Related articles: The Deseret News has been running a series on earthquake preparation in conjunction with the Great Utah ShakeOut drill.
HOLLADAY — This was the scenario: St. Mark's Hospital had sustained damage from an earthquake. Four "patients" were diverted to Holladay Healthcare Center for care.
Among them was a 14-year-old girl, "Betty Smith," who was in the throes of labor. Another was a patient who had been diagnosed with schizophrenia. Yet another needed stitches for a head wound. Still another had injured a hip.
They were all under the care of Jocelyn Jackman, a newborn intensive care nurse, who had been pulled away from her regular duties at St. Mark's Hospital to accompany the patients to the Holladay skilled nursing facility in a nursing home van.
The "patient transfer" was part of The Great Utah ShakeOut, the largest earthquake drill in state history. Some 930,000 Utahns took part in the exercise, which commenced with a mock earthquake at 10:15 a.m. Tuesday.
When the nursing home van arrived at the care center, members of the nursing staff and the facility's medical director, Dr. C. Steven Fehlauer, performed triage in the lobby.
"Betty" was moved to a private room where Jackman and Shantel White, a registered nurse who works at Holladay Healthcare, prepared for the birth. Fortunately, White has also worked as a labor and delivery nurse. Delivering babies, of course, is not a common occurrence at a nursing home, but White's training kicked in as she and Jackman coached the teenager, who was not aware that she was pregnant, through a difficult birth. The baby boy had an umbilical cord wrapped around his neck and he was born blue.
Jackman massaged the newborn (a plastic doll that Betty had carried in her purse until the drill got under way) until he cried.
While both nurses are experienced in delivering babies and their care after birth, the experience was largely an exercise in improvisation. While White was familiar with the available equipment, supplies and staff at the nursing home, Jackman was thrown into a new environment.
"It was really interesting. I'm glad I have my training to fall back on and I have my experience to fall back on. And I had a really good nurse to work with," Jackman said of White.
White said throughout the drill, she was taking a mental inventory of what equipment could be used in the event of such an emergency, whether it was the crash cart or something that could be used to tie off the umbilical cord.
For purposes of the drill, Jackman and White were on their own to deliver baby "Slate." Fehlauer popped in afterward to offer assistance and check on the condition of mother and child. "Did you deliver the placenta?" he queried.
"That's the doctor's job," White joked.
The birth was something of a dress rehearsal for "Betty Smith," who in real life is Whitney Shaver, a nursing student at Westminster College. She's also 25 weeks pregnant.
"It was fun to see how everyone reacts in a traumatic situation," she said.
While neither employees of the nursing home nor the hospital know what any given day will bring, Len Southwick, administrator of Holladay Healthcare Center, said the training was a help to both.
"This was good. There has not been a lot of coordination between the hospitals and nursing homes in this arena before," Southwick said.
He said the drill revealed a couple of problems with communications. The patients who were transferred to the skilled nursing facility were moved throughout the building as their care needs dictated but their whereabouts were not immediately available to key health care providers.
Yet the medical staff's previous and current experience helped ensure each of the new patients received the care they needed. White was pressed into service to deliver a baby. The nursing home regularly cares for wounds and was able to immobilize the patient who had been diagnosed with a hip injury.
The patient with diagnosed mental illness, who told nursing home staff he believed aliens had caused the earthquake, was cared for in a unit for patients with dementia.
The facility is a member of Utah Health Care Association, an industry organization for long-term care facilities, which is regularly engaged in emergency preparedness activities and staff training, Southwick said.
In fact, a new report assessing the disaster plans of the nation's nursing homes, Utah earned high marks. The survey of 101 Utah nursing homes found no planning deficiencies among the facilities surveyed, according to the report by the inspector general's office of the Health and Human Services Department that was released earlier this week.
That national survey noted that 30 percent of facilities surveyed had "total emergency training deficiencies," which the report said could be attributed to record keeping or insufficient staff responses during interviews with auditors.
Deb Burcombe, deputy director of the Utah Health Care Association, said the organization has been actively engaged in emergency preparedness planning with state officials for five years.
For the past two years, nursing homes have been partners in a regional planning coalition with hospitals, clinics and local health departments to further refine their response.
In December, hurricane-force winds ripped through Davis County resulting in lengthy power outages. Eleven long-term care facilities were affected. "I was getting texts from facilities that said 'We put our emergency plans into place. This stuff really works,' " Burcombe said.
Nationwide, 92 percent of the nation's 16,000 nursing homes met federal regulations for emergency planning, according to the audit, while 72 percent met the standards for emergency training.
Holladay Healthcare Center plans to conduct its own emergency drill in two weeks, Southwick said.
The Holladay nursing home has emergency supplies of food, water and prescription drugs. The facility also has a generator and an oxygen concentrator to produce oxygen should it become impossible to make deliveries to the facility.
The state association has placed a water purification system that can clean 700 gallons of water an hour outside the facility at 4782 S. Holladay Blvd. The water could be extracted from a nearby stream if necessary. It is one of four such systems purchased with government grants that have been placed in trailers parked in strategic locations statewide.
"I know we could take care of our residents for two weeks without any outside help," Southwick said.
While the Holladay facility is well-prepared for a number of scenarios, dealing with a mass casualty event is a nagging concern for Southwick, he said.
"This is these people's home. Most of these people have no one else. We are their family and we need to be able to take care of them."
Nursing homes that are part of Utah's long-term care association are able to communicate with one another via a statewide network of hand-held radios, which was made possible by a federal grant.
"I know we don’t have every answer to every problem but we're trying," Burcombe said.
"We know we're not going to be overwhelmed by (an emergency) and we'll figure it out."