Palo Alto's Medical Reserve Corps volunteers to help during a disaster

Group's role is to take on the less sick and injured to free up hospitals and clinics for more serious cases

Palo Alto is a far cry from the Third World, but in a disaster it will face many of the same challenges that often plague impoverished countries: communication failures; impassable roads; masses of sick and injured victims; and psychic shock, city disaster officials said.

Notwithstanding the city's robust emergency-services program and Stanford Health Care's first-class trauma center, Palo Alto is still missing a critical component that could affect the aftermath of a catastrophe: readily available, trained medical staff, local disaster officials say.

But the five-year-old Palo Alto Medical Reserve Corps (MRC) could put a dent in the problem. Local doctors, nurses and other health professionals have set up a volunteer medical unit that will set up at Cubberley Community Center in a disaster to provide first aid and triage. Their role could be significant, taking on the less sick and injured and freeing up hospitals and clinics for more serious cases, according to Nathan Rainey, emergency services coordinator for Palo Alto's Office of Emergency Services.

"There needs to be a relief valve to relieve the pressure on the hospitals. ... We think the MRC is one of those relief valves," he said.

The Medical Reserve Corps is one branch of the City of Palo Alto's Emergency Services Volunteers program. Its members would offer a higher level of assessment and care, bridging the gap between the Band Aids-and-splints first aid that the Community Emergency Response Teams (CERT) members could provide and the high-level skills of a hospital team.

The Corps was started in 2011 as the Palo Alto Emergency Medical Unit, co-chaired by residents Geri Spieler, a former emergency room interventional radiographer, and Bonnie Berg, a registered nurse. They recognized there was a critical gap in disaster services, they said.

Rainey characterized the founding of the Corps as an attempt to answer a fundamental question: "When we're in a large, regional event and everybody is holding onto their own resources and they get tapped out, what do we do?"

Spieler and Berg created protocols for the medical unit from scratch. With the help of retired emergency room nurse Marty Douglas, they established a supplies trailer full of stethoscopes, bandages, splints, antiseptic, tape and equipment — enough to last two days. The unit holds trainings and drills for different disaster scenarios (including a mock-earthquake, called "Quakeville," at Cubberley), and they attended a regional training session that involved people posing as victims, complete with fake blood, lacerations and burns. They also keep skills sharp by manning first-aid tents during community events such as the Palo Alto May Fete Parade, the Moonlight Run and the July 4 Chili Cook-off.

A year ago, the unit joined the national Medical Reserve Corps — a network of 200,000 volunteers who are organized in 987 local units to improve the health and safety of their communities. They prepare for and respond to wildfires, hurricanes, tornadoes, blizzards, floods and earthquakes and public health emergencies, such as disease outbreaks, according to the organization's website. They also provide first aid at large public events, health screenings and other health-related activities.

Membership allows Palo Alto's unit to access webinars, regional disaster drills, grant funding and 2,000 courses leading to advanced certifications.

Palo Alto's Corps took an additional significant step in March when Dr. Stephen Fisk, an adult critical care physician at Kaiser Foundation Hospital in Santa Clara, became a co-chair with Spieler. Berg and Douglas now are in charge of the medical supplies .

Fisk has experience in wilderness medicine and is certified in the fundamentals of disaster management with the Society of Critical Care Medicine. He will help organize and stage drills.

"Dr. Fisk brings a high level of medical experience in disaster preparedness," Spieler said.

Fisk said he joined the Corps because he wanted to give something back to the community.

"I realized in many ways it's woefully unprepared for a major disaster. There is no hospital in Santa Clara County that has sufficient surge capability to accept everybody in a major disaster," he said. "Even though Stanford responded wonderfully to the Asiana (Airlines) crash, this was still a small fraction of the number of casualties that one would have in a major disaster," he said.

Fisk estimated that hospitals could double their capacity in an extreme disaster.

"Beyond that, there would be a significant degradation in care. However, it's just a guess. The choke points in each of these scenarios are the emergency departments and the emergency rooms," he said.

Stanford Department of Emergency Medicine and Office of Emergency Management officials said they will be prepared for any disaster and will accept anyone who comes. (Read "When a disaster strikes, how prepared will Stanford Health Care be?")

Stanford officials do foresee an important role for the Medical Reserve Corps. In addition to taking on cases that are less acute, members could also assess and triage patients who show up at Cubberley and may need to be transported to the hospital, according to Brandon Bond, administrative director of the Office of Emergency Management at Stanford Health Care and Stanford Children's Health. Bond has attended some of the Palo Alto Medical Reserve Corps' drills.

There is a wrinkle, however, in how much the Corps can do because of Santa Clara County policy and liability issues.

