FOR YOUR OMTON

Surviving when the world fals apartADA members' skill, dedication, and teamworktriumph over devastation of California's earthquakeThe earthquake struck in the early morning darkness, sending waves of destruc-tion across California's San Fernando Valley. The shaking started at 4:31 AM onJanuary 17; 30 seconds later it had crumpled buildings, buckled freeways,severed gas lines, and shattered lives. News reports provide a grim tally of thedevastation: 61 persons killed, thousands injured, and tens of thousands leftwithout homes. Estimated costsfor rebuilding structures leveled by the 1994earthquake and its ongoing aftershocks have risen as high as $30 billion.

The article thatfollows, based on interviews with dietetics professionals whowork at two hospitals in Southern California, tells how training, teamwork,dedication, and courage helped these professionals and their colleagues servetheir communities in the chaotic hours and days after this tragic disaster.

ost reports place the epicentersomewhere beneath our emer-gency room," recalls Pam Mac-

Chlerie, RD, director of nutritional careservices at Northridge Hospital MedicalCenter. The 430-bed medical center sus-tained $30 million in damage but neverclosed its doors or suspended operations.About 10 years ago, the hospital's threefive-story towers had been retrofit withseismic expansion joints. When the earth-quake hit, the towers spread sidewaysrather than collapsing. Emergency crewsquickly built plywood and steel corridorsbetween the towers so staff memberscould navigate the hospital.

About 3 miles away, buildings at theVeterans Administration Medical Centerin Sepulveda were severely damaged. Thehospital immediately evacuated its inpa-tients to nearby veterans hospitals in WestLos Angeles, Loma Linda, and Long Beach."When I arrived the first day, the elevatorshafts looked like waterfalls. All the plumb-ing lines had snapped, and water was run-ning everywhere," remembers Gail Smith,DTR, chief of food production and serviceat Sepulveda Veterans Hospital.

Monday Morning DisasterThe earthquake hit on Monday morning.At Northridge Hospital, three dietary em-ployees were in the kitchen at 4:31 AM: thenight and the day cooks (the work shift wasabout to change) and a dietary aide. Thetremor knocked out all electric power andsevered water, gas, and telephone serviceto the hospital. Within 20 seconds, how-ever, the hospital's emergency generatorskicked in and about 25% of the lighting inthe kitchen was restored. Equipment thatwasn't bolted down moved 10 to 12 inches,and dishes and pans were flung onto thefloor. The floor itself looked as if a giantmole had burrowed through the room in a

Nancy I. Hahn is associate managingeditor of the Journal.

zig-zag pattern. In the storeroom, the spe-cially hung "seismic shelves" never moved,but everything on the shelves was thrownacross the room. Unfortunately, thedepartment's disaster supplies had beenstored with the regular supplies and nowlay somewhere in the rubble of foodstuffson the floor.

Luckily, the hospital's primary food ven-dor had not yet made the regular Mondaymorning deliverywhen the earthquake hit,and the driver reached the hospital loadingdock minutes after the earthquake. Thetwo cooks and dietary aide quickly set up amakeshift storeroom in the hallway adja-cent to the regular storeroom and acceptedthe supplies. Now the hospital had juicesand staples to get through the first 36hours. The hospital's emergency genera-tors supplied power to the kitchen's walk-in refrigerators and freezers so food sani-tation was never a concern, and coldprotein sources, such as milk, yogurt, andcheese, could be stored.

A temporary diet office was set up in thehallway, and the cooks and dietary aidefollowed the diet orders and began to plana cold breakfast using available supplies.The kitchen was a jumble of equipmentand dishware, but it was still possible tomove about the room. The night cook anddietary aide set up boxes and began fillingthem with cereals, juices, milks, yogurts,and sweet rolls. Then they carried theboxes of food up the stairs to all the nursingunits because there was no power to oper-ate the elevators. Amazingly, these threeemployees managed to serve breakfast, ontime, to all the patients and hospital staff.

MacChlerie, who lives across the SanFernando Valley in Santa Monica, was ableto reach the hospital by 8 AM. By that time,10 other dietary employees had also ar-rived for work, even though many had losttheirhomes to the earthquake. MacChlerieremembers with pride how she enteredthe department to see these dedicatedstaff persons stepping over debris in the

semidark kitchen as they worked togethermaking cold sandwiches to serve patientsand staff at lunchtime.

