News


Readying for any disaster

The Stanford ER is poised to handle mass injuries, staff say

The emergency room at the new Stanford Hospital includes this large trauma room as well as triage space and individual patient rooms. Photo by Veronica Weber.

When an Asiana Airlines flight crashed at San Francisco International Airport in 2013, Stanford Hospital received more patients than any other, staff said at the time. The hospital saw 55 patients and admitted 18.

Stanford staff were put to the test that day, taking on the usual caseload of emergency room (ER) patients in addition to the accident victims. The hospital staff scrambled to accommodate everyone, freeing up beds by sending home patients when possible.

The incident was small compared to other potential disasters. A devastating earthquake could send hundreds if not thousands of people to the ER. If just one local hospital is damaged or destroyed, the area's first responders would rely even more heavily on Stanford. (After the 1989 Loma Prieta Earthquake, for example, the Palo Alto Veterans Administration Medical Center, just four miles away, sustained $30 million in damage and was uninhabitable.)

But after 10 years of development, the new Stanford ER at 500 Pasteur Drive, which will open in late October, is equipped to handle a magnitude-8 earthquake and any other mass-casualty incident, as well as heart attacks and broken bones, Jennifer Winder, a hospital spokeswoman, said.

The new 42,692-square-foot ER and trauma center is part of a $2 billion hospital expansion. The 66 rooms in the emergency department, while designed to accommodate one patient per room, can handle two patients per room in a pinch, said Patrice Callagy, executive director of emergency services.

As the only regional Level-1 trauma center between San Francisco and San Jose, Stanford's emergency room is already one of the busiest in the country, according to a 2017 ProPublica report on hospital emergency rooms.

From the minute patients arrive at the new ER's security station, nurses inside will be able to look out the door and identify extremely ill patients.

"If someone is looking pale, they can be seen quickly from where the nurses are situated for triage," Callagy said.

Patients with suspected infectious diseases can be led to four infectious-disease isolation rooms with outside entrances so they don't expose others in the waiting room. Chair gurneys that convert into flat stretchers can be wheeled to the lobby for patients who need escalated care within seconds, she said.

In a mass-injury situation or during peak seasons of infectious diseases, the covered ambulance bay can accommodate overflow patients. The bay is built to house five ambulances — six if they are narrow — but outside of the covered area there's room for up to 20 vehicles. At the old ER, there's room for three ambulances, and including the area outside, up to six, said Vasily Rodin, the operations project manager leading the emergency room transition.

The new building also has a six-foot "floating wall" between the adjacent parking garage and the trauma center. The parking structure, large enough to accommodate 900 cars, can be converted into a triage center that connects directly to the emergency room.

There's also one important, recent change that staff made after the ER was built. The hospital planned to have 76 treatment rooms in the ER, but after assessing the large numbers of patients and their demographics, the hospital decided to create two ERs. The new ER at 500 Pasteur Drive is for adults; the old ER at 900 Quarry Road Extension will become a dedicated pediatric emergency room with 15 private rooms. The pediatric emergency department will open when the new ER opens this fall. The pediatric ER will be renovated to make it a more child-friendly environment; the work will be done in phases so the ER can remain operational throughout, hospital spokeswoman Courtney Lodato said. Rodin said all trauma patients will be sent to the new ER.

"Having a dedicated ED (emergency department) for pediatric patients helps to create a more supportive care environments for pediatric patients and their families. Visiting an emergency department can be a stressful experience for children and families, and this will help to streamline care and reduce waiting in a more kid-friendly setting," Lodato said in an email. "It also allows more space for child-sized equipment, beds and pediatric specialists. "

Rodin has a personal reason for valuing the separation of the two ERs. When his child needed to go to the ER, Rodin feared his child would be exposed to disturbing circumstances involving other patients and suffer lingering emotional trauma. But the new, separate pediatric ER will have child-friendly amenities such as colorful tilework and games to distract from the hospital setting.

Currently, there are seven rooms in the pediatric section of the old ER. When children and their parents arrive, they follow a blue river pattern in the floor from the adult emergency room to the pediatric area. Games and movies help to reduce anxiety and fear in the pediatric waiting room and there is free wireless internet access. A big-screen television in the waiting room shows cartoons and information.

In the new pediatric ER, each exam room will have a television and a computer with children's games, music, movies and internet access. Nurses will have monitors at the central nursing station to constantly observe patients' vital signs.

The private rooms will make it easier for multiple visitors to be at each child's bedside, Lodato said.

This is part of a larger story on the new Stanford Hospital that can be found here.

