Readying for any disaster

When an Asiana Airlines flight crashed at San Francisco International Airport in 2013, Stanford Hospital received more patients than any other, staff said at the time. The hospital saw 55 patients and admitted 18.

Stanford staff were put to the test that day, taking on the usual caseload of emergency room (ER) patients in addition to the accident victims. The hospital staff scrambled to accommodate everyone, freeing up beds by sending home patients when possible.

The incident was small compared to other potential disasters. A devastating earthquake could send hundreds if not thousands of people to the ER. If just one local hospital is damaged or destroyed, the area’s first responders would rely even more heavily on Stanford. (After the 1989 Loma Prieta Earthquake, for example, the Palo Alto Veterans Administration Medical Center, just four miles away, sustained $30 million in damage and was uninhabitable.)

But after 10 years of development, the new Stanford ER at 500 Pasteur Drive, which will open in late October, is equipped to handle a magnitude-8 earthquake and any other mass-casualty incident, as well as heart attacks and broken bones, Jennifer Winder, a hospital spokeswoman, said.

The new 42,692-square-foot ER and trauma center is part of a $2 billion hospital expansion. The 66 rooms in the emergency department, while designed to accommodate one patient per room, can handle two patients per room in a pinch, said Patrice Callagy, executive director of emergency services.

As the only regional Level-1 trauma center between San Francisco and San Jose, Stanford’s emergency room is already one of the busiest in the country, according to a 2017 ProPublica report on hospital emergency rooms.

From the minute patients arrive at the new ER’s security station, nurses inside will be able to look out the door and identify extremely ill patients.

“If someone is looking pale, they can be seen quickly from where the nurses are situated for triage,” Callagy said.

Patients with suspected infectious diseases can be led to four infectious-disease isolation rooms with outside entrances so they don’t expose others in the waiting room. Chair gurneys that convert into flat stretchers can be wheeled to the lobby for patients who need escalated care within seconds, she said.

In a mass-injury situation or during peak seasons of infectious diseases, the covered ambulance bay can accommodate overflow patients. The bay is built to house five ambulances — six if they are narrow — but outside of the covered area there’s room for up to 20 vehicles. At the old ER, there’s room for three ambulances, and including the area outside, up to six, said Vasily Rodin, the operations project manager leading the emergency room transition.

The new building also has a six-foot “floating wall” between the adjacent parking garage and the trauma center. The parking structure, large enough to accommodate 900 cars, can be converted into a triage center that connects directly to the emergency room.

There’s also one important, recent change that staff made after the ER was built. The hospital planned to have 76 treatment rooms in the ER, but after assessing the large numbers of patients and their demographics, the hospital decided to create two ERs. The new ER at 500 Pasteur Drive is for adults; the old ER at 900 Quarry Road Extension will become a dedicated pediatric emergency room with 15 private rooms. The pediatric emergency department will open when the new ER opens this fall. The pediatric ER will be renovated to make it a more child-friendly environment; the work will be done in phases so the ER can remain operational throughout, hospital spokeswoman Courtney Lodato said. Rodin said all trauma patients will be sent to the new ER.

“Having a dedicated ED (emergency department) for pediatric patients helps to create a more supportive care environments for pediatric patients and their families. Visiting an emergency department can be a stressful experience for children and families, and this will help to streamline care and reduce waiting in a more kid-friendly setting,” Lodato said in an email. “It also allows more space for child-sized equipment, beds and pediatric specialists. ”

Rodin has a personal reason for valuing the separation of the two ERs. When his child needed to go to the ER, Rodin feared his child would be exposed to disturbing circumstances involving other patients and suffer lingering emotional trauma. But the new, separate pediatric ER will have child-friendly amenities such as colorful tilework and games to distract from the hospital setting.

Currently, there are seven rooms in the pediatric section of the old ER. When children and their parents arrive, they follow a blue river pattern in the floor from the adult emergency room to the pediatric area. Games and movies help to reduce anxiety and fear in the pediatric waiting room and there is free wireless internet access. A big-screen television in the waiting room shows cartoons and information.

In the new pediatric ER, each exam room will have a television and a computer with children’s games, music, movies and internet access. Nurses will have monitors at the central nursing station to constantly observe patients’ vital signs.

The private rooms will make it easier for multiple visitors to be at each child’s bedside, Lodato said.

This is part of a larger story on the new Stanford Hospital that can be found] here.

A Q&A video with CEO David Entwistle is available here.

Dr. George Tingwald of Stanford Health Care, joins Weekly staff to discuss the planning that went into building the new Stanford Hospital on an episode of “Behind the Headlines,” now available on our YouTube channel and podcast page.