Medical reaction

Like hundreds of thousands of people in the North State, Kiyomi Bird vividly remembers how she spent the night of Feb. 12.

Bird, director for the Community Health and Sciences division of the Butte County Public Health Department, got word in the afternoon that public safety authorities might call for an evacuation south of Oroville Dam. With the main spillway and emergency spillway damaged, Lake Oroville had reached a critically high level that threatened flooding of low-lying areas.

Butte County Sheriff Kory Honea gave the evacuation order around 4:20 p.m., setting into motion a coordinated response not only from front-line emergency personnel such as police, firefighters and paramedics, but also the Public Health officials and hospital staff who compose the county’s medical system. Though not as prominent, the health response employs a structure akin to public safety—incident command centers at each location, communicating with a central hub—and people trained to handle these situations.

Bird, for one, worked through the night trying to mobilize medical staff, care facilities, ambulances, equipment and supplies. She couldn’t go to her office in Oroville because of the evacuation, so her house became her home base and she had to rely on her cellphone contact list.

“It was pretty intense,” she recalled. “I was on the floor with three phones ringing for seven hours, all going at the same time … there was a lot of action going on.”

Public Health caregivers—including Dr. Andy Miller, the recently hired public health officer—headed to evacuation centers and shelters.

Oroville Hospital decided to “shelter in place” rather than evacuate, yet still took the precautionary measure of moving patients out of ground-floor rooms and took in new patients—plus some shelter-seekers—through its emergency room.

Orchard Hospital in Gridley did evacuate, and enlisted Butte County EMS to transport 29 patients to Enloe Medical Center.

Bird and Aimee Crister, manager for Public Health’s Emergency Response program, helped keep these independent entities synchronized.

“We have an amazing [health care] community and they so stepped up to the plate,” Bird said. “There were a lot of challenges … but considering the circumstances and the magnitude of this event, we avoided a lot of things [that] could have gone worse. I still have a lot of adrenaline and emotions related to this event. It was so life-altering for so many people in so many ways, whether you were evacuated or you were responding.”

Butte County’s hospitals operate separately from each other and Public Health. They’re rivals—notice their billboards and commercials—but also partners, particularly when chips are down.

“Hospitals compete in a market at some level, but we cooperate on many other levels because of the nature of our business,” said Bob Wentz, Oroville Hospital CEO. “We work with Enloe, Enloe works with us, on many issues.”

For instance, had Oroville Hospital needed to evacuate, Enloe would have been the first place Wentz and his team would have contacted. However, he made the call not to evacuate. His facility is located on high ground, as is much of the area that Oroville Hospital serves, and was built to withstand earthquakes. It also has two electric generators, stores of oxygen, a heliport and a three-day supply of food and water.

That Sunday, Oroville Hospital held approximately 100 acutely and critically ill patients. Transporting them would have required ambulances; Bird said 35 ambulances got deployed countywide, 25 based locally, and Wentz said only seven would have been available for Oroville Hospital.

“If the hospital decided to evacuate, we would tie up a lot of EMS [paramedic] services doing so,” Wentz said. “And, if the disaster actually caused some other people to be injured, we might actually be consuming some of those same resources that would help save them—and we are that resource, so for us to be out of business would be a bad thing.”

The emergency room treated 73 people over the course of the night, plus referred others to shelters.

Carol Speer-Smith, the hospital’s director of nursing, opened the incident command center in her office and communicated with Public Health and the Sierra-Sacramento Valley Emergency Medical Services Agency.

“The toughest thing for us in incident command was rumor control,” Speer-Smith said. “Social media created a lot of panic for a lot of people.”

The hospital received status reports on the dam’s condition and the evacuation directly from authorities, with administrators using those updates to address concerns from staff and callers.

“The local media is exempted from this,” Wentz said, “but if you were getting information from the news media, especially Sacramento, that would have been bad, because there was a lot of misinformation.”

Speer-Smith rotated with Chief Operating Officer Scott Chapple and Wentz to keep the incident command center manned round-the-clock for three days, even after the mandatory evacuation ended that Tuesday. Emergency Preparedness Coordinator Chris Cunningham helped handle logistical matters such as clearing delivery trucks stopped at blockades.

Hospital operations continued uninterrupted in large measure due to doctors, nurses, technicians and support staff—some who’d rushed in from as far away as Sacramento.

“You wouldn’t want to go through this, but when you actually do, you see that these health care providers are different; they’re not working at a bank,” Wentz said. “They had the courage, the dedication, to go into a place that people were coming out of.”

In Chico, Public Health and Enloe got a reprieve from Oroville Hospital but still needed to accommodate patients evacuated from Orchard Hospital, skilled nursing facilities and convalescent homes, as well as other evacuees requiring medical attention.

Orchard is a small, critical-access hospital with a skilled nursing facility. Marty Marshall, Enloe’s director of emergency medical services, said Orchard had to evacuate nine hospitalized patients and 20 skilled-nursing patients. Enloe and Butte County EMS (for which Marshall is a managing director) dispatched gurney vans, ambulances and helicopters to transport the patients in short order.

“We were pretty chock-full at Enloe at the same time,” Marshall said.

The hospitalized patients came through the emergency room’s ambulance entrance, got evaluated and admitted to Enloe’s inpatient wards. The skilled-nursing patients went to Enloe’s rehabilitation center.

In the ER, “for days we were heavily impacted by patients from the Oroville area,” Marshall said. “We had to do what we do every day but ramp it up…. We took care of all those patients that showed up.

“These types of disasters have a huge impact on our daily operations,” he added, “but it’s something that we plan for; it’s something that we train for.”

Miller, who became public health officer in October, spent most of his time at the largest evacuation center, Silver Dollar Fairgrounds. There, he oversaw an impromptu clinic that drew providers from across the community. Public Health sent nurses; Enloe sent nurses and a physician; other doctors came voluntarily or in answer to Miller’s personal calls. Chico State nursing students and a local pharmacist also arrived to provide aid.

“There was nobody I called—and there were lots of people that I called, through the night Sunday into Monday and Monday night—trying to find a reason to say no,” Miller said. “Everybody did everything that they could.”