Telephone RelaysLimited telephone service had been re-stored to two lines at the hospital by after-noon, and MacChlerie immediately begantrying to reach vendors. Southern Califor-nia is sectioned into a complicated net-work of five area codes, and the hospital'stwo open lines could reach only two areacodes. One of the vendors, a distributor fortwo brands of bottled fruit drinks and wa-ter, was located in a reachable area code.With no municipal water supply, the hospi-tal had enough bottled water on site foronly 48 hours. MacChlerie called the ven-dor to order extra supplies of bottled bev-erages. By 4 PM, 1,000 cases of bottledwater (24,000 bottles) were delivered tothe hospital loading dock.

All the other vendors were located out-side the two accessible area codes, butMacChlerie was able to communicate withthem using an improvised telephone relay.She managed to call a friend who lived inone of the two area codes that could bereached from the hospital. Her friend wasthen able to call other area codes and relayMacChlerie's requests for supplies. An-other vendor got a telephone call throughto the hospital administrator who thencontacted MacChlerie by walkie-talkie.

Vendors also anticipated the hospital'sneeds and brought supplies based onrecords of previous orders. The bread ven-dor "just showed up" at the loading dockwith an assortment of rolls and breads.Another supplier brought a selection ofmilks based on the hospital's regular order.It was an incredible display of cooperationand quick thinking, MacChlerie explains,but the vendors' assistance also pointedout the importance of establishing coordi-nated plans and long-term relationshipswith vendors before a disaster strikes.

Adjusting the Disaster PlanThe dietary department at NorthridgeHospital had a disaster plan, complete withmenus, but the earthquake presented ob-stacles that hadn't been anticipated. Notonly were the disaster supplies strewnacross the storeroom floor, menus hadbeen planned for various emergency sce-narios, such as no gas or no water, butnone anticipated loss of all utilities.

MacChlerie designed a simplified menuthat could be filled from existing food sup-plies and used across the spectrum of dietorders, from regular to sodium-restrictedto calorie-controlled. Sandwiches, a staplemenu item during the first 2 days, weremade from no-salt turkey roasts that hadbeen cooked the night before the earth-

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quake. Patients on pureed diets were givenfoods such as high-protein milk shakes,custards, and gelatin. In planning specialmedical diets, MacChlerie concentratedon the most basic dietary restrictions: "Ididn't focus on whether someone was sup-posed to eat 1,200 kcal per day, but I didmake sure that patients with diabetes didnot consume concentrated sweets."

By 4 AM Wednesday, about 48 hours afterthe earthquake hit, electric power and gasservice were restored. By 7 AM, the hospitalcafeteria was reopened, and patients wereserved a hot breakfast. Hot meals couldnow be prepared, but patients and staffwere served from a nonselect menu forthe next 10 days.

Alfresco Emergency CareThe Northridge communitywas devastatedby the earthquake, and injured residentspoured into the hospital's emergency room.More than 500 persons were treated in thefirst 24 hours. Because of structural dam-age and the continuing aftershocks, theemergency room was moved outside to thehospital parking lot. Surgical suites werealso set up under plastic domes in theparking lot. The dietary department pro-vided free coffee and doughnuts to thehundreds of persons waiting for emer-gency treatment. The hospital also pro-vided free food to anybody who came tothe hospital seeking help, as well as tofirefighters, police officers, and other di-saster volunteers. "We fed everybody whocame to us," says MacChlerie, "and some-how, we never ran out of food."

Picnics Amid the RuinsAt Sepulveda Veterans Hospital, theearthquake's force left the main six-storybuilding, where acute-care patients hadbeen treated, unsafe for occupancy. Thehospital campus also lost all electric, gas,telephone, and water service. The poweroutage shut down the kitchen's freezersand refrigerators, and the hospital had justreceived a month's supply of food. Duringthe first hectic 24 hours after the earth-quake, as patients were evacuated to otherveterans facilities for safety, Smith alsomade arrangements to transport perish-able foods to the other veterans hospitals.

By the second day all the patients hadbeen moved, and Smith and her staff turnedtheir efforts to feeding the employees whoremained at the hospital and their families.Because many homes in the surroundingcommunity were badly damaged and with-out power or water, Sepulveda Hospitalalso provided meals to veterans and theirfamilies who lived near the hospital.

