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When a disaster strikes, how prepared will Stanford Health Care be?

Administrators say they are ready, but some patients may have to wait

In a major catastrophe such as an earthquake, pandemic or chemical contamination, Stanford and Lucile Packard Children's hospitals will be ready, hospital administrators say.

"We are prepared to take care of anyone who shows up," said Dr. S.V. Mahadevan, interim chair of the Department of Emergency Medicine at Stanford Health Care.

But the hospital will triage patients according to the severity of their injuries, as staff do in the emergency room every day. That way, patients who are the most in need are prioritized, he said.

In a disaster, that could mean some people will wait in a tent in the parking lot if the emergency room is overflowing. But no one would be turned away.

Stanford Health Care and Stanford Children's Health, which include both hospitals, have a flexible system that allows the hospitals to mobilize teams of doctors, nurses, social workers, translators and other personnel, plus the necessary resources, said Brandon Bond, administrative director of the Office of Emergency Management at Stanford Health Care and Stanford Children's Health. In a disaster, hospitals will coordinate their staff through technology devices and with city and county offices of emergency services and local emergency responders.

Boots-on-the ground training, which goes on continuously in the hospitals, is preparing staff, Bond said. There are unit disaster drills, trainings with the executive team and unannounced tests of the command center. All emergency-room nurses take a two-hour mass-casualty course, for example, including triage training and simulations, he said.

As a regional trauma center, Stanford is called upon to handle the most serious emergencies. After the 2013 Asiana Airlines crash at San Francisco International Airport, Stanford Health Care received more patients than any other hospital, Bond said.

The hospital saw 55 patients and admitted 18.

To handle the influx, when the first reports of the crash came in, the hospitals' emergency department paged nearly 900 employees, putting the hospitals on preliminary alert for a full disaster response.

As the first patients were being loaded into ambulances, officials activated the full mass-casualty plan. Through the Hospital Command Center, different department leaders monitored aspects of the response and tracked available beds. Nurses from throughout the hospital were sent to the emergency department, and medical teams waited outdoors in the ambulance bay to take in patients, quickly freeing up ambulances to return to the crash site.

Emergency-room patients not associated with the crash continued to be seen, Bond said, and some were placed in hospital beds or sent home.

Nathan Rainey, emergency services coordinator for Palo Alto's Office of Emergency Services, lauded the hospitals' response in the Asiana disaster. But he and others fear that a much bigger disaster will strain not only Stanford and Lucile Packard, but other regional hospitals as well. He and Stanford administrators say the Palo Alto Medical Reserve Corps could help reduce the strain on hospitals in a disaster by administering first aid and taking on some of the less serious medical cases, Rainey said. ==I (Read "Palo Alto's Medical Reserve Corps volunteers to help during a disaster")

Bond has attended some of the corps' drills at Cubberley Community Center. As Palo Alto's and Santa Clara County's emergency-response plans continue to be refined, there will be increasing opportunities for joint exercises. Stanford University along with Stanford Health Care's Office of Emergency is planning a large-scale exercise involving the campus and the hospitals in November, and Bond said the hope is that the next iteration of the exercise would be city-wide, with both Stanford and Palo Alto's Office of Emergency Services participating.

Although Medical Reserve Corps volunteers are currently only allowed to do first aid unless they have credentialing from Santa Clara County, Stanford also has policies and procedures in place that could allow the specialized services of corps doctors and nurses to be used in a disaster.

"If the need is great enough, we can do emergency credentialing," Bond said.

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