The Santa Clara County Medical Director must sanction and activate the Corps, but currently, the director only recognizes the county-level Medical Volunteer for Disaster Response program. Without recognition from the county, the Palo Alto Corps members can only give people first aid — not the level of care the volunteers are capable of giving, Spieler said.

In early April, Spieler and Douglas attended a meeting in Saratoga with county officials and that city's Medical Reserve Corps, including county Medical Volunteer for Disaster Response managers. The group agreed that all medical corps in the county's cities would be required to meet the county's criteria if participants want to be able to treat patients beyond the first-aid level, Spieler said.

When the county boots up its training program, Spieler will invite all Palo Alto Corps volunteers to take part and receive county credentialing, she said.

Rainey raised another issue that is yet to be resolved. While Palo Alto is outfitted with supplies and medical-treatment gear, the county has a vote on how the Corps will use those resources. If called upon, Palo Alto's Corps might be deployed in other parts of the county.

"It's a county-run system. The trick is for the Medical Reserve Corps to figure out how we really fit into that medical system," Rainey said.

The challenges will be for the city Corps to coordinate with the county system while still ensuring local needs are met, he said.

Fisk said that he has additional broad concerns, including ones of a more physical nature: In the immediate aftermath of a major disaster, collapsed buildings and impassible roads "will limit in many ways how suppliers and people can actually get to the hospital," he said.

Spieler and Douglas don't sugar coat the challenges that a disaster will bring for the Corps.

Patients arriving at Cubberley would likely have a range of injuries: lacerations, burns, bruises, broken bones, crushed internal organs and head trauma. Some might have medical conditions such as a diabetic emergency, stroke or heart attack. Others will exhibit hysteria or anger.

Spieler outlined the basic setup for the Cubberley Community Center: People will be coded with the "colors of injury": green for stable; yellow needs attention; red for critical; and black for dead. There will be three treatment stations, a recovery station and a room for those whose injuries are too serious to treat or who must be transported to a hospital.

But there will be no CPR, no setting of broken bones, no X-rays nor surgeries nor no life-saving measures at Cubberley, Spieler said.

It's a hard fact that in the first hours and days of a disaster, the Corps will need to work to help the most people they can while using the least amount of time and resources. And some people will die, she said.

Spieler recited a question put to the volunteers at a drill last year that sums up the reality of the disaster response:

"You have three minutes per person. What could you do with three minutes? You have to do something to stabilize the person and move on. You train for the worst possible scenario. You have to go for the greater good," she said.

Currently, the Corps has about 40 members, but more are needed so that they will be able to work in shifts when a disaster strikes. Without shift changes, volunteers would burn out in about 24 hours, Rainey said. The goal is to get enough people to get through at least the first critical 72 hours.

Spieler said she would need at least 50 people. But many others who do not have medical training are also needed. They would free up the Corps' medical staff by doing intake, registration, communications and running for supplies.

People who want to volunteer shouldn't wait until a disaster strikes, however. In an emergency they won't be able to serve unless they have had a security clearance, she said.

"Bottom line: If you have not cleared a background check, they don't want you around ... even if you are a registered nurse of physician," Spieler said.

Annette Glanckopf, a non-medical volunteer, said that the Medical Reserve Corps plays an important role in Palo Alto's Emergency Services Volunteers program.

"I've always thought that you've got to have a local team. ... We always talk about 'backup, backup, backup.' It reduces the points of failure," she said.

Many Palo Alto neighborhoods, including hers in Midtown, now have medical-supply caches for immediate first aid, which can be administered without leaving the neighborhood. As chairperson of the Palo Alto Neighborhoods Emergency Preparedness Committee, Glanckopf has spearheaded efforts to ready residents by preparing their homes for disaster and recruiting them for the block-preparedness program and the other arms of the City of Palo Alto's Emergency Services Volunteers group. The program includes the Palo Alto Neighborhoods Block Preparedness Coordinator and Neighborhood Preparedness Coordinator programs, CERT, and amateur radio communications (ARES/RACES).

Residents can choose their level of involvement: They can be the the eyes and ears of their neighborhood, check on neighbors in need, serve as ham-radio operators or conduct light search-and-rescue operations, fire suppression and administer first aid.

Rainey said these local response groups, including the Medical Reserve Corps, are especially important to Palo Alto, which faces a situation not found in many other cities — a population that balloons during the day due to workers.

"The things that worry us are the 'Palo Alto problem': the public-safety resources are sized to the residential population and not to the doubling of the daytime population," he said.

That is compounded by the vast number of city employees, including first responders, who do not live in Palo Alto, he said.

If a disaster happens when critical city staff aren't on hand, Palo Alto residents will have to rely on each other — and they had best be prepared.