A Q&A video with CEO David Entwistle is available here.

Dr. George Tingwald of Stanford Health Care, joins Weekly staff to discuss the planning that went into building the new Stanford Hospital on an episode of "Behind the Headlines," now available on our YouTube channel and podcast page.

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Comments

6 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 13, 2019 at 10:29 am

I'm very glad about the new ER and the seismic safety of the new building at 500 Pasteur. I hope that the seismically unsafe 300 Pasteur will eventually be removed/replaced. I have the impression that parts will remain open to staff (not the public). I hope for the sake of the staff and community that my impression is incorrect, and that -all- earthquake-vulnerable structures will be removed.


10 people like this
Posted by Resident
a resident of South of Midtown
on Sep 13, 2019 at 10:50 am

Resident is a registered user.

All well and good, but since Stanford and Anthem apparently could not come to a deal, anyone that has Anthem health insurance can no longer go to Stanford. I’ve been using them for 30 years (ER, to have my kids, etc) since grad school, but I guess now I can’t. Just got the letter this week.

If you also have Anthem, I guess I’ll see you at El Camino Hospital next time I’m there.


8 people like this
Posted by Local
a resident of Another Palo Alto neighborhood
on Sep 13, 2019 at 1:26 pm

I love the emphasis on connection with the natural world and how important it is for healing. The down side is that patients will be sent home in bumper to bumper traffic to their airplane-noise- and pollution-filled neighborhoods and schools with less and less connection with nature LOL....

@Resident,
Stanford has agreed to honor insurance prices during negotiations, so hopefully you don't need to interrupt your care.


I'm glad for this new facility, but really wish that Stanford would create some kind of interim facility for urgent, non-emergent care that the local urgent care centers can't accommodate, such as imaging on a semi-urgent basis after business hours. Got sent to ER for that very thing, and refused to go if I had to be an emergency patient, but the urgent care team assured me that wasn't the case and that their medical instructions and records would translate instantly to Stanford (they were wrong).

If you go to the ER and it's not an emergency, even if you tell them that up front, and that the urgent care team says everything is in the shared electronic system, they subject you to the whole rigamarole (and say it's necessary, but they don't tell you they are going to ignore why you think you're there) and then treat you like a hypochondriac who self-referred to emergency (including things that are just hell when you aren't feeling well), while also chastising you being a bad patient for refusing the unnecessary perfunctory blood draws and catheter insertions. Then they send you a $5,000 bill without ever giving you the imaging you were sent there for. (To cap the indignities in my case, the security guard wouldn't let me leave because I couldn't walk a straight line, saying I needed my "medication" to wear off -- when I wasn't on any meds, the unsteadiness/dizzyness was one of the symptoms I had been sent there for imaging for in the first place! The perils of medical care while while female...new buildings don't fix that.)

Walk-in family medicine centers and urgent care centers definitely filled a big gap in care, but there is still a big gap between urgent care and emergency care. Emergency rooms should really be there for serious emergencies and traumas, and there really needs to be a separate program/facility to do evaluation for the many situations where one's doctor kneejerk says "go the ER" and as a patient you have to weigh alone whether you are risking a serious consequence by not getting an emergency addressed, or risking your mental health/financial health/getting treated really badly in the future by going to the ER without it ending up being an emergency. Just last week I was advised to go to emergency and gambled that the latter side of the equation would be worse and didn't go. I'm still having trouble with my vision, but don't want to lose their taking it seriously if it turns into a more obvious emergency (and told my doctor so). Their nurse knew exactly what I meant.

It would really help if there was an interim "triage" that could involve real medical evaluation, something between urgent care and emergency, with better coordination of care between local practitioners and medical centers (like PAMF) and Stanford.

Anyway, Congratulations on the beautiful new center, and thanks to everyone who worked so hard to make it happen.


1 person likes this
Posted by Traffic impacts?
a resident of College Terrace
on Sep 13, 2019 at 6:47 pm

Traffic impacts? is a registered user.

The whole area will benefit from this wonderful new facility, most especially when the big earthquake happens. It also sounds as if being a patient in the new hospital might be a completely completely different experience than the 13 hours of sleep I got over one five day visit to Stanford because of a noisy patient in the next bed with visitors talking through the night, to say nothing of the the constant night time clatter and loud voices in the hallway outside the room!

However, since this new hospital will be larger with more employees, can we expect more congestion along El Camino, especially at the intersection with and on Embarcadero during the morning and evening commute? Especially ambulances needing to get through. Or is it anticipated that because so many hospital and clinic staff work different shifts from normal office hours, there won't be much impact?


