The Night West Blew Up

Explosion Tests Disaster Response

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Public Health Feature – July 2013

Tex Med. 2013;109(7):41-45.

By Crystal Zuzek 
Associate Editor

The April 17 fertilizer plant explosion that killed 15 people and injured more than 160 in the Central Texas town of West put the state's disaster response system to the test. Area health professionals and emergency responders mobilized quickly to care for the injured and prevent more deaths.

Waco otolaryngologist Bradford Holland, MD, learned of the explosion in West while monitoring his Facebook feed.

"My Facebook friends were commenting on the incident, so I called the Hillcrest emergency department to ask about incoming casualties. I arrived to help around 9 pm, just as the first injured patients arrived. The events of the evening were both tragic and inspiring in terms of the medical response," he said.

Dr. Holland sutured six wounded patients that night. Physicians treated about 110 patients at Hillcrest Baptist Medical Center/Scott & White Healthcare and about 50 patients at Providence Health Center. Physicians at Scott and White Memorial Hospital in Temple, Parkland Hospital in Dallas, and John Peter Smith Hospital in Fort Worth also treated victims.

"The physician response to the disaster in West was spontaneous, immediate, and overwhelming in scope. Neither Hillcrest nor Providence officially called for physician support, but a significant bulk of the medical staff, representing a broad spectrum of specialties, showed up," he said.

Overall, the medical response to the explosion in West impressed Dr. Holland.

"Both Hillcrest and Providence hospitals kicked into gear with a response I didn't even think possible. Patients were treated in a timely manner, and medical staff did a great job of getting people into the system fast," Dr. Holland said.

Waco internist and McLennan County Medical Society President Lisa Duchamp, MD, traveled to West the night of the explosion and helped triage patients at the community center with her medical partner, Felicia Macik, DO.

"It was a true honor to assist the people of West who are not only our family and friends, but who are also our patients and coworkers," Dr. Duchamp said.

Room for Improvement

William "Chip" Riggins, MD, executive director and local health authority of Williamson County and Cities Health District, says the incident in West is another reminder of the importance of planning for unexpected public health emergencies.

"Public health preparedness is a journey, not a destination. We're continuously working to improve our public health and medical plans, policies, and procedures," said Dr. Riggins, a member of the TMA Council on Science and Public Health.

Dr. Duchamp says she's proud so many medical professionals rose to the challenge presented by the incident. She also acknowledges the need to improve local emergency preparedness efforts.

At the time of the emergency, the McLennan County Medical Society lacked a solid plan for getting physicians involved in the response and communicating with them, Dr. Duchamp says. Since then, the organization met to discuss defining its role in emergencies and working with emergency medical service (EMS) and trauma professionals, hospital officials, and those involved in community disaster preparedness.

"Once we have a plan and a structure set up, we will be better prepared to provide up-to-date information to physician members while assessing the community's medical needs and responding appropriately in the wake of an emergency. We want to be as much help as possible and work as efficiently and effectively as possible," Dr. Duchamp said.

Many patients required ongoing medical care for up to two weeks after the disaster. The medical society emailed members the week following the explosion to ask them to assist patients at the West community center. Dr. Holland heeded the call. He and other physicians traveled to West to treat minor injuries that residents suffered while rummaging through debris and to help them obtain medications.

Response System in Action

The Texas Department of State Health Services (DSHS) is the lead state agency for public health and medical activities surrounding emergency preparedness and response and is a member of the Texas Division of Emergency Management (TDEM) Council.

"During an emergency, DSHS activates the State Medical Operations Center [SMOC], which allows us to support TDEM and our regional and local response partners. By coordinating with them, we can provide resources needed to support the health and medical needs of people during and after a disaster," said DSHS Assistant Press Officer Chris Van Deusen.

DSHS activated the SMOC following the explosion and worked closely with emergency management staff to respond to medical needs and to help with recovery. Specifically, DSHS deployed a large mobile medical unit to care for patients and responders and a two-person medical incident support team to help coordinate EMS functions. The department provided mortuary assistance via two morgue trailers and a four-person team from the Texas Funeral Directors Association. About 25 DSHS staff members provided help on site and from regional and Austin health department offices.

The department sent to the area a disaster behavioral health response coordinator who provided stress management counseling and emotional support for disaster workers, first responders, and survivors.

DSHS receives federal preparedness funding awarded through the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR).

As Mr. Van Deusen explains, most of the funding for preparedness comes from two federal grants: Public Health Emergency Preparedness (PHEP), administered by CDC, and the Hospital Preparedness Program (HPP), administered by ASPR. State and local public health departments receive PHEP funds to enhance their ability to respond to public health threats and disasters.

Health care systems, such as hospitals, EMS, long-term care facilities, and nursing homes, receive HPP funds for preparedness planning, improving the ability of public and private entities to work together in an emergency, and strengthening the health care system's preparedness and response infrastructure. HPP funds help enhance hospital surge capacity to serve more patients in an emergency or epidemic. Together, the PHEP and HPP grants for 2013 are $63.8 million, with more than $47 million funding local and regional preparedness and response efforts. Local and regional health departments and health systems received about 77 percent of the PHEP award and 78 percent of the HPP award this year.

