This article first appeared in the St. Louis Beacon, Dec. 2, 2010 - Too many people in charge, not enough hospital training, a lack of help for the poor and disabled and a 50-year-old communications system -- these and other factors were cited as severe drawbacks to the St. Louis region's readiness in a Beacon series on disaster preparedness in fall 2009.
More than a year later, these conditions are virtually unchanged. St. Louis is still far from ready for a serious earthquake, tornado or other major emergency.
Officials are relying on St. Louisans to prepare themselves to handle the first hours of an emergency.
Preparation Begins At Home
Jacki Kelam has suffered internal injuries during a tornado and facial lacerations in an earthquake. Another disaster left the Manchester resident "dead," although she's very much alive today.
It's not that she's a walking miracle or a disaster magnet; Kelam, 58, is a Community Emergency Response Team (CERT) volunteer. Twice a year for the past four years, she's participated in disaster drills such as an earthquake exercise held Oct. 27 at Barnes-Jewish Hospital.
Boasting a basement stocked with flashlights, changes of clothes for any season, water, canned food and even pet food, Kelam's own household could sustain itself for the first three days after a disaster, as recommended by the American Red Cross. But her readiness at home is just a starting point.
Kelam and hundreds of other Missouri CERT volunteers -- ordinary citizens with an interest in emergency readiness -- are preparing not only for themselves and their families but for their neighborhoods as well. Each is trained in roughly 20-hour sessions to rescue, triage and give basic first aid, skills they practice on a routine basis.
"The CERT creed is to care for yourself, your family and your neighbors, and then go out from there," Kelam said. "So if I can help take care of my neighborhood and not have first responders worry about us, they can go help somebody else."
'Help Yourself' Is Campaign Message
What Kelam knows --- "waiting for rescue" is a dangerous mindset --- is a lesson that local disaster planners want to teach all St. Louis-area residents.
In early 2011, they will roll out a new publicity push telling people how to prepare for an emergency. Local public relations giant Fleishman-Hillard is creating the $140,000 campaign urging residents to have enough supplies to get by for the first 72 hours of an emergency without electricity and water. The promotion will include a get-ready website as well as bus stop posters and social media.
Like a good Girl Scout, St. Louisan Liz Bohn is already ahead of the game, having adopted "be prepared" as her motto years ago. Way before 9/11, Bohn stashed a few essentials in her basement and in her car trunk. After Hurricane Katrina, she added toothbrushes, canned tuna and peanut butter. The whole kit is packed in a suitcase with a shoulder strap should an emergency require the Bohns to get out quickly.
A wind-up radio is upstairs but in easy grabbing distance when heading to the basement, which is stocked with toys, games, blankets and even portable urinals. Last fall, Bohn, her husband, her daughter, 4-year-old granddaughter and 2-day-old grandson holed up comfortably in the basement workout area for two hours during a tornado warning.
"We felt safe, and we were able to listen to the weather updates on the radio," Bohn said. "You don't have the added stress of 'why didn't I plan'?"
Communications Woes Persist
One of the chief obstacles to disaster readiness cited by a 2007 Focus St. Louis reportwas an inefficient patchwork of communications systems. St. Louis County police, fire and EMS still rely on a radio system in place for more than a half century. While disaster planners joke that it's "held together with bailing wire and bubble gum," its potential for failure is no laughing matter.
Voters in 2009 approved a ballot measure to replace the county's abysmal communications system, but bids for overhauling it are still being accepted for the next few weeks. With many more steps to go, it will be 2013 before the new setup is in use.
Until the new system is working, county officials will continue to be cut off from communications with their counterparts in St. Louis and Jefferson, St. Charles, Madison and St. Clair counties.
"We still don't have first responders talking to each other on a communications network, and the whole system is vulnerable; it could fail at any time --- and at the most inopportune moment," said Nick Gragnani, executive director of the St. Louis Area Regional Response System.
Too Many Chiefs, Too Little Practice
The "clear chain of command" called for by the Focus St. Louis report is in place, but it's a top-heavy list. Unlike areas such as the Seattle-King County region, where one emergency czar calls the shots, the local buck stops with eight different people: St. Louis Mayor Francis Slay and the top executives of St. Louis, St. Charles, Franklin, Jefferson, Monroe, St. Clair and Madison counties.
That's too many --- "a nightmare" scenario, Saint Louis University public policy professor Ken Warren told the Beacon last year. Still, there are no plans to put just one person in charge.
Medical facilities and their employees appear no more ready for disaster than they were a year ago, and local nursing schools still do not require students to take an emergency preparation course.
Once they're working, nurses, doctors and other staff are unlikely to get even on-the-job training for disasters. Twice a year, Barnes-Jewish Hospital involves only around 400 of its 9,300 employees in an emergency drill. Those who work nights or weekends never get to practice how they'd handle a disaster situation, according to Teresa Wineland, Barnes' emergency management coordinator who's worked at the hospital 12 years.
"As far back as I can remember, we've never drilled at night or on the weekends," Wineland said.
It's almost the same story at DePaul Hospital, except that once in a while a night-shift supervisor comes in for a daytime drill.
Regional medical facilities do have a new leg up when it comes to tracking symptoms of epidemic illnesses. Since April 2010, 55 area hospitals and nine health departments have been using a $960,000 surveillance software package provided by the federal government. The process starts when someone describes their symptoms, such as vomiting, diarrhea, fatigue or rash.
"As the charge nurse is putting that in the computer, the 'Essence' program looks for patterns that could be similar to an anthrax attack, smallpox outbreak or HINI flu," Gragnani said. "It automatically alerts local health departments that something's going on out there."
Disabled, Poor Must Fend For Themselves
If the elevator fails during a disaster, most people know to take the stairs out of a building that must be evacuated. But what if a wheelchair is your means of mobility? As directed by Focus St. Louis, disaster planners are taking steps to address the needs of people with disabilities.
But real change is years away.
Focus St. Louis, the local Red Cross and St. Louis' Office on the Disabled have been involved for the past year in a survey of people with "functional needs": mobility issues, health problems, lower incomes and language barriers. A preliminary poll revealed ways in which shelters can prepare for people with physical disabilities, according to Focus St. Louis' community policy director John Wagner.
"You have to know how many wheelchairs and shower stalls you need to accommodate people, and you also need to know whether the facility itself is ADA-compliant," Wagner said.
The recent survey also demonstrated that most people with disabilities support the idea of a roster of those such as themselves, so that emergency responders can know where they are --- and rescue them. But privacy issues are problematic.
"If you create a list that isn't protected by HIPPA rules or something else, somebody could come along and ask for a copy of that, and whatever data are on that list isn't protected," said David Newburger, commissioner of the city's Office on the Disabled.
Beyond the privacy concerns, it's impractical to think that rescue workers could even get to a small percentage of people who are unable to navigate traditional means of escape. The bottom line, Newburger said: People with disabilities must create their own survival plans, relying on family members and neighbors.
Disaster training works in this community, according to the survey. Those who've been taught how to prepare are more likely to have a plan. But they are few and far between, Newburger said, echoing an increasingly popular notion.
"We need to get people to take charge of their own lives," Newburger said.
Nancy Fowler Larson is a freelance writer in St. Louis.
