are the emergency departments and the emergency rooms," he said.
Stanford Department of Emergency Medicine and Office of Emergency Management officials said they will be prepared for any disaster and will accept anyone who comes. (Read "When a disaster strikes, how prepared will Stanford Health Care be?")
Stanford officials do foresee an important role for the Medical Reserve Corps. In addition to taking on cases that are less acute, members could also assess and triage patients who show up at Cubberley and may need to be transported to the hospital, according to Brandon Bond, administrative director of the Office of Emergency Management at Stanford Health Care and Stanford Children's Health. Bond has attended some of the Palo Alto Medical Reserve Corps' drills.
There is a wrinkle, however, in how much the Corps can do because of Santa Clara County policy and liability issues.
The Santa Clara County Medical Director must sanction and activate the Corps, but currently, the director only recognizes the county-level Medical Volunteer for Disaster Response program. Without recognition from the county, the Palo Alto Corps members can only give people first aid not the level of care the volunteers are capable of giving, Spieler said.
In early April, Spieler and Douglas attended a meeting in Saratoga with county officials and that city's Medical Reserve Corps, including county Medical Volunteer for Disaster Response managers. The group agreed that all medical corps in the county's cities would be required to meet the county's criteria if participants want to be able to treat patients beyond the first-aid level, Spieler said.
When the county boots up its training program, Spieler will invite all Palo Alto Corps volunteers to take part and receive county credentialing, she said.
Rainey raised another issue that is yet to be resolved. While Palo Alto is outfitted with supplies and medical-treatment gear, the county has a vote on how the Corps will use those resources. If called upon, Palo Alto's Corps might be deployed in other parts of the county.
"It's a county-run system. The trick is for the Medical Reserve Corps to figure out how we really fit into that medical system," Rainey said.
The challenges will be for the city Corps to coordinate with the county system while still ensuring local needs are met, he said.
Fisk said that he has additional broad concerns, including ones of a more physical nature: In the immediate aftermath of a major disaster, collapsed buildings and impassible roads "will limit in many ways how suppliers and people can actually get to the hospital," he said.
Spieler and Douglas don't sugar coat the challenges that a disaster will bring for the Corps.
Patients arriving at Cubberley would likely have a range of injuries: lacerations, burns, bruises, broken bones, crushed internal organs and head trauma. Some might have medical conditions such as a diabetic emergency, stroke or heart attack. Others will exhibit hysteria or anger.
Spieler outlined the basic setup for the Cubberley Community Center: People will be coded with the "colors of injury": green for stable; yellow needs attention; red for critical; and black for dead. There will be three treatment stations, a recovery station and a room for those whose injuries are too serious to treat or who must be transported to a hospital.
But there will be no CPR, no setting of broken bones, no X-rays nor surgeries nor no life-saving measures at Cubberley, Spieler said.
It's a hard fact that in the first hours and days of a disaster, the Corps will need to work to help the most people they can while using the least amount of time and resources. And some people will die, she said.
Spieler recited a question put to the volunteers at a drill last year that sums up the reality of the disaster response:
"You have three minutes per person. What could you do with three minutes? You have to do something to stabilize the person and move on. You train for the worst possible scenario. You have to go for the greater good," she said.
Currently, the Corps has about 40 members, but more are needed so that they will be able to work in shifts when a disaster strikes. Without shift changes, volunteers would burn out in about 24 hours, Rainey said. The goal is to get enough people to get through at least the first critical 72 hours.
Spieler said she would need at least 50 people. But many others who do not have medical training are also needed. They would free up the Corps' medical staff by doing intake, registration, communications and running for supplies.
People who want to volunteer shouldn't wait until a disaster strikes, however. In an emergency they won't be able to serve unless they have had a security clearance, she said.
"Bottom line: If you have not cleared a background check, they don't want you around ... even if you are a registered nurse of physician," Spieler said.
Annette Glanckopf, a non-medical volunteer, said that the Medical Reserve Corps plays an important role in Palo Alto's Emergency Services Volunteers program.
"I've always thought that you've got to have a local team. ... We always talk about 'backup, backup, backup.' It reduces the points of failure," she said.
Many Palo Alto neighborhoods, including hers in Midtown, now have medical-supply caches for immediate first aid, which can be administered without leaving the neighborhood. As chairperson of the Palo Alto Neighborhoods Emergency Preparedness Committee, Glanckopf has spearheaded efforts to ready residents by preparing their homes for disaster and recruiting them for the block-preparedness program and the other arms of the City of Palo Alto's Emergency Services Volunteers group. The program includes the Palo Alto Neighborhoods Block Preparedness Coordinator and Neighborhood Preparedness Coordinator programs, CERT, and amateur radio communications (ARES/RACES).
Residents can choose their level of involvement: They can be the the eyes and ears of their neighborhood, check on neighbors in need, serve as ham-radio operators or conduct light search-and-rescue operations, fire suppression and administer first aid.
Rainey said these local response groups, including the Medical Reserve Corps, are especially important to Palo Alto, which faces a situation not found in many other cities a population that balloons during the day due to workers.
"The things that worry us are the 'Palo Alto problem': the public-safety resources are sized to the residential population and not to the doubling of the daytime population," he said.
That is compounded by the vast number of city employees, including first responders, who do not live in Palo Alto, he said.
If a disaster happens when critical city staff aren't on hand, Palo Alto residents will have to rely on each other and they had best be prepared.
"As they say in the army, 'You go into battle with what you've got,'" he said.
Information about the Palo Alto Medical Reserve Corps and the other programs in the city's Emergency Volunteers Services is posted at cityofpaloalto.org/emergencyvolunteers.