At press time, the legislature hadn't finalized the 2014-15 state budget. Mr. Van Deusen says state budget proposals contained a provision to allocate an additional $5 million in state funds to preparedness activities.

Emily Kidd, MD, is project director for the Texas Disaster Medical System (TDMS), a statewide collaboration among DSHS and public health and acute medicine professionals to improve disaster response in Texas. She learned of the explosion in West about 10 minutes after it happened. Her husband, W. Nim Kidd, MD, is TDEM chief.

"He got the call about the explosion while we were eating dinner, and it didn't take long for both of us to spring into action," Dr. Kidd said.

She drove to West from San Antonio and arrived four hours after the blast.

"By the time I arrived, all of the injured patients had been transported to hospitals," she said.

That's how the system should work. As Dr. Kidd explains, in 2010, DSHS created eight Emergency Medical Task Force (EMTF) regions in the state. As part of TDMS, the goal of the task forces is to oversee the organization of the following five components within each region: 

  • Ambulance strike teams of five ambulances and one supervisor per region that travel together to evacuate nursing homes, hospitals, and other health facilities;
  • Nurse strike teams of five emergency and specialty nurses per region that assist hospitals overwhelmed by incoming patients;
  • Ambulance bus teams that can transport up to 20 bed-confined or critical patients in large ambulances (two per region) equipped with medical gear, physicians, and EMS personnel;
  • Mobile medical unit teams that set up large climate-controlled tents that serve as on-site emergency rooms, staffed by emergency physicians, nurses, and pharmacists; and
  • Command and control teams that oversee logistics in the wake of an emergency. 

Dr. Kidd says these components work together to effectively respond to large-scale emergencies. Aside from deploying EMTFs for planned events like marathons and large festivals, the explosion in West represents the first no-notice, unplanned EMTF implementation.

"I'm personally very pleased with how well the system functioned in response to what happened in West," Dr. Kidd said.

The EMTFs deployed four ambulance buses from North Texas and Schertz, one medical mobile unit team from San Antonio, and a portable morgue unit from the Houston area. Additionally, a medical incident support team of emergency medical services supervisory personnel assisted.

"Fortunately, we didn't need the portable morgue. We determined we needed only one medical mobile unit team to treat minor blast injuries, eardrum ruptures, sinus pain, and cuts for the first 48 hours after the event," Dr. Kidd said. 

Physician Volunteers

Dr. Kidd stresses the importance of having a structured, formal system through which physicians and other health professionals can volunteer during emergencies. She says physicians showing up at the scene of a mass emergency unannounced can actually be dangerous.

"All medical personnel who help out during a disaster have to be with a group that has vetted their credentials. Patient safety has to be protected," she said. "It's also essential that doctors working at the scene of a disaster understand incident command structure to ensure their own safety. The structure ensures everyone knows who the physicians are, what they should be doing, and where they're supposed to be."

She encourages emergency medicine physicians to volunteer to join one of the EMTFs. Volunteering requires completing an application process and undergoing training on a quarterly basis. To inquire about volunteering, physicians should visit the TDMS website, select their county from the list, and contact the district coordinator or EMTF coordinator.

DSHS recognizes the value of local physician volunteers and encourages physicians and other health professionals to register with the Texas Disaster Volunteer Registry (TDVR) online to be credentialed and verified as a volunteer health professional before a disaster.

"It is important for volunteers, especially those with a professional license, to complete the registration and credentialing process prior to a disaster so they can be utilized more quickly and efficiently," Mr. Van Deusen said.

Collaboration among doctors, public health officials, state and local health agencies, hospitals, and other groups and organizations helps to ensure a successful response to a public health emergency. Many of Texas' county medical societies have emergency preparedness committees that make it easy for physicians to get involved and assist the public during emergencies and to work with city and county officials to plan and coordinate an effective emergency response. To find out how to get involved in a committee, physicians should contact their county medical society.

Crystal Zuzek can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.


West Physician Helped Save Lives

George Smith, DO, West emergency medical service (EMS) director, helped save 127 West Rest Haven nursing home residents by coordinating their removal from rooms near the fertilizer plant before it exploded. Dr. Smith, the nursing home's medical director, suffered cuts on his face and back when the ceiling fell in on him. He and other first responders organized rescue groups and treated the injured all through the night.

One elderly nursing home resident died of a heart attack after being evacuated from the facility.

"We were fortunate there weren't more fatalities," Dr. Smith said.

He said the blast knocked out ambulance radio and cell phone communication, so he used a satellite radio in a helicopter to tell the EMS dispatcher to send medical help. Because EMS personnel couldn't talk to one another, they had to rely on their training.

"It's important for medical professionals and first responders to know prior to a disaster how they should function if lines of communication get knocked out. It frustrated me that I couldn't talk to my ambulance drivers to give them guidance. Luckily, they knew what to do," Dr. Smith said.

Dr. Smith has practiced in West for 38 years and lives only 250 yards from the site of the explosion, which destroyed his home. Helping his long-time friends and neighbors in the aftermath of the explosion meant the world to him.

"That's what I'm trained to do. I'm the acting medical commander of the Disaster Medical Assistance Team, and I helped after hurricanes Katrina and Ike. I've now been on the giving and receiving end of disaster response," he said.

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