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All photos courtesy of Simi Valley Hospital	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
As wildfires race down Whiteface Canyon, a mountain range adjacent to the hospital, 33 ambulances stand by to evacuate staff and patients in the parking lot of Simi Valley Hospital.

The deadly Southern California fires last week stretched the staffing capacities of some hospitals in the San Diego and Los Angeles areas, but facilities by and large avoided catastrophe as fears of mass patient evacuations and critical worker shortages failed to materialize.

As the fires burned from the Los Padres National Forest to the Otay Mesa, regional hospitals worked with local emergency officials to triage patients and maintain skeleton crews for the heightened alert levels. Some facilities canceled elective surgery procedures earlier in the week, and gave support to staff nurses and physicians whose own homes and families were in harm's way.

Two small hospitals were forced to evacuate patients, according to California Healthcare Association spokeswoman Jan Emerson. Simi Valley Hospital officials were nearly forced to evacuate more than 110 patients in the middle of the night Oct. 26 before encroaching fires from a neighboring ridge were fought back by city firefighters.

Most hospitals were "operating well," Emerson said, as many spent the latter part of the week coordinating social and mental health professionals to help with the psychological fallout of the $2 billion disaster that has killed 20, destroyed more than 2,800 homes and burned more than 750,000 acres of forest.

"The Red Cross is assisting our staff with intervening with some of the families," said Mary Middleton, MSN, RN, director of patient care services for the University of California, San Diego, Medical Center. UCSD, as a regional burn center, was serving as the first-responder facility for all ICU and intermediate care burn victims and coordinating with San Diego County emergency workers to send less critical respiratory patients to other hospitals. Operating at "Code Orange," or internal disaster alert, the hospital was working directly with San Diego County emergency officials and had its entire staff on-call.

"The community has been wonderful, and we have volunteers helping us with child care. We even have one ex-nurse who is bringing all the staff some lunch," Middleton said.

Kaiser Permanente San Diego Medical Center was also on Code Orange, as Kaiser officials struggled with how to account for as many as 18 nurses and physicians who were displaced and evacuated or unable to reach the hospital. Some were even coping with the deaths of family members killed in the blaze.

"We stopped doing elective surgery procedures for two to three days, and because of that our hospital census went lower than we normally have," said Tony Minks, MSN, RN, assistant administrator and chief nurse executive.

Teamwork also kept services unaffected at Loma Linda University Medical Center, where nurses juggled schedules to help co-workers affected by housing, transportation or child care issues, said Liz Dickinson, RN, senior vice president of patient care services at Loma Linda.

Much closer to disaster was the 197-bed Simi Valley Hospital northwest of Los Angeles, where officials called together 33 ambulances in its parking lot to prepare for a mass evacuation of patients from the campus's north building.

"The [Simi Valley] fire department hadn't told us to prepare, but we felt we needed to because … we had a campus in the area where they had 10-minute [evacuation] warnings," said Simi Valley spokeswoman Alicia Gonzalez. "We actually transferred 13 patients, but stopped the evacuation because the fire department was able to get a handle on it."

UCSD and Kaiser San Diego set up temporary child care centers to help staff members, because schools were closed.

Although many facilities were returning to normal by week's end, the fires were worsening in the Lake Arrowhead area, where two hospitals that evacuated patients Oct. 25 still were waiting for clearance to reopen their doors Oct. 30.

"We evacuated all our patients on Sunday by 2:30 a.m.-25 patients, plus a mom and a baby," said James Hoss, executive director and administrator of Mountains Community Hospital. He was answering the phone in an emergency room now providing food and shelter for area firefighters. "We kept a skeleton crew…through 4 p.m. Monday, but they told us to shut it down completely. We don't have anything operating right now."

The 30-bed Bear Valley Community Hospital also was closed down last week as fires circled Lake Arrowhead.

Although no centralized nursing volunteer program was put in place regionwide, many nurses did lend a hand where they could.

Almost 60 student nurses and teachers from the California State University, San Bernardino, Department of Nursing trekked to the former Norton Air Force Base site to help out in distributing resources for relief workers.

Contact Glen Fest at glenf@nurseweek.com

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