Medical Care Staffing

Doctors, nurses and other staff, and administrators, worked twelve, twenty-four and sometimes for eight hour shifts. They often caught up on sleep in quarters set up by the hospitals. Shifts did not occur in an orderly manner (Nurseweek, 1992). In every case there was sufficient staff immediately available to care for the patient load. However, a massive first response on Wednesday tended to burn out the staff making it difficult to maintain the response without replacements at D Freeman. As noted, Martin Luther King/Drew and Saint Francis Medical Centers were able to provide shift changes. Doctor Leon Bender, Cedars-Sinai Chief of Medical Staff, commented on staffing for the civil disturbance. We knew we needed specialties such as orthopedic surgeons, neurosurgeons, bloodbanking, and so forth in-house constantly. ...So we contacted various epartments and ordered two physicians from each specialty to stay in-house. The auditorium was set up for sleeping the staff, and a child center was set up. We slept an extra 400 people here. We had 10 operating crews ready and four trauma rooms going. We were prepared for 10 times the volume we got (Stein, 1992). Nearly all the hospital administrative and LAEMSA staff interviewed indicated that they underestimated how long the civil disturbance would last compared to 40% of the EMTs surveyed. Unlike an earthquake where the damage occurs over a very brief period, a civil disturbance can last for a few hours, a day, a few days, or even a week (Kerner, 1968, "Charts on Level of Violence and Negotiations"). Most felt the event would end Wednesday evening. The willingness of staff to travel through riot torn areas varied from hospital to hospital. At Martin Luther King/Drew Medical Center, 89% of the nursing staff came through the curfew zone. African-American nurses personally drove Asian nurses to their homes. In some cases, the Asian nurses laid down on the car's back seat to avoid being seen by rioters (Renford, 1992b). Saint Francis Medical Center was also able to bring staff in. Neither hospital experienced staffing problems. Daniel Freeman Medical Center may have lost about 30% of their staff due to this problem. Casualties began arriving Wednesday evening about the same time that the shift change was taking place. Both shifts stayed on to respond to the high volume. Unfortunately, the disturbance d-id not end. It continued and quickly wore out both shifts by late Thursday. Some staff members formed a caravan and reported for work. The hospital made arrangements with LAEMSA to supplement their emergency department staff. (See discussion of LAEMSA and of the state's role below.) Kaiser Permanente West LA reported increased absenteeism for Thursday and Friday. Fifty six employees and physicians stayed over on Thursday night. A few also stayed Friday night. Kaiser Permanente Bellflower and Harbor City placed all employees on twelve-hour shifts Thursday night. All of the hospitals either closely monitored satellite clinics or closed them if they were in an area affected by the disturbance (clinics may be vulnerable during civil disturbances, see: Hospitals, 1968). Critical clinic services were moved to hospitals. For example, Harbor City moved Chemical Dependency Recovery Services, and "after- hours" Urgent Care Service to the hospital. Home health services to Hawthorne were limited and discontinued in Long Beach from Friday through Sunday (Kaiser Permanente, 1992). Many hospital staff members live in the communities where the civil disturbance was taking Place. "Near her home in Compton, Almond [a nurse] recalls walking through dense, black smoke. She doon realized its source: the gas station across the street from her home was burning down" (Nurseweek, 1992b). Other staff did not want to return home for the same reason. On occasion, private vehicles were short on gas. Daniel Freeman Medical Center made gas available to their employees so they could travel home. Unfortunately, fear of traveling through the riot area led to two hospital workers being fired at Centinela Hospital (Los Angeles Times, 1992). Their case is being reevaluated by the hospital. Hospitals located in the disaster area were unable to identify safe travel routes for their employees to come to or leave the hospital. Hospital administrators and staff did attempt to resolve the problem. Saint Francis Medical Center and Martin Luther King/Drew Medical Center both established a staging area in a relatively safe location for their staff. In one case, transport and protection was Provided by hospital security, in the other, individual peace officers provided it (hospitals taking care of their own transportation needs is not unusual, see: Hospitals, 1968b). Daniel Freeman Medical Center did not establish a staging area nor provide an escort service for its staff but, instead used the county's emergency aid system. Rioters attacked individual staff members on their way to or from the hospitals. One Asian physician's car had a brick thrown through the windshield as he was trying to make his way to Mart Luther King/Drew Medical Center. A nurse at Daniel Freeman Medical Center experienced the same problem when she left the hospital. Other nurses reported being shot at as they tried to come to work. A Kaiser Permanente security guard was shot at (Kaiser Permanente, 1992). Hospital staffs at all the hospitals are ethnically mixed. During the civil disturbance the staff watch as various ethnic groups attacked other groups or burned down their homes or businesses. This problem exacerbated existing tensions at one hospital and sharpened ethnic distinctions at others. However, never was the ability to provide patient care compromised. At Martin Luther King/Drew Medical Center, staff developed several creative approaches for dealing with emergent ethnic issues. Unit conferences organized by hospital administrators helped African American and Asian nurses to deal with emotions that emerged during the civil disturbance. Child care became a problem for some hospital staff. Closure of public schools put many children the streets and created child care problems for their parents. The long hours, location of their home and other factors made the problem worse. At least two hospitals and Cedars-Sinai Medical Center, and Kaiser Hospitals, provided child care services. The Los Angeles Trauma system already has problems with obtaining emergency on-call physicians and specialists (HCSC/LAEMSA, 1990). During the disaster one hospital reported that they could not get a vascular surgeon for three patients. A second hospital reported that they could not get a neurosurgery panel (fortunately no patients required neurosurgery). Whether this was due to access problems for the surgeons to the hospitals, or to long standing problems with establishing and maintaining panels, is unknown. Typically, when a disaster occurs numbers of medical volunteers call hospitals and offer their services. This phenomena did not occur, probably because of the associated security problems with getting there (HCSC, 1992).

Medical Care for the Injured

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