Case Review: Special Delivery

Winter weather can play havoc with everything. How can you handle it?

The weather forecasters couldn’t have been in greater agreement: There was not going to be a big snowfall, just a lot of wind. But the wind was worry enough for the EMS and emergency department leaders in the region, so the chief asked the Attack One crew assigned to work the day the “wind event” would move through to prepare a plan for a potential severe winter weather event.

The crew members reviewed their department’s major weather incident plan and sent a few notes to friends in cities to the north that had seen notable winter events over the years. They talked with the managers of the emergency departments they saw on their usual rounds, and found they were all preparing storm plans. The crew met two days before the front was due, updated their weather plan and briefed department leadership, then called a meeting for the ED leaders. They prepared a briefing for all crew members who would work the weather day. That day the forecast was modified to include “maybe an inch or two of snow.”

A day later, the forecast was “too close to call—maybe more snow, but clearly a very windy day.” The fire, EMS, police and emergency management leaders met, and all agreed they would institute their severe weather incident action plan at 0700 the next day. All departments would staff up, and the jurisdiction’s small fleet of snow removal equipment would be prepared, with backup plans for private contractors and agencies with heavy removal equipment. They would announce their plans to the public on the evening news. They would establish a joint information center, and all department public information officers (PIOs) would work through it.

Fire, EMS and hospital leaders met that afternoon, and the hospitals were prepared to announce they were canceling all elective operations, bringing in and housing extra staff, and discharging all patients who could safely leave. The Attack One crew leader was asked to chair the meeting, be responsible for ensuring emergency plans were not in conflict, and cover the necessary elements of emergency medical response and patient removal. About midway through the meeting, the group realized they would need support from the regional 9-1-1 call center, so a representative was asked to report. One of the hospitals agreed to serve as a regional coordinating center for emergency medical and hospital operations, and one of its employees would be present at the emergency operations center, should it be stood up.

By the time the evening news aired, meteorologists had upgraded their expectations to “blizzard-like conditions for a short period, with 4–6 inches of precipitation and high winds for 6–8 hours.” By the 11 o’clock broadcast, the forecast was worse.

The precipitation started with a light snow at 0600 hours, by which time the Attack One crew was already in the station, briefing the crews from both shifts that would be on duty. Fortunately, schools and businesses closed in preparation for the storm, so traffic on the roads was light. By 0900 hours, it was a solid shield of wind-driven snow, and by 1000 hours it was officially a blizzard. Wind howled around the stations, and crews were having trouble keeping the doorways clear for equipment. Power lines began falling, and calls came in for persons blown over by winds, arcing power lines, and other, more routine medical calls. By 1900 there were many large drifts, and it was difficult to drive on many streets. Road maintenance crews could not keep the roadways clear, but did their best to keep critical areas open to traffic near hospitals, fire stations, utility stations and police headquarters. The public was advised to stay off the roads. After sundown, conditions worsened, and the blizzard continued.

The Call

After dinner Attack One is dispatched to a peripheral area on the north side of the city for a woman in labor, with additional information that she is near term, and the apartment building where she’s located is at the top of a hill and snowed in. The dispatcher advises that a fire engine and snowplow are being dispatched to assist access.

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