6 people like this
Posted by Jack will not be happy
a resident of Another Palo Alto neighborhood
on Sep 13, 2019 at 8:51 pm

Traffic impacts-- The intersection of El camino and Embarcadero has been screwed up for over a decade and the city has done nothing to address the problems. I guess they believe the old palo alto mantra-- if you decrease lanes and impede traffic the cars will just disappear. That has worked out well.
I think the only person who may be unhappy with the new hospital will be former councilmember jack morton-- he opposed the new cancer center and about a decade ago he paid for a pamphlet attacking Stanford.


1 person likes this
Posted by m2grs
a resident of Midtown
on Sep 13, 2019 at 10:00 pm

They must charge arm and leg for each patient. I suspect that federal and state government will have to pay for most it, through Medicare and Medicaid. It's like building a 5-star hotel and then ask the government to pay for guest stays. Is that a good thing?


Like this comment
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 14, 2019 at 8:03 am

Posted by m2grs, a resident of Midtown

>> They must charge arm and leg for each patient. I suspect that federal and state government will have to pay for most it, through Medicare and Medicaid. It's like building a 5-star hotel and then ask the government to pay for guest stays. Is that a good thing?


Google this:

"california state mandate seismic upgrades hospitals"


4 people like this
Posted by old enough to remember
a resident of Downtown North
on Sep 14, 2019 at 12:58 pm

So this newspaper has an article on the new hospital without even once mentioning the who the architect that planned it is. It is very well planned and for that you need an extraordinary architec.

Rafael Viñoli, the justly celebrated architect who planned so many well thought out buildings is the architect.

Web Link


2 people like this
Posted by musical
a resident of Palo Verde
on Sep 14, 2019 at 9:16 pm

^ Manhattan's 432 Park Avenue is one of those well thought out buildings. 125 condos.
Same footprint as Palo Alto City Hall. Would please Sacramento for our housing crisis.

Rafael Viñoly: "There are only two markets, ultraluxury and subsidized housing."


Like this comment
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 15, 2019 at 1:46 pm

>> Rafael Viñoly: "There are only two markets, ultraluxury and subsidized housing."

Web Link

From the NY Times. Note the date on that: May 2013. While "gentrification" used to be sometimes good and sometimes bad, but, not -always- a bad thing, this new form that New York and SF + Peninsula have been suffering is something else. "Gentrification Squared" I guess, in this new Gilded Age.



1 person likes this
Posted by Paul
a resident of another community
on Sep 18, 2019 at 1:00 pm

Does this, "is equipped to handle a magnitude-8 earthquake and any other mass-casualty incident," mean that they can handle the projected number of casualties (from a magnitude-8 earthquake elsewhere in the area); or that the building will still be usable after a magnitude-8 earthquake which hits Stanford; or both?
As written, it is ambiguous
Thanks


Like this comment
Posted by Me 2
a resident of Old Palo Alto
on Sep 19, 2019 at 10:35 am

Now you know where all your healthcare money is going.


Like this comment
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 19, 2019 at 10:40 am

Posted by Paul, a resident of another community

>> Does this, "is equipped to handle a magnitude-8 earthquake and any other mass-casualty incident," mean that they can handle the projected number of casualties (from a magnitude-8 earthquake elsewhere in the area); or that the building will still be usable after a magnitude-8 earthquake which hits Stanford; or both?

Both, one hopes, but, the number of people needing treatment after an earthquake is somewhat difficult to predict. The fate of the old hospital in a massive earthquake was easier to predict. Hospitals all over the state have been undergoing upgrades, rebuilds, and replacements as required by the 1994 version of the Seismic Safety Act -- Web Link -- not easy to do, depending on the site. Lots of status detail here for anyone who wants it: Web Link

I guess it is the Twitter Age that we live in, but, many hospitals seem to be marketing the shiny new aspect to the upgrades, rather than the "seismic" aspect. I guess because people would rather not think about earthquakes and safety. I don't agree with this approach myself. We know that these new facilities are being paid for somehow, and, that the money somehow came out of the cost of care, directly, indirectly, or through charities and wealthy donors who could have spent the money on care. Therefore, I think people should understand that there is a very, very good reason all this money was spent. Google will discover thousands of pages about this, but, here is one regarding the 1971 Sylmar quake, which was a medium 6.5 quake:

Web Link


Like this comment
Posted by Anon
a resident of Another Palo Alto neighborhood
on Sep 19, 2019 at 10:45 am

Posted by Me 2, a resident of Old Palo Alto

>> Now you know where all your healthcare money is going.

Web Link


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