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The 1989 Loma Prieta Earthquake: Issues in Medical Control

Published online by Cambridge University Press:  28 June 2012

Jorge Palafox ,
James E. Pointer ,
Julie Martchenke ,
Marie Kleinrock  and
Janet Michaelis
Jorge Palafox*
Affiliation:
Emergency Medical Services Agency, Department of Public Health, City and County of San Francisco, San Francisco, Calif.
James E. Pointer
Affiliation:
Emergency Medical Services Agency, Department of Public Health, City and County of San Francisco, San Francisco, Calif.
Julie Martchenke
Affiliation:
Emergency Medical Services Agency, Department of Public Health, City and County of San Francisco, San Francisco, Calif. Emergency Department, San Francisco General Hospital, andthe University of California San Francisco Mastersin Nursing Program, Department of Public Health, City and County of San Francisco, San Francisco, California
Marie Kleinrock
Affiliation:
Emergency Medical Services Agency, Health Services Department, Contra Costa County, California
Janet Michaelis
Affiliation:
Kettering Medical Center, Department of Medical Education, Dayton, Ohio.
*
EMS Specialist; Disaster Coordinator, EMS Agency, City and County of San Francisco, 1540 Market Street, Suite 220, San Francisco, CA 94102USA
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Abstract

Introduction:

The role of the base-hospital and on-line medical control in a disaster has not been investigated previously. This study assesses the roles of base-hospitals and the value and feasibility of on-line medical control during the 1989 Loma Prieta earthquake.

Methods:

The researchers studied five Bay Area counties most affected by the earthquake: San Francisco, Alameda, San Mateo, Santa Clara, and Santa Cruz. Researchers sent questionnaires to all 1,498 registered EMTs and paramedics in these counties; 620 were returned (41.4%). Respondents answered questions about activities performed, contacts with base-hospitals and other agencies, and problems encountered the night of the earthquake. Researchers selected 63 paramedics for in-depth interviews based on their performance of significant advanced life support (ALS) activities performed during the disaster. The coordinators of the 13 base-hospitals (BHCs) in the region also received and returned questionnaires about medical control, base-hospital roles during the disaster, and problems encountered. Researchers interviewed all five county emergency medical services (EMS) agency directors.

Results:

The surveys of EMS directors, base-hospital coordinators, and paramedics indicate that confusion existed over the status of medical control after the earthquake. There was general agreement among base-hospital coordinators (BHCs) that suspension of medical control is appropriate in a major disaster.

Three bases had appropriate equipment to function as back-up dispatch centers. Eight bases had adequate personnel, but only one BHC felt his personnel had adequate training to function in a dispatch capacity. Nine paramedics did not start or continue resuscitation on patients whom they ordinarily would have begun resuscitation.

Conclusion:

Emergency medical services should suspend medical control immediately following a major disaster and ensure that all prehospital and base personnel are notified. Disrupted communications protocols for prehospital personnel should reflect the skill and knowledge level of paramedics and the need for rapid, advanced practice in a disaster. Disaster planners should consider other roles for base hospitals in major disasters.

Keywords

base hospitalsdirect medical controldisaster planningdisastersearthquakesemergency medical serviceson-line medical controlparamedicsprehospital care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 4 , December 1993 , pp. 291 - 297
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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References

