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And essentially no one outside the planning process has scoured the EOP. Two OES staffers, in separate conversations, joke that I may be the only person to have read it in its entirety.
Blood Everywhere -- Honest!
When the next big quake comes along and claims those estimated 8,000 to 18,000 casualties, a flood of blood will be needed. The source will be the Irwin Memorial Blood Bank, headquartered on Masonic near Turk, which collects and distributes roughly 300 units per day throughout San Francisco and Marin counties.
Is Irwin ready? The EOP notes that Irwin "has [only] enough equipment in stock to draw 5,000 units of blood. In general, San Francisco hospitals have no supplies for drawing blood. ... Irwin has a VERY LIMITED capability to type and screen or to crossmatch blood. Hospitals are expected to do their own crossmatching, as they currently do." In other words, after drawing 5,000 units of 450 ml each, Irwin, the city's one-stop blood source, will be finished until it obtains more disposable syringes, bags, bandages, and other gear from outside the city. And Irwin can draw blood -- up to a point -- but can't really type it, while the hospitals can type it in their labs, but can't draw it. Some system.
In a speakerphone interview with three Irwin officials, Richard Harveston, Irwin's director of blood product services, downplays these concerns, saying that in a severe disaster the bank would just bring in pre-typed blood products from the outside world. But the OES's planners assume the city to be isolated for the first 72 hours. How will Irwin import more blood? In the ensuing conversation, all Harveston volunteers is generalities about how it won't be a problem.
Pressed on the point, Irwin's supervisor of blood product services, Paul Merrill, boasts, "We can get blood here within the hour from anywhere in California." Considering that you can't even fly from L.A. to San Francisco in that time, this seems unlikely.
Harveston and Merrill seem incapable of imagining being isolated from the statewide blood-banking system. "I think the logistics might be difficult -- getting it in -- but just getting one's hands on large amounts of blood would not be difficult," says Harveston. After a major earthquake, one would have to agree, but perhaps not in the way he thinks. The folks at Irwin do, however, note that there is a total of 2,000 units of blood in stock at Irwin and about 2,000 more on the shelves of city hospitals.
Has there ever been a really large-scale need for blood in the United States? They apparently don't know.
"The worst need for blood I've ever seen was in a low-level [Avianca] airplane crash [on Long Island two years ago]," Harveston answers. But what about the need for blood in a really large-scale earthquake-type disaster?
Harveston again: "The need for blood after an earthquake is minimal, if experience we have previously had holds true. ... I know that we used virtually no blood after the Loma Prieta earthquake. I could count [it] on one hand."
But the concern here is for a major disaster, not Loma Prieta. Think big-bigger-biggest. The conversation is disturbing in that Harveston and Merrill, despite their experience, don't seem to have the specifics of how Irwin would operate after a major disaster, nor how other blood organizations have done so around the world.
In a second phone conversation five days later, Irwin's president, Dr. William Heaton, fields the questions. He explains in exhaustive detail that blood demand didn't increase much after the Kobe quake relative to the normal elective-surgery demand; that Irwin has five days' worth of diesel for its generator and a deal to secure another truckful if necessary; that Irwin has 10 vans and a four-wheel-drive for transporting blood around the city; how Sacramento blood banks would drive through San Jose to get to San Francisco in 24 hours; and so on.
Getting Irwin to articulate its plans for the aftermath illustrates the OES's underlying challenge: Public and private disaster planners, as well as generals, must take care not to fight the last war -- Loma Prieta, in this case -- but look ahead to the next one.
Disaster Is in the Details
The EOP isn't all sketchy details. The Emergency Broadcast System, which has metamorphosed into the Emergency Alert System, will serve as the Bay Area's post-doom voice. And the EOP has thoughtfully written the lede for broadcasters in this and 15 other kinds of emergency:
"At approximately (blank) today, an earthquake registering (blank) on the Richter scale struck the (blank) area, with its epicenter at (blank). Fire and police units were immediately dispatched ..." Having these sorts of messages on hand and thought out ahead of time will certainly smooth the flow of information to the public.
Since a post-earthquake incident isn't the right time for playing, the Recreation and Park Department will "establish and maintain shelter operations" in conjunction with the Red Cross. If such shelters become necessary, Rec/Park will also provide specialists to work with the disabled, the elderly, children, non-English speakers, and the deaf.
Although it's covered only lightly in the EOP, the city's formal emergency services will be assisted by trained civilian volunteers: NERTs (Neighborhood Emergency Response Teams). NERTs were formed by the Fire Department when a group of citizens from the heavily damaged Marina District insisted that the city should have a program for organizing citizen volunteers, such as Los Angeles does.