Distribution of Casualties
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The Southern California Hospital Council identified hospitals close to the curfew area and requested hospital emergency department admissions data. LAEMSA requested the same data from 98 hospitals throughout the Los Angeles Basin (LAEMSA, 1992a). The latter data shows that hospitals outside the immediate disaster area received significant numbers of casualties (this point is examined more closely below). LAEMSA reports that twenty-eight hospitals cared for about 85% of the casualties.*
* Hospitals not included on the Southern California Hospital Council list but that are among the first twenty-six on LAEMSA's list are: Memorial Hospital, Kaiser Harbor City, Charter Suburban, Henry Mayo, Century City Hospital, and Daniel Freeman Marina. On the other hand, the following hospitals did not show up among the top twenty six on LAEMSA's list: Kaiser Foundation Hospital Los Angeles, Children's Hospital Los Angeles, Westside Hospital, Santa Marta Hospital, San Pedro Peninsula Hospital, and East Los Angeles Doctors Hospital.
USC County Hospital which received 145. Some possible reasons for this are discussed below. (It is noteworthy that a similar hospital distribution pattern occurred during the Mexico City earthquake.
Generally, it appears that Hospitals close to where the event started on Wednesday (map identified numbers 16, 11, 12) received the most casualties. As the civil disturbance spread north (3, 2, 1) south (15, 13, 23) on Thursday, hospitals in these areas began to receive significantly more casual This pattern is consistent with that reported by Dr. Pratt of the Los Angeles County Fire Department (Pratt, 1992). This pattern is also supported by an analysis of 9-1-1 calls conducted by the Webster Commission which found that most of the initial violence was restricted to South Central Los Angeles and did not spread until after 7 PM Wednesday night (LA Times, October 22, 1992).
Saint Francis Medical Center's experience doesn't seem to fit this pattern. Although the hospital i close to the incident's starting point, their patient load did not increase substantially until Thursday. Two factors may account for this: the time that it took for the civil disturbance to come to the hospital's neighborhood, and efforts by LAEMSA to distribute patients.
First, on Wednesday, LA City Fire Department ambulances that typically went to Martin Luther Medical Center or to Daniel Freeman Medical Center, came to Saint Francis. These vehicles didn’t want to cross the disaster area. The -4olume of patients that they brought was relatively low. Saint Francis' emergency department saw relatively few walk-ins. Thus the event had a relatively small effect on the emergency department on Wednesday. Hospital administrators observed the direction the civil disturbance was taking from the hospital roof by watching smoke plumes from fires (see Hospital, 1968, p. 21 for a similar account). It was not until Thursday that the disturbance moved into the hospital's neighborhood resulting in a significant increase in walk-in patients.
Second, LAEMSA initiated a poll of all basic emergency department licensed receiving hospitals close to the disaster area just after midnight Thursday morning (LAEMSA, 1992a). Early polling data indicated that Martin Luther King and Daniel Freeman were receiving a large number of patients. For example, Daniel Freeman Medical Center reported that the "injured cover every surface of the emergency department." LAEMSA decided to try to take the pressure off these two hospitals.
"EMS Providers were encouraged to avoid transporting patients to Daniel Freeman Medical Center and Martin Luther King Medical Center as much as possible because both of these facilities were receiving many walk-ins and drive-in patients who did not access the prehospital system" (Chaffin, 1992).
It appears that this decision took the pressure off Daniel Freeman Medical Center on Wednesday but increased it on Saint Francis Medical Center on Thursday. This decision had limited impact on Martin Luther King/Drew Medical Center since Wednesday represented their most violent night of the four day ordeal. Most of those with gunshot wounds arrived by ambulance that day (Edward Renford, 1993). Daniel Freeman Medical Center reported that things quieted down on Thursday night to the point where there was less business than usual. The combination of the quick increase in transports, and walk-ins from local incidents probably accounts for the pattern of patient's arrival at Saint Francis.
In summary, a cursory review of Map 4 might lead one to the conclusion that patient distribution to hospitals was not optimal. Four factors may account for this. First, this was not a multi-casualty incident occurring at one particular time and location. The violence seems to have started at a central point and then moved north and south creating varying loads on local hospitals as it progressed. The disturbance also went on for three days, lasting longer than many responders and disaster managers expected. Second, the fact the majority of injured were self-transporting created a situation where LAEMSA could not predict the load of casualties that any one hospital would receive. Hundreds of casualties were transported in this way during the geographic ebb and flow of the violence. Third, ambulance personnel were reluctant to cross the disaster area exposing themselves to attacks. Finally, it was impossible to predict when law enforcement protection would be available for ambulances or when it would be effective in reducing the level of violence. (See section on Law Enforcement and Curfew.) All of these unknowns made it very difficult to rationally manage the hospital destination of the injured.
Hospitals that received the largest number of injured admitted more patients and had more in-hospital deaths (Table 21). However, this does not mean that hospitals with a lower volume of patients necessarily received fewer seriously injured. Table 21 reports injuries, admissions, and deaths by hospital where information about the cause of death is available. The data is incomplete and does not agree with earlier tables. Also, it is difficult to know, let alone measure, the actual distances people w re taken for care. However this data is still instructive. Apparently, hospitals not located near the civil disturbance received a relatively small number of injured, and had about the same admission ratios as hospitals receiving larger numbers of the injured who were located close to the disturbance. This suggests that severely injured patients may be taken a considerable distance for care.
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Medical Care for the Injured