1. Earthquake Associated Deaths, MMWR 1989;38:767.Google Scholar
2. Population Estimates of California Cities and Counties: January 1, 1988 to January 1,1989. Department of Finance, State of California (report 89-E1), Sacramento, 1989.Google Scholar
3. American Hospital Association Guide to the Health Care Field, Chicago, AHA 1987.Google Scholar
4. California Health and Safety Code (Title 22), Division 9, Chapter 4.Google Scholar
5. Williams, M: Region II Disaster Planning Project: Bay Area EMS Disaster Communications Study, The Abaris Group, Tustin, California, Final Report prepared for the California Emergency Medical Services Authority, 1991.Google Scholar
6. Thiel, CC, Schneider, JE, Hiatt, , Durkin, et al. : 911 EMS process in the Loma Prieta earthquake. Prehospilal and Disaster Medicine 1992;7:348–358.CrossRefGoogle Scholar
7. Haynes, BE, Freeman, JC, Rubin, JL et al. : Medical response to catastrophic events: California's planning and the Loma Prieta earthquake. Ann Emerg Med 1992;21:368–374.CrossRefGoogle ScholarPubMed
8. Koehler, GA, Foley, D, Jones, M: A computer simulation of a California casualty collection point used to respond to a major earthquake. Prehospital and Disaster Medicine 1992;7:339–347.CrossRefGoogle ScholarPubMed
9. Jacobs, L, Goody, M, Sinclair, A: The role of a hospital trauma center in disaster management. J Trauma 1983;23:697–701.CrossRefGoogle Scholar
10. Orr, S, Robinson, W: The Hyatt Regency skywalk collapse: An EMS-based disaster response. Ann Emerg Med 1983;12:601–605.CrossRefGoogle ScholarPubMed
11. Klain, M, Ricchi, E, Safer, P et al. : Disaster reanimatology potentials: A structured interview study in Armenia I. Methodology and preliminary results. Prehospital and Disaster Medicine 1989;4:135–154.CrossRefGoogle Scholar
12. Noji, E, Kelen, G, Armenian, H et al. : The 1988 earthquake in Soviet Armenia: A case study. Ann Emerg Med 1990;19:891–897.CrossRefGoogle ScholarPubMed
13. De Bruycker, M, Greco, D, Lechat, M: The 1980 earthquake in Southern Italy morbidity and mortality. International J Epidemiology 1985;14:113–117.CrossRefGoogle ScholarPubMed
14. Gueri, M, Alzate, H: The Popayan earthquake: A preliminary report of its effects on health. Disasters 1984;8:18–20.CrossRefGoogle Scholar
15. Compton, DMJ et al. : Hospitals in the Mexico Earthquake of September 19, 1985: Impact, Response, Recovery, Reconstruction. Safety Sciences, Inc. of San Diego, California Final Research Report. Prepared for the National Science Foundation Grant, 1990.Google Scholar
16. Mahoney, L, Reutershan, T: Catastrophic disasters and the design of disaster medical care systems. Ann Emerg Med 1987;16:1085–1091.CrossRefGoogle ScholarPubMed
17. Hiatt, J, Larmon, B: Impact of urban disaster on a university trauma center. Western J Med 1988;148:225–228.Google ScholarPubMed
18. Gilliland, MGF, McDonough, E, Fossum, R et al. : Disaster planning for airline crashes: A retrospective analysis of Delta Airlines flight 191. Am J Eorensic Med Path 1986;7:308–316.CrossRefGoogle ScholarPubMed
19. Waeckerle, J: Disaster planning and response. N Engl J Med 1991;324:815–821.Google ScholarPubMed
20. Auf de Heide, E: Disaster Response: Principles of Preparation and Coordination. St. Louis: C.V. Mosby Co., 1989, pp 50–52.Google Scholar
21. Macleod, BA, Seaberg, DC, Paris, PM: Prehospital therapy past, present, and future. Emerg Clin N Am 1990;8:57–74.CrossRefGoogle ScholarPubMed
22. Polsky, SS, Weigand, JV: Quality assurance in emergency medical service systems. Emerg Clin N Am 1990;8:75–85.CrossRefGoogle ScholarPubMed
23. Boyd, D, Micik, S, Lambrew, C, Romano, T: Medical control and accountability of emergency medical services (EMS) systems. IEEE Transactions on Vehicular Technology 1979;VT–28:249–261.CrossRefGoogle Scholar
24. Holroyd, B, Knopp, R, Kallsen, G: Medical control: Quality assurance in prehospital care. JAMA 1986;256:1027–1031CrossRefGoogle ScholarPubMed
25. Callaham, M: EMS base station function and design on-line medical control. Prehospital and Disaster Medicine 1989;4:53–56.Google Scholar
26. Hoffman, J, Luo, J, Schriger, D, Silver, L: Does paramedic base-hospital contact result in beneficial deviations from standard prehospital protocols? Western J Med 1990;153:283–287.Google ScholarPubMed
27. Selden, BS, Schnitzer, PG, Nolan, FX: Medicolegal documentation of prehospital triage. Ann Emerg Med 1990;19:547–551.CrossRefGoogle ScholarPubMed
28. Salerno, S, Wrenn, K, Slovis, C: Monitoring EMS protocol deviations: A useful quality assurance tool. Ann Emerg Med 1991;20:1319–1324.CrossRefGoogle ScholarPubMed
29. Pointer, J, Osur, M, Campbell, C et al. : The impact of standing orders on medication and skill selection, paramedic assessment, and hospital outcome: A follow-up report. Prehospital and Disaster Medicine 1991;6:303–308.CrossRefGoogle Scholar
30. Wasserberger, J, Ordog, G, Donoghue, G et al. : Base station. Ann Emerg Med 1987;16:867–871.CrossRefGoogle ScholarPubMed
31. Pointer, J, Osur, M: Effect of standing orders on field times. Ann Emerg Med 1989;18:1119–1121.CrossRefGoogle ScholarPubMed
32. Pointer, J et al. : The 1989 Loma Prieta earthquake: Impact on patient care. Ann Emerg Med 1992;21:1228–1233.CrossRefGoogle Scholar
33. Martchenke, J, Pointer, J, Michealis, J et al. : Hospital disaster operations during the 1989 Loma Prieta earthquake. In press.Google Scholar
34. Barton, C: Medical dispatch centers in the Loma Prieta earthquake. In press.Google Scholar