I got the alert on my cellphone at 1:51 a.m the morning of Monday, Oct. 9, 2017. “Please come to the ED if you are available to help with the surge from fire victims and evacuees.”
My first thoughts: “What fire? What evacuees? Which ED is this?”
I was sound asleep, and it took a while to figure it out. I’d transferred from Kaiser Permanente (KP) Walnut Creek Medical Center in Walnut Creek, California, to KP Santa Rosa two years prior, and I still received the occasional alert from Walnut Creek.
I finally woke up enough to realize I could log onto the ED track board. KP Santa Rosa didn’t look unusually busy. I called my friend and colleague Josh Weil, MD, who was on the overnight shift.
“Josh, I got the page. Was that you guys? Do you need help?”
His voice was uncharacteristically strained.
“I think my house is gone. Claire and Sophie just evacuated. They literally ran through a wall of flames to get out.” Claire is his wife, and Sophie is his 15-year-old daughter.
“What do you need?” I asked. It was hard to take in; our entire emergency department just had an end-of-summer barbecue at their house a few weeks before.
“I don’t know what I need.”
“I’m coming in,” I said. I hung up the phone. This was real.
My partner, Fred, came in through the back door. I hadn’t even noticed he was gone. He’d been driving around our small neighborhood to see if he could locate a fire.
“I can’t see any fire, but the smoke is bad,” he said. I stepped outside. The wind was brisk, and the smell of smoke was pervasive. The Tubbs Fire, which had started around 9 p.m. the previous day, was raging.
“I have to go into work,” I told him. “Josh’s house is on fire. Claire and Sophie barely got out.” Fred’s face fell.
He turned on the TV. I threw on some scrubs. “There are fires everywhere,” he said.
Realizing I might be gone for a while and Fred might need to evacuate, I gathered some things for him to take just in case—papers, pictures, and cherished family items. My hands were shaking as I packed.
I’m an emergency physician, and I also spend half my work time in disaster planning and training for KP Northern California. I’ve worked both domestically and internationally in disaster response, including New York after Superstorm Sandy in 2012 and Haiti after the 2010 earthquake. I’d like to say all I had to do was grab my prepacked evacuation bag and head out the door in five minutes, but I didn’t. Although we have a home disaster kit with supplies, food, and water for our family and an evacuation bag for our dog, I hadn’t compiled the important documents and family items I now found myself stuffing into boxes and bags.
After what felt like an eternity, I found myself hurtling east down Guerneville Road toward the hospital. There was a large orange glow on the horizon, and the smell of smoke was growing stronger. I couldn’t help but notice the steady stream of cars driving west, away from the fire.
There weren’t many cars going in my direction, toward the fire.
Entering the Fire Zone
My normal route was blocked. The exit was blocked; there was a police car stationed there with lights flashing.
I showed my ID, and the officer let me through. I thought back to all the times I’d taught staff to keep their IDs with them. I always promise it will get folks through a roadblock, and it had. I later learned many of our hospital administrators were not so lucky. It didn’t matter what they showed or said, they were turned away at other entry points because they were in active fire zones.
I kept driving. A sea of flashing lights and emergency vehicles appeared before me only a half block from the hospital. I turned left into the parking lot, wound my way around the buildings, and parked in the garage.
The smoke was incredibly thick when I got out of the car, and a security guard was controlling access to the emergency department.
That’s when things get fuzzy. My brain didn’t register the people carrying their belongings walking the other way or the embers flying through the air. And although I walked right past the Journey’s End mobile home park on my left, only yards away from the hospital’s property line, my brain didn’t register anything unusual there either, despite the fact it was almost completely engulfed in flames.
Here’s what I do remember: the smoke in the emergency department and hospital hallways; the calm, focused intensity in the hospital command center; and the decision to evacuate the hospital when the fire department told us it was making “a last stand.” I remember the cadre of police officers who showed up when we needed to step up the evacuation even further and how we went floor to floor in teams to clear out the bedbound patients. My brain finally registered the fire as I passed a fourth-floor window and saw the flames at our hospital’s property edge.
We staged patients by the freight elevators and took them down one by one. Once downstairs, we lined them up in the hallway to await transport. We assigned one staff member, from MDs to RNs to environmental service workers, to every patient and documented each patient as they went through the lobby doors onto the ambulances and city buses waiting to take them to safety. The patients and staff were amazing; there was no panic and very little noise.
Here’s what I remember most: watching the last bus pull away from the KP Santa Rosa Medical Center at 6 a.m. and realizing we safely evacuated 122 patients in two and a half hours.
Not a bad night’s work.
Our work didn’t end there, of course. It would take more than three weeks until the hospital and clinics were fully back up and running. Even now, things are not back to normal, given that more than 200 of our staff and physicians lost homes and entire neighborhoods in our community are gone.
Things will never be back to normal. Instead, we have a new normal, one that is wiser, stronger, more realistic, and, most of all, kinder and more cooperative.
Dr. Fitzgerald is an emergency physician at Kaiser Permanente Santa Rosa in Santa Rosa, California.
- Not all disasters happen at 10 a.m. on Monday. A disaster that occurs at 3 a.m. on Sunday presents increased challenges in terms of personnel availability and functionality.
- Keep your medical ID with you at all times.
- Some of your key responders may not be able to get to the hospital in a disaster event.
- Evacuation is a parallel process. The resources needed to evacuate the adult ICU and NICU patients are different from those needed to evacuate the patients on the floor. For those who can walk, buses and private cars are your new best friends if the situation is urgent. If you even think you might have to evacuate, start preparation immediately, including making plans for how you will track your patients and the supplies, patient care information, and medical personnel you will send along with them. You can determine and practice much of this in advance.
- When evacuating patients or when handling a patient surge, assign one staff member to each patient to monitor, track, and help transport. Having direct eyes on every patient, whether by someone medically trained or not, is invaluable during chaotic disaster events.
- Practice makes perfect when it comes to disaster response and infrequently used plans such as evacuation plans. Talk through and drill your plans as often as you can. Muscle memory will prove extremely helpful when the time comes.
- The concept of the “disaster brain” is real, though the extent to which it dictates behavior in a disaster varies. We may not even realize our brains are not 100 percent until much later. It’s like they used to teach us for codes, “Take your own pulse first.” Call a huddle; do a quick time-out. Make sure everyone is on the same page. If the situation gets worse or more chaotic, repeat this sequence, just like you would repeat the ABC’s in a difficult or extended code. Drill under time pressure to grow more resilient.