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April 20, 2014

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Recent events raise the question: Is Las Vegas prepared for a major medical emergency?

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Charles Krupa / AP

Medical workers aid injured people at the finish line of the 2013 Boston Marathon following an explosion in Boston, Monday, April 15, 2013.

Dr. Aaron Meltzer spent a week in November learning about medical care during emergencies and disasters in Israel, a country that handles multiple-casualty incidents on a regular basis.

He returned to Las Vegas with questions about U.S. cities and how they have prepared for large-scale medical emergencies. In Israel, the public gets regular reminders on how the safety network functions. In the United States, while emergency planners may be working behind the scenes on comprehensive plans, the public often does not notice until an emergency occurs.

“The United States and Vegas are obviously different situations,” Meltzer said. “When I returned though, I was thinking about all of the cities I’ve been to (and wondering) how prepared are they really?” Meltzer has lived here for the past five years after practicing for most of his career in Northern California

Meltzer’s questions were only amplified after a series of disasters this year.

Boston Marathon Explosion

In this Monday, April 15, 2013 photo, Boston Firefighter James Plourde carries an injured girl away from the scene after a bombing near the finish line of the Boston Marathon in Boston. The FBI's investigation into the bombings at the Boston Marathon was in full swing Tuesday, with authorities serving a warrant on a suburban Boston home and appealing for any private video, audio and still images of the blasts that killed at least three and wounded more than 170. Launch slideshow »

Texas Fertilizer Plant Explosion

A fire burns at a fertilizer plant in West, Texas after an explosion Wednesday April 17, 2013. Launch slideshow »

Massive Tornado Hits Moore, Okla.

A tornado moves past homes in Moore, Okla. on Monday, May 20, 2013. Launch slideshow »

In the aftermath of the Boston Marathon bombing, approximately 300 injured people were treated at 26 Boston-area hospitals. That same week, a fertilizer plant in West, Texas, exploded, sending more than 200 inured people to area hospitals. Monday, after a devastatingly large and powerful tornado ripped through Oklahoma, 200 people, including 50 children, were treated for injuries.

So, how is Southern Nevada prepared for a large-scale medical emergency? After all, Clark County has one of the largest tourist corridors in the world in the Las Vegas Strip.

In a recent interview, while making an argument for funding from the federal government for security initiatives, Metro Police Sheriff Doug Gillespie summed up the case for Clark County as a potential target for terrorists.

“It’s very difficult to go someplace, somewhere, where people don’t know Las Vegas,” Gillespie said. “The other thing is the volume of people that are here, in a very small area. … And then when you factor in other aspects of what’s here, from the Hoover Dam, to Nellis Air Force Base, Creech Air Force Base, to 20 of the 25 largest hotels in the world, 156,000 hotel rooms and the seventh-busiest airport …”

Meltzer asked himself: How would Las Vegas cope with a disaster that produced hundreds of wounded? How would the large resorts make sure ambulances could get to their properties in an emergency? How do the valley’s hospitals coordinate to triage and treat the injured? How would emergency services handle a chemical attack?

It turns out a collection of county officials, medical professionals, hospital administrators and private-sector security and emergency management personnel have been focused on refining their strategies for a decade, and they have solid answers to Meltzer’s questions.

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After 9/11, federal and local coordination on disaster mitigation rose to an unprecedented level, aided by funding from the Homeland Security Act of 2002. Clark County put together a mass-casualty plan as part of its overall emergency management plan in 2003, updated it in 2005 and is revising it again this year, according to Irene Navis, plans and operations coordinator for the Clark County Fire Department Office of Emergency Management. Specific details of the plans are not public for security reasons.

Also in 2003, the Legislature established the Nevada Commission on Homeland Security, and the processes for handling various emergencies were thoroughly evaluated.

“I can say with confidence that Southern Nevada is as prepared as anyone else in the United States, because we have major events all the time. We are constantly planning for large events with thousands of people, from the regular boxing matches to the marathon, Electric Daisy Carnival and New Year’s Eve. No other city has the volume of events that we have. It’s the ‘Entertainment Capital of the World,’” said Dale Carrison, chairman of emergency services at University Medical Center and the former chairman of the Nevada Commission on Homeland Security.

Carrison led the commission for its first eight years and said one of the biggest improvements was establishing clear communication networks and backup plans. Federal and local authorities are better linked to each other and private service providers, such as ambulance companies. Plans are in place for various scenarios. Emergency managers run practice exercises, he said.

Greg Goll, vice president of security and operations at New York-New York and the only member of the Nevada Emergency Coordinating Council from the private sector, said communication and coordination have advanced a great deal since 9/11.

“There are monthly meetings between security officials and public officials like Metro Police, which include people from all over the city,” Goll said. “We have very good communication lines across the city to various departments. It’s very different from prior to 9/11. Everything is transparent and seamless, and we have much more coordination between local and federal authorities.”

New Year's Eve on the Strip

Launch slideshow »

For the largest Las Vegas events, such as New Year’s Eve, a command center is set up with representatives from all of the Strip properties, local police and fire officials and federal law enforcement to coordinate communications and responses to incidents.

