This document summarizes a reconnaissance trip to Chile to examine the effects of the 2010 earthquake and tsunami on healthcare facilities. Key points include: 1) The earthquake was magnitude 8.8 and caused widespread damage, leaving over 800,000 homeless. Hospitals suffered nonstructural damage but no complete collapses. 2) Hospital damage was mostly nonstructural, including water damage, equipment losses, and supply chain disruptions. This was still enough to shut down some facilities. 3) The trip found that hospitals need more redundant backup systems, local emergency plans, and autonomy in disaster response. Recent EMS collaboration helped coordination when other systems failed.

1. Chile Earthquake Reconnaissance Trip March 2010Rick Bissell, PhD UMBC Dept. Emergency Health Services

2. Where is Chile?

3. Geographic Background Source: NYTimes 3 March 2010

4. Tectonics Source; http://www.google.com/imgres?imgurl=http://www.showcaves.com/maps/Big/Plates.png&imgrefurl=http://www.showcaves.com/english/explain/Geology/PlateTectonics.html&h=354&w=572&sz=19&tbnid=t1wGiEg-aGOQiM:&tbnh=83&tbnw=134&prev=/images%3Fq%3DNazca%2BPlate&usg=__FrbMqwx3nrcN963FgA3NcAYWoHo=&ei=CJGnS_zLHYe-NoSAqf0C&sa=X&oi=image_result&resnum=5&ct=image&ved=0CBkQ9QEwBA

5. Trip Background Rapid reconnaissance grant from NSF through the Earthquake Engineering Research Institute (EERI). Focus of our subgroup: Effects of earthquake building damage on health care provision. Focus of larger group: Examination of reasons structures failed (or didn’t) in the most powerful earthquake in recent history.

6. Team Members Rick Bissell U. of Maryland, Baltimore County Francisco de la Masa Ministerio de Salud Judith Mitrani-Reiser Johns Hopkins University Bill Holmes Rutherford & Chekene Tom Kirsch Johns Hopkins University Mike Mahoney FEMA Nicolas Santa Cruz Pontificia Universidad Catolica

7. Earthquake Description Magnitude 8.8, by far the largest since 1964. Lasted 1.5 – 3.5 minutes Subduction-type quake; tend to be most damaging. 3:34 AM; timing saved many lives. Tsunami followed almost immediately in 3 waves. > 150 aftershocks at mag. 5 or greater

8. Earthquake Description - 2 Santiago (~ 450km from epicenter) moved 24cm to the west. Earthquake felt as far away as Buenos Aires, Argentina (~1,500km ) and Sao Paulo, Brazil (~3,000km). Coastal area elevation increases are expected but not confirmed.

9. Destruction Summary ~ 450 deaths, ~ 500 injured, 800,000 homeless > 60% of deaths due to tsunami Most destruction in Concepción, Talcahuano, Valdivia, Arauco, Coronel, Los Angeles, Talca and Maule areas. Destruction area covers 80% of Chile’s pop. Tsunami severely damaged several occupied coastal areas and the port of Talcahuano.

10. Destruction Summary - 2 Most modern buildings (p 1995) did pretty well, except for a few catastrophic failures. Major failures in older adobe-based housing and historical buildings. Some 1940s era hospitals w/very thick walls fared pretty well. Numerous bridges were lost, roads suffered major damage.

11. Destruction Summary - 3 Water systems in Concepción, Talcahuano and other coastal towns suffered major failures due to broken piping. Electrical system for the entire country was out for 4-7 days. Subsequent shorter outages. Communications out for 3-5 days. Few notable fires, except at Univ. Concepción.

12. Concepción O’Higgins Bldg.

13. Talca

14. Talca

15. Prat Bldg Concepción

16. Prat Bldg top

17. Prat Bldg west side split

18. Prat Bldg bottom

19. Prat Bldg rescue hole bottom

20. Prat Bldg rescue holes east side

21. Prat Bldg rescue holes east side

22. New Prat Bldg beam/column damage 6th Fl

23. Concepción bridge

24. Concepción bridge

25. Universidad Concepción Chemistry Bldg

26. Talcahuano water line w/Judy MitraniReiser

27. Talcahuano water damage housing

28. Talcahuano bldg and boat

29. Bissell in drydock

30. Talcahuano port damage

31. Concepción crushed cars

32. Concepción water in streets

33. Concepción grain storage silos

34. Concepción street tents

35. Hospital Damage No hospital (to our knowledge) suffered a complete structural failure. Of 79 affected hospitals, 54 require minor repair, 8 major repair, and 17 a complete rebuild. (Source: http://www.redsalud.gov.cl/noticias/noticias.php?id_n=761&show=3-2010) 22 Mar 2010 Many had extensive loss of equipment. All lost power, external water supply, communications.

36. Talca Hospital

37. Talca Hospital

38. Talca Hospital

39. Talca Hospital

40. Talca Hospital

41. Talca Hospital

42. Impressive field hospital in Talca run by Chilean military

43. Summary of Physical Damage:Nonstructural Severe damage to suspended (“American”) ceilings. Loss of power, water, and communication. Mechanical equipment damage resulted in loss of hot water forcing hospitals to be creative with kitchen, laundry, and sterilization services (e.g., water boilers and chillers). Medical equipment damage forced hospitals to do their sterilization off site, and disrupted diagnostics (e.g., damaged radiology equipment) Water damage forced hospitals to shut down entire buildings, disrupted dialysis treatment, and had severe sterilization implications (e.g., surgical ward). Standalone shelving damage, resulting in disorganization of medical records for few days to several weeks (e.g., Talcahueno still organizing now!).

44. Hospital Physical Damage Impact Damage resulting from very small details can shut down a hospital. Water damage from even a small pipe break can shut down operations. Securing both mechanical and medical equipment can be critical to maintaining hospital operations. Distributions to systems are not as critical in Chile and were more redundant.

45. Hospital Operability Issues:Redundant Systems All hospitals had backup systems for water and electricity, although the systems were not always sufficient. None had adequate backup for sewer. Communications systems needed planning and redundancy. Hospitals proved remarkably adept at using ambulance radios for local communications.

46. Hospital Operability Issues:Pre-event Emergency Planning Hospital emergency committees were very helpful in providing leadership. All directors said emergency plans needed to be redone in a practical way, which includes local decision making. Current plans have decisions being made in Santiago, but did not take into account communications problems.

47. Hospital Operability Issues:Evacuations and Transfers Some hospital s did an excellent job in evacuating patients, while others did not; loss of elevators impacted evacuation capability; many had to carry patients (old style ramps actually were very efficient). Hospitals were very resourceful at relocating patients within their own facilities. US hospitals should reconsider policy of mass transfer of patients to other hospitals based on damage. Most hospitals reduced patient load by: Discharging patients to families with instructions for care. Some hospitals sped up normal transfer of patients back to their home hospitals, especially maternity.

48. Summary This is a preliminary investigation, hopefully leading to a more thorough one. Hospitals do not have to collapse to be rendered inoperable. Hospital directors noted the need for more local preparedness planning and training and more decision-making autonomy. Recent collaboration with EMS (SAMU) led to a very effective use of EMS as a communications and coordinating unit when other systems failed.