6.12 Special Needs
During the Old Fire incident, the Bear Valley Community Hospital was evacuated along with schools.
Bear Valley Community Hospital long-term residents were evacuated. This was the first time the entire community hospital had ever been evacuated.
The evacuation of the elderly care residents from the hospital was coordinated with Big Bear City Fire Department and the City of Big Bear Lake Emergency Management Services through the Emergency Operations Center.
A week before the evacuation of the hospital, the fire chief contacted the hospital and conducted pre-disaster planning such as, if the need for an evacuation was clear, what type of transportation was needed and from where would the transportation come.
Once the decision was made to evacuate the community, the hospital instituted an internal disaster plan. When the hospital was informed of a voluntary evacuation, the director of nursing provided guidance to staff and delegated responsibilities to perform certain tasks. Some staff were directed to prepare the residents for an evacuation, pack up residents’ medical records, pack up 3 days of food, pick up the medications, call in additional clinical staff, and contact families. By delegating tasks, the staff were focused on the evacuation of patients and not necessarily on the fire situation.
By the time the ambulances arrived at the hospital, residents and staff were ready to leave. To facilitate information regarding a resident, the resident’s individual medical file went along with the patient, in addition to the medication.
A task force from American Medical Response (AMR) provided five ambulances to transport the 20 long-term residents located at the hospital. Two of the acute care residents were evacuated by air due to the lengthy ambulance trip. Normally, it takes 1 ½ hours to get off the mountaintop, but this trip took 3 hours.
The total time to evacuate the hospital was approximately 3 ½ hours.
During the voluntary evacuation period, the incident command center found beds for the residents, but the beds were scattered among several nursing homes. There was a concern with the separation of the residents, and it revolved around three main areas:
- The residents would find it difficult to adjust to new surroundings, and familiar staff is needed to maintain continuity. With the residents being divided among multiple nursing homes, there was not enough staff to maintain contact and continuity among the residents.
- Family members would need to be directed to multiple nursing homes, and it was felt that one nursing home location would be beneficial to family members.
- Additional residents would tax the existing staff at the nursing homes. To alleviate this issue, Bear Valley hospital staff would be needed at the multiple nursing homes. There was not enough staff for this to occur.
The director of nursing contacted several nursing homes; in the meantime, Braswell’s Colonial Care in Redlands, California, contacted the director and offered the number of beds required. At the time of the Big Bear Valley evacuation, the hospital did not have agreements with other nursing homes to take in residents. Since that time, this has been corrected.
To assist Braswell staff, seven hospital staff were sent to look after the residents. They remained at Braswell’s for 5 days until they could be returned to Big Bear Valley. For the return to Big Bear Valley, AMR was contacted for the return trip. Residents were returned a day after the evacuation order was lifted.
Communication with the staff in Redlands proved to be difficult due to downed telecommunication lines. Cell phones provided coverage, and as a result, staff now have cell phones.
Drills and Training
The hospital participates in annual disaster training drills, an annual statewide disaster drill, and valley tabletop exercises, but not on the scale of the evacuation. However, training did help familiarize staff with the need for an evacuation.
The focus at the beginning of the evacuation was to find one facility that could accommodate all of the residents. During the evacuation, the focus was on getting residents ready for the evacuation, dealing with anxious staff whose homes were under an evacuation order, and dealing with family members who were contacting the hospital for information and the evacuation location.
After the evacuation, the focus was on making sure the residents received the care they were accustomed to and keeping the residents calm due to unfamiliar surroundings and people.
The hospital continued to function for 3 days after the evacuation of its long-term residents. The hospital emergency room remained open to provide medical facilities for people in need of care. After 3 days, the smoke from the fires proved to be overwhelming, and the hospital was closed.
Lessons LearnedThere are several lessons that were learned from the Old Fire incident:
- Create a disaster book with emergency contact information and local nursing homes phone numbers.
- Ensure staff have cell phones for communication purposes.
- Have a written evacuation plan that is shared with the staff.
- Maintain a current list of emergency contacts for residents, patients, and staff. Staff information should include home number, cell phone number, and emergency contact numbers.
- Ensure there is a place to send residents/patients during an emergency. There are now verbal agreements with other facilities for the evacuation of patients/residents.
- Pack supplies for longer than 3 days. Residents were away from the hospital for 5 days.
Why a Success
The evacuation of the hospital was coordinated with the Bear City Fire Department and the City of Big Bear Lake Emergency Management Services through the Emergency Operations Center. A week before the evacuation occurred, the fire chief contacted the hospital and conducted pre-disaster planning such as, if the need for an evacuation was clear, what type of transportation was needed and from where would the transportation come.
The hospital also participates in tabletop exercises and understands its roles and responsibilities. Preplanning for the evacuation assisted in the successful evacuation of the hospital.
Schools in Big Bear Valley were evacuated. The day before the evacuation of the valley, the superintendent of the schools was informed of the potential for an evacuation and passed this information along to staff of the school district. Students of the schools were sent home. District staff were told that the local emergency management officials would not try to evacuate when school was in session. However, the next day after students were at school, the winds picked up and a mandatory evacuation of the valley occurred.
One of the high schools served as a collection point for surrounding schools for students without transportation. Students were bused to that location and placed in the gymnasium until parents could be reunited with their children. Parents either were known to school administrators or were required to show identification.
This decision was made on “the fly” and not incorporated into any of the school training. School training normally consists of annual fire drills; however, the decision to use one school as a collection area was dictated by geography and the fire. The school selected was the furthest away from the fire.
Approximately 75 percent of high school students have their own transportation and left on their own accord. Approximately 900 high school students were evacuated, and it took 5 hours for parents to be reunited with their high school children.
Within the first hour of school, a voluntary evacuation order was given to the community. At that time, the middle school decided to evacuate and reunify parents with their 600 children. Phone calls were made for over 3 hours to parents to tell them of the need to pick up their children.
The school determined that an orderly process was needed for reuniting students with their parents. School children were informed to return to their home room class to await their parents and a sign-out sheet was created to check out the students.
As parents arrived at the school, they were directed to an office, where they could pick up their children. Staff were directed to the front of the building to keep parents calm during the incident.
All of the students were picked up within 3 ½ hours of the start of the evacuation. As the number of students decreased, staff with small children were released to go pick them up for evacuation of the valley.
Lessons LearnedThere are several lessons that were learned from the Old Fire incident:
- If family is not available, friends can be contacted to pick up a student. Some of the family members work off the mountain and had difficulty in returning to the valley.
- Almost every student had a cell phone. The school policy is not to allow students to use cell phones while in school. During this incident, when the students were in the gymnasium, they called their parents to inform them of the school closing. After this incident, the high school has thought of relaxing this school policy.
Use a workaround for a communication issue. The landlines were lost, there was no radio repeater, and the handheld radios worked for approximately a mile. Communication back to the district office was problematic, so a workaround was to position school buses at a jump point where a bus could be contacted, which in turn contacted another bus and so forth until the district office was contacted.
Why a SuccessThe evacuation of schools in Big Bear Valley was a success due to several factors:
- An orderly process was developed to allow parents to pick up their children in a calm setting.
- There was school training for emergency drills.
- The Big Bear Valley incident commander decided to hold off announcement of an evacuation until the school children arrived at school, thus allowing for an orderly evacuation of students.
February 6, 2006