Preparing for the worst

On the morning of Nov. 14, Enloe Medical Center got a call from Mercy Medical Center Redding. A gunman’s shooting spree in Rancho Tehama had left nearly a dozen people—adults and children—in need of critical care; how many could Chico treat?

Such an inquiry isn’t shocking at Enloe, the region’s trauma center, which routinely handles crises. Nor, really, are gunshot wounds unfamiliar to smaller hospitals’ emergency rooms.

Still, staff at Enloe took pause. A question arose: Is this a drill?

Because, right at that moment, Enloe was getting ready to rehearse a medical response to a mass casualty incident with gunshot victims. Hospitals statewide were conducting similar drills, either that day or two days later, to ensure preparedness for actual incidents.

“We had to verify first that whatever this event going on in Rancho Tehama [was] was in fact a real event,” said Bob Kiuttu, Enloe’s emergency services manager. “We confirmed that pretty quickly. But in the back of our minds was like, Is this somebody who started a drill and didn’t announce it?”

Enloe, of course, called off its drill and prepared to receive actual patients. Five arrived: two adults, three children. The hospital was staffed for more; under its mock scenario, a driver would mow down a crowd downtown, then exit the car and shoot bystanders—leaving around 50 injured. The emergency response team didn’t need to set up the special receiving area in their plan (a large tent, provided by FEMA), though otherwise followed standard protocol for a crisis.

On one level, reality was simpler than fiction.

“Except for that we were getting truly injured patients, some of them being children, which is always the worst,” noted Judy Cline, director of the emergency department and trauma services. “But, yes, in doing disaster drills, preparing for large-scale disasters, we like to prepare for the worst. We feel if we prepare for the worst situations, then the ones that aren’t so bad, hopefully we’ll be even more prepared for at the time.

“That is exactly how this event went for us.” After a pause, she added: “We don’t expect to always be that lucky.”

Jade Reese, Enloe’s trauma program manager, learned of the Rancho Tehama shootings while sitting in an airport in Chicago, waiting to fly home from a conference. After landing, she texted Cline asking if she needed to come in; the answer was no.

Of the five patients, three were treated and released; the others were discharged by last week.

“It was handled quickly and efficiently,” she said. “Everything I heard, talking to my counterpart in Redding, was they felt it went well there [too].”

Along with participating in crisis-action planning at the hospital, Reese spearheads Enloe’s efforts to teach average citizens how to save lives on-scene. The program—part of a national campaign called Stop the Bleed (BleedingControl.org), co-sponsored by the American College of Surgeons—offers instructional materials and courses demonstrating techniques to stem blood flow from bullet holes, gashes and severed limbs.

In the past few years, Reese explained, medical and disaster-response professionals determined “bleeding was the major cause of death for traumatically injured patients”—not the traumatic injury itself.

“Bleeding can be stopped by laypeople, just like we teach people CPR or how to help someone choking in a restaurant,” she continued. “We want them to know what to do, not just in a mass casualty incident, but if you’re out hunting or come across a vehicle accident or your child cuts themself.”

The basic steps:

• Call 9-1-1.

• Grab a piece of fabric—for instance, a T-shirt.

• Clear the wound from debris and clots.

• Stuff as much of the fabric as possible into the wound.

• Hold pressure as hard as possible until help arrives.

“It’s almost easier than CPR or the Heimlich maneuver,” Reese said. “It’s not sterile, it’s painful for the victim … but you’re saving their life.”

To block massive bleeding from a limb, use the fabric to fashion a tourniquet and tie the band tightly. First responders—EMTs, firefighters, police—all carry manufactured tourniquets in their vehicles; so do Reese and Cline.

“It used to be we never used tourniquets,” Reese said, for fear of irreparably harming the body part deprived of blood, but research has found that “the amount of time it would take for the tourniquet to do that amount of damage is so extensive that usually you can get to a facility in time. So you’re usually better off saving a life than worrying about losing a limb.”

The drill Enloe planned—and thought Mercy might have been running—constituted Chico’s piece in the California Statewide Medical and Health Exercise. The California Department of Public Health and California Emergency Medical Services Authority designate a disaster for each annual run-through; the theme for 2017 was “active shooter” due to prevalence.

With an integrated response system, kept sharp with planning and drilling, “we’re way more advanced than any other state,” said Melissa Barnard, emergency department director and emergency management committee chair at Adventist Feather River in Paradise.

Enloe is a designated disaster control facility for four North State counties—Butte, Colusa, Glenn and Plumas—as Mercy is for counties near Shasta. Its incident command center is like an air traffic control tower for patients and surrounding hospitals.

Other facilities prepare, too. While they’re more likely to handle hometown incidents, facilities such as Feather River and Oroville Hospital could get the call Enloe did Nov. 14.

“When there was a bus that crashed on I-5 [in April 2014], we were on standby,” Barnard said by phone. “Because we’re available. What if Enloe Hospital is 100 percent, completely full, and there’s 30 patients? We could take five of them.”

Feather River conducted its drill Nov. 3—independent of, but related to, the state exercise. The Butte County Office of Emergency Management got grant funding from the U.S. Department of Homeland Security to conduct a crisis response scenario in Paradise; the mid-November dates did not work for all the agencies (local, county, state and federal) involved.

Oroville Hospital did not answer requests for information about its disaster planning or participation in the Statewide Medical and Health Exercise by the CN&R’s deadline.

Enloe runs disaster simulations twice a year. Feather River has done so three straight years. Both hospitals also prepare for an active shooter on-site.

“We even talk about when the big, big, big one hits—the earthquake on the coast,” Barnard said. “I don’t care if it’s from Redding or Orland or San Francisco or Chico, we do all coordinate and prepare to be there for other people.”