Consider the human toll if a bioterrorism event was to occur in Palo Alto. Thousands would end up sick or dead, Eric A. Weiss, M.D., medical director for Stanford Medical Center's Office of Emergency Management, warns.
In a pandemic, an estimated 20 to 30 percent of Santa Clara County's 1.8 million people would need medical care, much of it immediate, according to Weiss.
Now multiply that by many hundreds to get to the estimated death-and-injury toll from an 8.3-magnitude San Andreas Fault earthquake occurring at 4:30 p.m. on a weekday -- swamping Stanford Hospital and surrounding hospitals and clinics.
Projections are that 250 would die and nearly 1,000 people would need hospital care, according to the city's emergency-operations plan.
But San Mateo County has no trauma center and many trauma patients would be rushed to join the 1,000 or more seriously injured at Stanford. Normally, 50 percent of trauma cases seen at Stanford Hospital's emergency room are from San Mateo County, Weiss said.
Weiss and others say no city alone can handle those numbers, let alone one hospital. That's why Stanford, the City of Palo Alto and many other groups are banding together to create major, groundbreaking, region-wide disaster plans.
Palo Alto has the Citizen Corps Council, a broad-based coalition of city department heads, community leaders and residents. Stanford Medical Center and Lucile Packard Children's Hospital are collaborating with the city, county, state and federal agencies and businesses along the Sand Hill Road corridor to provide and receive disaster services.
The hospital is expanding its trauma center and upgrading its decontamination system. It is upgrading its emergency power supplies that run everything from lights and surgical tools to power-chilled water to cool equipment and produce steam for sterilizing.
And the nonprofit Joint Venture Silicon Valley has implemented a Disaster Preparedness Initiative and is developing a regional public-private "Disaster Resiliency Center" at Moffett Field in Mountain View.
Officials are taking lessons from the Sept. 11 disaster in New York City. If that was a wake-up call, the floating bodies left by Hurricane Katrina sent the message home, they said.
"The horrendous scene we witnessed in New Orleans with Hurricane Katrina and its aftermath -- including especially the failed integration of local, state and federal relief efforts -- is a subject of compelling interest to Silicon Valley," Joint Venture Silicon Valley said in a summary of its initiative.
"On this basis, our vision for this initiative is simple and straightforward: We would like to know with complete certainty that our region is prepared."
"We need to stand up for ourselves," Steven Jordan, project director of Joint Venture's Disaster Resiliency Center, said of the effort. Jordan has 37 years experience in emergency management.
It's a warning long echoed by Palo Alto police Officer Kenneth Dueker, coordinator of Homeland Security and public outreach under the city manager's office. It is also echoed by Palo Alto Police Chief Dennis Burns, who with Dueker heads the city's effort to create regional cooperation in the event of a disaster.
The efforts have already been tested. On Feb. 17, 2010, a major incident occurred when a small plane crashed into a PG&E electrical tower and plunged the city into darkness for a full day. The plane then crashed into an East Palo Alto neighborhood, setting homes and vehicles on fire and causing panic among residents. Three people in the plane were killed.
The Palo Alto City Council made disaster prep one of its 2010 priorities -- but all agree the preparation takes more than one year. It is built upon step-by-step collaborations and carefully constructed infrastructure, from communications to leveraging every resource available in the community, from the corner drug store that might offer supplies and medications during a pandemic to the hotel with spare beds for the injured or displaced in an earthquake, Dueker said.
Palo Alto's Citizen Corps Council is collaborating locally and regionally. It is the coordinating body for all emergency planning and Homeland Security within the community, he said.
Re-activated by the City Council in 2009, the Citizen Corps is comprised of "sectors" that include business, Stanford University, Stanford Medical Center, the Stanford Research Park, schools, seniors, shopping centers and volunteers and neighborhood groups -- some of which have pushed for better emergency preparation for years, as did former Palo Alto Mayor Judy Kleinberg during her term in 2006.
Technical working groups investigate funding, set up trainings, and coordinate resources related to pandemics, public health and other issues, Dueker said.
