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The 1989 Loma Prieta Earthquake: Issues in Medical Control

Published online by Cambridge University Press:  28 June 2012

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

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.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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