by Timothy Gieseke, MD, CMD

On the evening of October 8, the expected “El Diablo” winds arrived in Sonoma and Napa Counties with peaks winds of 80 mph.  Unfortunately, wildfires began that evening.  Late that night, the Tubbs Fire that started in the Calistoga area became a blowtorch that moved within 4 hours through a broad swath of Northern Santa Rosa, consuming a broad swath of our city.  We were shocked that it jumped a 6-lane freeway continuing a path of destruction through another 2 miles of North West Santa Rosa.  During that short time, emergency evacuations of residents at 2 of our 3 acute hospitals occurred (Sutter & Kaiser).  The rest of Santa Rosa awoke to explosions, dark smoke, and glowing surrounding skies.  Within hours, 5 of our 8 SNFs (1 CCRC) were evacuated to shelters and then on to other out-of-area facilities.  Communication by phone, cell, and internet was difficult with wide power outages and 80 cell towers down.  Battery-operated transistor radios allowed for local on-the-ground, real-time news (KSRO) about the surrounding uncontrolled wildfires.  When the internet returned, many of us used the EMS emergency text message system (Nixle), which sent out updates on impending fire threats based on zip code of end user.  (If you want Nixle updates, simply text your zipcode to 888-777; please note text messaging rates from your phone carrier apply - visit www.nixle.com for full details.)

That Monday morning, October 9, I received a text from my Sebastopol facility requesting help admitting a number of frail refugees they had agreed to shelter.  Many of these persons were from destroyed RCFEs.  They arrived with nothing but the “clothes on their backs.”  We were able to identify their primary medical problems, but had trouble identifying their medications.  The VA in San Francisco was quite helpful for those so connected.  Identifying the medications from local providers was very difficult since many pharmacies and providers weren’t open due to displaced employees, power outages or destruction of their physical location.  In one case, a patient went 2 days without his prescription meds because that’s how long it took to contact his PCP, who then quickly emailed his list of Rx meds.   This facility’s patient population rapidly expanded to include 2 dining rooms, which reminded me of the Wards of the 70’s at San Francisco General.       

I was amazed and grateful for the rapid surge of Cal Fire and EMS services not only to fight the fires, but also to evacuate over 35,000 residents so quickly.  Unfortunately, this well-coordinated response at a local, regional, state, and national level was not evident to me in the health care provided for those displaced.  Many of my facilities sent nurses to receiving facilities in nearby counties since those facilities were overwhelmed and didn’t have surge capacity.  My associate, Dr. David Greene, provided onsite medical care at sheltering sister facilities in San Francisco and Oakland since there wasn’t that capacity locally.  In addition, most of our SNF patients have paper records.  The charts didn’t follow the patients (at least initially) and the copied MAR didn’t necessarily follow the patient’s dispersed from evacuation centers, with patients from the same facility commonly sent out to multiple different facilities, creating a higher probability of separation from facility MARs.  Other remaining local providers and I received many calls from families and facilities regarding these prescription gaps.   

Thankfully, the fires have been contained, rain came, the air is much better, and our patients are returning to our facilities.  I’m amazed at our patient’s mental resiliency, but the toll is obvious, with many residents showing the obvious external manifestation such as a 4-to-6-pound weight loss.  The internal, emotional damage may not be as visible, but research has shown clearly that relocation from a long-term care facility during a disaster is associated with significant negative health outcomes.  I am hoping that my residents, and all of those from our area, will be able to recover from the trauma.

For our city, this is a time of great loss.  Twenty-three persons in Santa Rosa died and some 400 health professionals, including one-sixth of our physicians (roughly 200) have lost their homes in that initial fire.  Sutter Hospital reopened on October 17, but Kaiser hadn’t as of the time of submission of this article (October 26, 2017).  My CCRC hopes to reopen their SNF unit early next week.

As we enter the recovery process, it would be good for the medical community to reflect on the obvious gaps in medical care provided for those living in RCFEs and SNFs.  From my perspective, 2 glaring gaps need to be addressed.  First, we need robust integrated medical records in the cloud that allow for seamless assumption of care by receiving facilities.  For those cared for by Northern California Kaiser and the VA system, which have such records, the off site care was much less chaotic.  Second, our disaster preparedness model needs to be expanded beyond a county response system designed for small disasters, to a regional model that coordinates medical care better for the frail elderly.  We need to go beyond a model that mainly emphasizes sheltering out of harm’s way to one that also delivers the onsite health care required for our frail patients.

I’m only one observer and would appreciate the thoughts of other readers affected by this apocalypse.