How one small health care team prepared for wildfire — and what they didn’t foresee

Sacramento Bee (CA)

Aug. 12--Make a list.

After evacuating two weeks ago for the Mendocino Complex Fire, hospice CEO Corrigan Gommenginger offered that advice as the most critical piece for leadership teams at small health care companies all around California.

Gommenginger has led the nonprofit Hospice Services of Lake County in Lakeport for 3 1/2 years and, in that time, wildfires have swept through swaths of his county four times. This year was different for him and his staff of 50. This was the first time they had to evacuate.

"Firefighters stopped the fire before a lot of structures, including ours, were engulfed," said Gommenginger. "They estimate it came within an eighth of a mile. It was on the west. It was coming east toward us. ...There's a whole hillside that our office looks out on, Hopland and Cow mountains. That's all completely burned."

In mid-July, before the Mendocino Complex fires even began, Gommenginger and other leaders of the organization started talking about what an evacuation plan should look like. When an evacuation advisory was made a day after the Ranch and River fires chewed their way into Lake County, they said, they felt that they were as prepared as they could be. They had a list of what they should grab, what key tasks they had to perform and who was responsible for each item, Gommenginger said.

Administrator Jennifer Neylon would turn off the propane tank and gather supplies that the office and clinical staff would need.

Gommenginger would work with systems administrator Alberto Paez, developer director Janine Smith-Citron and communications liaison Kristy Weiss to disconnect all the computers and load them into their cars.

Smith-Citron would put all the patient files into her car. With Paez, she would ensure that the hospice's temporary office in a vacant building in Middletown was set up with servers, monitors and all the other necessary equipment. Gommenginger already had asked a local property owner for permission to move in if the hospice HQ had to be evacuated.

Gommenginger would grab all the financial information and the check stock. Bills would still have to be paid, and paychecks had to be issued.

Clinical services director Heather Armstrong would begin calling patients and their family members to let them know the advisory evacuation order had been issued. She would ask them where they were going, ask them if they needed assistance, help those who needed it, tell them that the hospice would remain in touch, and remind them to take all their medications with them. If they had pets, she would refer them to Lake Evacuation & Animal Protection.

"If we were guessing and hadn't made a list, it would have taken us hours, and we might have grabbed the wrong stuff or we might have forgotten about stuff," Gommenginger said.

Also on his list, he said: a meeting with staff to share the plan.

"We actually had a staff meeting on the 25th of July ... and we had actually gone through the whole plan with our staff," Gommenginger said. "We said we hoped we never had to use the plan but here it is, and this is what everybody's responsibility is if we have to evacuate."

People seemed comforted, he said, to know the plan and who was responsible. Gommenginger said he made a point of over-communicating not only before the evacuation but during it. He held staff conference calls in the evenings to check in on his team, communicate plans and share concerns.

His team focused on its mission of caring for people who were seriously ill or dying, ensuring that nurses, social workers and home health aides could go about their clinical work. And, despite advisory and subsequently mandatory evacuation orders, Gommenginger said, the clinical staff continued to serve patients. For those who were evacuated, Gommenginger contracted with hospices serving areas where Lake County hospice's patients had evacuated to ensure continuity of care.

The hospice already employed a nurse-staffed answering service on weekends and after hours, Gommenginger said, so he just kept the service going for the entire week that his hospice was evacuated. For days, he didn't know whether his building had survived, but he finally got the news last week that firefighters had managed to stop the flames before they reached the building at 1862 Parallel Drive.

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Despite all their planning, Gommenginger and his team said, they were met with unexpected challenges that they would warn other health-care companies to anticipate:

-- If a fire is headed in the direction of your community, pay close attention to the gas gauge in your vehicle. Gas stations in your area may run out of gas once an advisory evacuation order is issued. Even if they don't run out, the lines could be long and filled with people under high stress.

Smith Citron said: "My husband was really irritated with me because there was a point when we were evacuated and my car was on a quarter of a tank. It was like, 'Whoops!' I'm notorious for getting down to a quarter of a tank. I was traveling 25-30 miles a day back and forth from where we were evacuated to Middletown. It was not pretty."

-- When an evacuation order comes, pharmacies and medical supply companies will also close. There will be a run on medications at the pharmacies that remain open, and many of their supplies get depleted. In advance, advise patients that this could happen and work with them to ensure they have at least two weeks' worth of supplies and prescriptions on hand. Think about alternative pharmacies and equipment stores.

-- Will there be a physician who can help out patients you serve if you encounter problems getting medication for someone who needs it?

-- If you find a temporary headquarters, how will you get internet service? It took a while before Gommenginger was able to arrange this service at his temporary headquarters, so staff had to make a lot of phone calls to ensure nurses and other field workers were apprised of latest developments on their patients.

-- Staff should update medical records on their laptops or mobile devices each evening to ensure they have the latest updates on patients. Patients could be evacuated, Gommenginger said, and that could mean a change in schedule.

-- The smoke-filled air is likely to lead to coughing, gravelly voices and even irritated eyes. Consider getting masks for the staff to use outside the building. Change the air conditioning filters more often than usual.

An evacuation will trigger a lot of emotions for both patients and family members, said Jo Moore, a bereavement counselor at Lake County Hospice. Individuals who are recently bereaved may struggle with the loss of a landscape where they shared so many memories with their loved one. Relatives who approve evacuations may have added stress about the impact they could have on a family member who is so near death.

And, Gommenginger added, some people may not feel comfortable taking a sickly relative with them if they have uncertain plans.

"I was actually talking with the staff at one hospital, and they said people were just dropping their loved ones off at the hospital because they couldn't take care of them," Gommenginger said. "People were just pulling into the emergency department and saying, 'Here you go. We need to go.' It was a very tragic situation for a lot of people."

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