The Clark County Emergency Management Division within the Clark County Fire Department helps keep everyone in Southern Nevada on the same page. In the case of a disaster, a carefully orchestrated plan is set in motion depending on the nature of the incident, such as an explosion, fire, chemical spill or building collapse.

“The first-responders, police and primarily the fire department, work with ambulance companies to set up staging areas – and casualty collection areas – to bring people to be assessed,” Navis said.

There is also a “medical surge” plan that kicks in if area hospitals reach capacity.

“They would cancel all nonessential surgeries, empty rooms as best they could of patients who are not critical or can be discharged earlier,” Navis said. “They would use emergency rooms, and then if we needed to we can set up medical shelters in community centers or other community buildings.”

The city of Las Vegas owns an emergency medical tent that can be loaned to hospitals in case of an emergency or need to quarantine patients. The 3,000-square-foot tent can be set up in a couple of hours and holds up to 20 patients.

The county received a federal grant several years ago to provide decontamination trailers to each hospital in the valley in the case of a chemical spill or attack, Carrison said. If a chemical attack were to occur, hospital emergency rooms would go on lockdown and patients would be screened to make sure they were decontaminated.

The plan also lays out the system for calling on emergency resources such as school nurses and a cadre of medical volunteers, retired and practicing professionals, available for large-scale medical emergencies.

“It would take a catastrophic, major event to get to the medical-surge stage. We have more than 20 hospitals in the area,” Navis said. “It’s not like we have four or five. There are hundreds and hundreds of beds that could be available. Many hospitals close off space and don’t use them, and they can be opened up in an emergency.”

Carrison said one area of improvement needed for Nevada’s system was a universal identification system for medical personnel who show up to assist in an emergency.

“One thing I’d still like to see is uniform ID for providers, a chip in their badge that can be read and then tells the person this is so-and-so doctor who is credentialed to do these types of procedures,” he said, noting that people posing as doctors showed up in Louisiana after Hurricane Katrina.

Navis said officials constantly were reviewing incidents in other places to make sure their plan was equipped to handle the scenario. Those include large events like the Boston Marathon attack, but also events with fewer casualties, such as the July 2012 mass shooting in Aurora, Colo.

“Mass-casualty planning is part of the main emergency operations plans,” Navis said. “There are different levels of authority, and everyone has areas of responsibility and knows what role they play. Everything is laid out to what’s supposed to occur in a mass-casualty incident. It’s a very regional approach so everybody can be on the same page.”

Also, states can call on each other for help using the 1996 Emergency Management Assistance Compact, which made it easier for states to share personnel after a governor declares a state of emergency. The policy preemptively ironed out issues of liability and responsibility for costs, and it allows for credentials, licenses and certifications to be honored across state lines.

Private businesses, like the large resorts on the Strip, are required to have their own emergency plans. If there is a medical emergency, plans are in place to meet first-responders and outline where ambulances and other emergency vehicles should arrive.

All security personnel on the Strip are trained in basic first aid, Goll said, and all MGM Resorts International employees get regular training in handling various emergencies based on their specific positions. MGM has teamed with the Harry Reid Center at UNLV to produce training videos starring their own employees.

“The main thing is communication,” Goll said. “We have a phone on-site which goes direct to a 911 operator. So we let them know we’ve had a mass-casualty incident, or we have a head injury, or whatever is going on. They have protocols on who they will contact and what resources will be sent, and our job is to triage the people as best we can until paramedics and those with a higher level of training get here.”

While every major casino and resort operator on the Strip was contacted, MGM was the only company that made someone available to discuss emergency management plans.

Clark County also has compacts with the large properties to use their space in case of an emergency.

“One big difference in Las Vegas is that we already have built-in resources through the casinos and convention centers, where if we had a really large event where shelter is needed, we could turn a convention stage into a portable hospital,” Navis said.

Carrison said his biggest concerns, from a medical emergency perspective, were an attack or disaster that damages a hospital, displacing medical personnel and reducing capacity, or several incidents happening close together that would clog hospitals and spread medical staff too thin.

“The worst possible thing would be a large disaster at one of the major properties,” Carrison said. “Let’s say a hotel collapses and it has 7,000 people inside. Can we handle 7,000 wounded? No. No one in the United States can. … My other biggest fear in terms of a disaster is, what if they took out UMC? That would be a true disaster. We’d have no burn center and no Level 1 Trauma Center.”

Carrison said emergency planning for large events such as the Electric Daisy Carnival and New Year’s Eve start six months in advance, and while the public may not notice, a great deal of strategizing for every possible scenario is conducted.

“We’re not cavalier about any of this,” Carrison said. “We do table-top exercises, and there is a lot of infrastructure behind every event. The public has no clue everything that goes into planning for these events.”

Meltzer believes the public should be more aware of their city’s emergency management strategies, and even take more of an involvement in planning for a disaster.

“The public has a responsibility to be more alert and more informed of how things will operate. They should know what they should and shouldn’t do,” Meltzer said. “We should be secure in knowing that our hospitals are ready to handle it, our ambulances are ready to handle it, our doctors and nurses are ready, and there are teams that are ready to handle an emergency if it happens. We need to know and be confident that our city can do this.”

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