"As they say in the army, 'You go into battle with what you've got,'" he said.

Information about the Palo Alto Medical Reserve Corps and the other programs in the city's Emergency Volunteers Services is posted at


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13 people like this
Posted by Safety First - Benn There
a resident of Another Palo Alto neighborhood
on May 13, 2016 at 8:01 am

It's not just the numbers of out of town employees who will be a problem, it's our city's veins and arteries (roads) that are woefully inadequate in the best of times or that have been designed to choke down traffic, which will become impassable for emergency vehicles or evacuation. This problem is an epic threat that development mongers are creating. The residents are often doing nothing about this or makng things worse for poorly thought out ideological reasons. People don't care until the wirst happens and then it's too late. Are residents prepared to see a lot of people die because we have been unwilling to deal with the problem of overstressing infrastructure through overdevelopment?

Don't know if anyone noticed, but pathetically small resources allocated for emergency preparedness in the schools were even cut in the last budget vote. Teachers and administrators (including top administrators) got epic raises rather than just great raise and class size reductions and other important budget items like emergency preparedness.

Many of the losses from our nation's worst disasters, including the Oakland firestorm and hurricane Katrina were largely preventable because the problems were predicted and predictable (in Oakland, mutual aid could not help for way too long because Oakland had different hose fittings than the surrounding communities and there was no way to distribute adaptors - it's no accident that most if the losses were in Oakland rather than Berkeley. This was a known potential problem before the fire. Hurrucane Katrina was called a manmade disaster, the levees were the prected and predictable problem causing much of the damage, not the storm itself.)

In every case of preventable disaster, there is always a mix of hubris and people with selfish priorities in power who put safety last, as if safety advocates are just silly old worry warts. We unfortunately have that in spades right now in Palo Alto.

4 people like this
Posted by Lindsay Joye
a resident of Ventura
on May 13, 2016 at 10:19 am

As a long time member of Palo Alto's Community Emergency Response Team (CERT) I encourage Palo Altans to join the Emergency Services Volunteers.

It is as easy as completing the Volunteer Application form (Web Link) and once accepted, attending one of the 3 hour Block Preparedness Coordinator (BPC) training dates:

- May 21, 1-4:00 PM
- August 9, 6:30-9:30 PM
- October 29, 1-4:00 PM

A little training and organization can make a huge difference in how we take care of our neighbors in the time of a major disaster.

Please come join us!

2 people like this
Posted by LAH CERT
a resident of Los Altos Hills
on May 13, 2016 at 12:18 pm

I hope Palo Alto has set up emergency plans with companies in Stanford Industrial Park. If a disaster happens during working hours, these companies will be key resources to keep their employees safe and try to get them home. All companies in Stanford Industrial Park should have evacuation routes and plans to help locally in a disaster.

As a LAH CERT and CERT Supervisor, we who are trained can help other communities where we may happen to be stuck in a disaster. Our first responsibility is to our own safety and to our families but after that, we can pitch in wherever we are state wide.

Please get the employees in the Research Park trained!!!

Like this comment
Posted by Safety First - Been There
a resident of Another Palo Alto neighborhood
on May 15, 2016 at 7:47 pm

Schools and community centers often become makeshift hospitals. Staff and employees should be given training. It could save many lives.

Like this comment
Posted by Mark
a resident of another community
on May 15, 2016 at 10:13 pm

The creation of a field treatment site is a good idea, and is an integrated approach of a much larger plan for community resiliency. But the one question that I would ask is, "How will patients get to this treatment site?"

First is the simple question: How will those in Palo Alto know that a field treatment site has opened and can seek basic medical attention? This medical program is not common knowledge and I am certain that most citizens are unaware that Cubberly Community Center would be a place to seek care. Would the information be posted on Facebook (which may be down if internet services fail) or announced on KZSU? Not knowing about this site would limit its usefulness.

Second, would ambulances be permitted to transport patient to this Field Treatment Site? As it stands, the current Santa Clara County Multiple Patient Management Plan does not clearly state when it might be appropriate to seek an alternative transportation location other than a hospital. Ideally, paramedics and EMTs could be able to triage lower acuity patients (i.e. those who need just first aid) to a Field Treatment Site like the one at Cubberly. But I'm not certain those protocols are in place.

Third, will there be enough staffing at Cubberly? One of the unwelcome truths about volunteers in the disaster preparedness community (myself included) is that many of us may have multiple responsibilities - such as being a CERT member and a Red Cross volunteer. When "the big one" finally hits, many pre-designated volunteers may need to make a choice which organization they are going to report to, and emergency management officials might discover that some response organizations are, in fact, understaffed.

Sorry, but further commenting on this topic has been closed.

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