Within the Citizen Corps, the Sand Hill Neighborhood Disaster Committee coordinates with hotels, senior facilities, neighborhood groups and businesses, Stanford Medical Center, Stanford University School of Medicine, Stanford Shopping Center, Palo Alto Medical Foundation, SLAC National Accelerator Laboratory, Ronald McDonald House and Oak Creek Apartments, Rosewood hotel and Vi senior-living residences.
Stanford Medical Center's Office of Emergency Management plans strategies and conducts joint emergency-response exercises.
The hospital has agreements with pharmacies such as Walgreens, hotels such as the Westin and Sheraton and the Palo Alto VA Health Care System to provide medicines, supplies, shelter and other needed resources, Bernadette Burnes-Line, administrative director of the Office of Emergency Management, said.
During the Feb. 17 plane-crash/power outage incident, teams from multiple agencies rolled into Stanford Hospital to lend assistance after the lights went out and in case mass casualties occurred. San Mateo County provided emergency medical personnel, Stanford Public Safety and Transportation was ready to deal with traffic, and engineers from SLAC stood ready with generators to light up the Medical Intensive Care Unit, Burnes-Line said. Teams from the American Red Cross Silicon Valley and liaisons from the City of Palo Alto were also on hand.
"This would never have happened if Sand Hill and the Citizen Corps Council didn't exist," she said of the quick, coordinated response.
Weiss said hospital staff members train on a daily basis. And every other month the Sand Hill group meets to strategize, discuss, build relationships or drill, according to Burnes-Line.
Sometimes, they train through county- and state-run exercises. On Thursday, Nov. 18, up to 200 bomb "victims" were to arrive during a two-hour simulated improvised-explosive-device drill put on by the county and state.
Nurses, doctors and other hospital staff set up a "surge plan" for the mass casualties, which trickled in batches into the emergency room. Teams set up triage system to assess severity of injuries; a rapid-discharge plan for less critical patients to make room for the injured; and a plan for the mass-casualty influx, she said.
But in a real disaster, knowing just how many people will walk -- or be carried -- through the door is a guessing game, Weiss said. Tiered surge plans help prepare for any eventuality. Phase I might plan for a 10- to 20-percent patient increase versus a 30- to-40-percent increase, he said.
Hospitals are generally prepared to be self-sufficient for 96 hours, but any hospital must consider the percentage of employees who live out of the area and who must commute across bridges that might be down in a disaster, he said. Any emergency plan must consider not only nurses and doctors, but also ancillary services, such as radiologists, he said.
If handling the sick or injured becomes untenable, Stanford and Lucile Packard are also part of the National Disaster Medical System, which can arrange to transfer victims across state lines, Weiss said.
"During Katrina, since the entire city was decimated, you can't just transfer to a hospital within Louisiana, especially with patients with specialized needs, such as neonatal patients," he said.
Hospitals such as Stanford respond by providing information on the number of beds and medical care assets available, such as neonatal surgeons, and the information is coordinated through the Veterans Administration and the Department of Defense. The defense department provides air transport, he said.
To that end, Moffett Field is the perfect spot for a regional center because it has aircraft, light- and heavy-rail access, and can provide temporary housing, Jordan said.
The regional center, funded by a combination of government and private grants, will involve every municipality in the Silicon Valley area. It has been in the making for the last four to five years, he said.
The center will offer logistics and support to response teams and emergency personnel and a training center will help emergency medical teams, firefighters, hazardous-materials teams, rescue-operations and trauma teams to help them work together effectively.
Other components include a research center to investigate how best to incorporate and use social media and other modes of communications to reach out to the public. The research is headed by Carnegie Mellon University, which has a Moffett Field campus, as well as a learning center to develop training methods and help businesses and communities recover after a disaster. The operations training could begin in 2011, he said.
No other such center exists west of the Mississippi River, although something similar was created in New York after the 9/11 terrorist attack.
The Silicon Valley project could become a model for the country, wherever a disaster strikes, he added.
Disasters will come, he said. They will come in many forms, from intentional acts of terror to unintentional acts such as the Bhopal, India, chemical disaster of Dec 2-3, 1984, when thousands died and thousands more left chronically ill.
California has its earthquakes, but there are other natural disasters, such as pandemics and storms, Jordan said.
The fabric of life as it is known in the Bay Area can be blunted by a major regional disaster -- but it cannot be destroyed if plans and preparations are in place, he said.