Smith found that stocking the freezerswith dry ice would keep them cold enoughto store foods safely. Telephone servicewas restored within a few days, and Smith

arranged for vendors to deliver small ship-ments of supplies several times per week.The problem of how to cook without elec-tricity or gas was solved by rounding up anassortment of barbecue grills from acrossthe hospital campus. (Buildings for thenursing home complex had patios withbarbecue grills.) "We weren't allowed in-side any of the buildings, so we barbecuedand served food in the parking lot," saysSmith. "We fed about 900 persons everyday. Everyone enjoyed the food and thecompanionship. Formanypersons, I'msureit was the only hot food they ate all day."

Regrettably, the extensive damage atSepulveda Veterans Hospital has left em-ployees with somewhat uncertain futures.The acute-care building, too damaged forrepair, will be razed but not rebuilt. Conse-quently, the Veterans Administration willno longer provide acute-care services atSepulveda, focusing instead on outpatientservices and long-term care. Repair andrenovation plans include construction of anew ambulatory care center. Except for a120-bed nursing home, Sepulveda will be-come an outpatient health facility withlikely ramifications for the 1,700 hospitalemployees who worked there before theearthquake. "We had 96 employees as-signed to dietetic service before the earth-quake," explains Smith. "Most of theseemployees went with our patients to otherveterans hospitals on 'temporary detail'assignments. Sepulveda employees havebeen guaranteed jobs within the VeteransAdministration although locations of fu-ture positions remain uncertain."

Seeking Safe WaterThe loss of a safe municipal water supplywas one of the biggest obstacles facing thedietary departments atbothhospitals. Evenwhen running water was restored about aweek after the earthquake, it was contami-nated and unsafe for drinking, cooking, orwashing dishes. Disposable dishware wasused until water trucks could pump inclean water for washing dishes. Tap waterand bleach were used to wash floors andclean work areas. Only bottled water wassafe for drinking, and contacting vendorsto order additional cases of bottled waterbecame a priority for both MacChlerie andSmith. At Northridge, MacChlerie receivedsome unexpected, but much appreciated,assistance fromthe Anheuser-Busch brew-ery located in town. The brewery, whichhas an on-site water purification plant,donated thousands of beer cans filled withdrinking water to the hospital.

Power of TeamworkMacChierie and Smith agree that the chal-lenges presented by the earthquake re-vealed the value of ongoing training andplanning. Both their institutions had devel-

oped hospital-wide emergency plans andconducted periodic disaster drills. Whenthe real crisis came, staff automaticallyknew their responsibilities. Both hospitalscentralized communications through acommand center where employees re-ported for assignments, got or left mes-sages, and obtained status reports. Eventhough specific emergency plans devel-oped for the dietary departments had to beadjusted in the face of unanticipated prob-lems, their principles offered guidance anddirection. "We knew what our prioritieswere," says MacChlerie. "That part of theemployee education program is what ismost valuable in a crisis."

In the midst of the chaos and hardships,a heightened sense of teamwork prevailed.Departmental distinctions disappeared asstaff members were assigned on the basisof their skill level to areas of the hospitalsthat needed help. "The amazing thing was,it didn't matter whether someone had an'MD,' a 'PhD,' or 'CEO' after his or hername. We all worked together," saysMacChlerie. Smith also recalls how teamspirit provided both strength and comfort:"We developed new levels of trust andunderstanding because we learned we hadto rely on each other. We all were fright-ened but, working together, we were ableto get through those first difficult days."

Happily, moral support was abundantfor dietetics professionals strugglingto copewith the earthquake's devastation. TheCalifornia Dietetic Association (CDA) re-ceived hundreds of inquiries about mem-bers living and working in areas damagedby the earthquake. Because telephone ser-vice was erratic throughout the SanFernando Valley, CDA served as an infor-mation clearinghouse. As news becameavailable, bulletins were prepared and faxedto CDA leaders throughout the state. CDAalso established a disaster relief fund withdonations from across the country.

Jackie Saracino, RD, chief clinical dieti-tian at Northridge Hospital, remembershow important it was to have her col-leagues' support. Saracino was injured inher home the morning of the earthquake.Within days, she received telephone callsfrom headquarters staff at The AmericanDietetic Association (ADA) and a letterfrom ADA President Sara Parks. "I wasoverwhelmed by the outpouring of sup-port from my colleagues. I want my ADAcolleagues to know that we belong to agroup of wonderful and caring people."

Earthquake-surviving members of theAmerican Society of Hospital Foodser-vice Administrators are compiling aresource manual on disaster planningthat will be available infall 1994. Fordetails, call Pam MacChlerie inSeptember at 818/885-8500, ext 4603.

604 / JUNE 1994 VOLUME 94 NUMBER 6