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Ready, or not? Can St. Louis cope with catastrophe? Part II: When 'what if?' becomes 'what now?'

This article first appeared in the St. Louis Beacon, Oct. 30, 2009 - You've just settled down with some overdue paperwork when your chair starts to sway. Running to your downtown office window, you witness the pavement buckle -- then swallow a car.

The earthquake you always knew could happen, but never thought would, has just jolted you into reality. Your thoughts immediately jump to your spouse, your partner, your children.

"The fact of the matter is, you may not be at home and your kids may be at school," said Mark Diedrich, emergency management specialist with the St. Louis County Police. It's very likely that emergency responders won't be where they need to be either.

CONFUSION IN THE EYE OF THE STORM

As 911 callers jam phone lines, Mayor Francis Slay, Fire Chief Dennis Jenkerson, Police Chief Daniel Isom and several dozen representatives from other agencies like the Red Cross and Salvation Army try to make their way to the St. Louis emergency operations center, a former nuclear fallout shelter in the basement of Soldiers' Memorial Military Museum. Their counterparts in surrounding counties race to their own emergency centers where they can all communicate with each other.

If that's not possible, the regional meeting takes place in an online command center through a software program called E-Team, which can be accessed wherever an internet connection is available. If the power's out in an emergency manager's home or the nearby Starbucks, he or she can probably find a nearby police or fire station with a generator to power the laptop after the battery goes dead.

As sirens begin to scream, St. Louis EMS, members of the building department and police fan out across the city to assess the situation. What's the magnitude of the damage? Did the quake spark any fires? What about injuries? First responders begin notifying hospitals about an influx of victims. What about people at home or work -- or in their cars? Should they stay put or evacuate?

If all bridges are down, one thing's for sure: The only way out of the city is west on Manchester Road. Most of the time, though, the advice is to stay put. Damaged roads may make travel impossible, and because many city buildings were erected before today's seismic standards, no one knows which potential shelters would be safe -- or even standing.

"At this point, it would be a shot in the dark as to which ones would stand and which ones wouldn't," said Nick Gragnani, executive director of the St. Louis Area Regional Response System.

If electricity is out, as is likely the case, bulletins are broadcast on battery-powered radios. Others listen for messages over the outdoor warning system or from public address speakers atop roving emergency vehicles. Where roads are impassable, volunteers, including thousands of community emergency response team (CERT)-trained individuals, try to knock on as many doors as they can.

By this time, the city Emergency Management Agency is in contact with emergency managers in surrounding communities. That's where a complex situation becomes even more complicated. Rescue workers who cross over city-county lines lose communication abilities because the region operates a hodge-podge of radio systems. Another huge issue: Who is the decider?

"That's been the big problem here in St. Louis -- who's in charge?" said John Wagner, Focus St. Louis community policy director.

CHAIN OF COMMAND: EIGHT PEOPLE IN CHARGE

Focus St. Louis put the establishment of a clear "chain of command" among its top three recommendations in its report on disaster preparedness released two years ago. The two other top recommendations: improved communications and individual preparedness.

First, a look a the chain of command.

STARRS, an agency formed in 2003 to seek and spend mostly federal grant money, is charged with figuring out who will make decisions and how they will flow from the top.

The command chart, part of a regional emergency coordination plan, should be officially in place in January, according to Gragnani. Instead of placing one person at the top of the chain, the plan divides the power equally among eight people: Mayor Slay and the executives of St. Louis, St. Charles, Franklin, Jefferson, Monroe, St. Clair and Madison counties.

"You can't put one person in charge of this entire region; it's just legally not possible," Gragnani said.

Perhaps not, but in at least one other region, the decision-making doesn't depend on such exquisite collaboration.

Seattle-King County, touted as one of the best-prepared cities in the country, has a "disaster czar." The director of public health is in charge when it comes to health care during an emergency situation. Because King County is its own disaster region and the city and county share a health department, their chain of command fell easily into place.

A single decision-maker is by far the best model, said Ken Warren, professor of political science and public policy at Saint Louis University. He called eight people at the helm "a nightmare."

"Literature is replete with problems caused by not making someone, legally speaking, the person where 'the buck stops here," Warren said. "But everyone protects their own little fiefdom and doesn't want to give power to someone else. And in a sense they shouldn't, because they'd be giving away power they were elected to have."

Slay's administration is comfortable with the arrangement.

"Our city's emergency response planners met with a group of emergency professionals from around the region in several STARRS planning sessions to discuss exactly your question," Public Safety director Charles Bryson said through a spokesman. "We agreed on several things:

  • Almost all emergencies happen locally (in one jurisdiction and spread out from there).
  • It is critical to have local control over your jurisdiction in case of emergencies.
  • If there is a need to reach out for assistance, there is a methodology to do so in a very coordinated way.
  • Therefore, there is no need for a regional "emergency czar."

FIRE, POLICE COMMUNICATIONS GETS LOW MARKS

If disaster struck today, St. Louis County's police, fire and EMS radio system -- "held together with bailing wire and bubble gum," Gragnani joked -- would present a tremendous challenge. On top of that, if it isn't overhauled before 2013, the county will be subject to fines for being in violation of new Federal Communication Commission rules. County voters will decide the matter Tuesday when they cast their ballots on Proposition E-911.  The measure would raise the sales tax one-tenth of one percent to collect $16 million a year.

The E-911 program would set up a procedure for 911 operators to identify the location of cell phone callers and increase the number of emergency sirens. It would also pay for the replacement of the county's mid-20th-century radios with a 700 or 800 MHz system and create interoperability with similar, newer systems already in place or being set up in St. Louis city and Jefferson, St. Charles, Madison and St. Clair counties. That fix would allow local police, fire and EMS workers to communicate with each other at the same peak efficiency as rescue crews that rushed to the August 2007 bridge collapse in Minneapolis.

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St. Louis Regional Disaster Preparednes Checklist

Still to be addressed:

Buy and set up 700 or 800 MHz emergency radio system for St. Louis County and create interoperability among St. Louis city and St. Louis, Jefferson, St. Charles, Franklin, Monroe, Madison and St. Clair counties.

Include more hospital workers in full-scale drills.

Identify those who are disabled and living independently to ensure they have a personal emergency plan.

Equip disadvantaged St. Louisians with emergency kits and assist them with planning.

Require mandatory training of all officials who will make decisions during emergencies.

Increase interactions among hospital and public health committees under the St. Louis Area Regional Response System (STARRS).

Ensure regular participation of representatives from nursing homes, home health, and long-term care and mental health providers.

Investigate sources of local, sustainable funding for disaster readiness.

Accomplishments Since 2007 Focus St. Louis Report

STARRS is set to roll out a regional plan in January 2010 to establish a chain of command and a plan for getting regional resources such as medical equipment. It will also decide locations of shelters and other services.Continued at least twice-a-year meetings among emergency managers in bi-state region.

Placed E-911 initiative on St. Louis County Nov. 3 ballot for buying new radio system and interfacing with others in the region.

Secured $140,000 grant for public awareness campaign for individual preparedness to begin in summer 2010.

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"Literally before the dust had settled, there were people flying out the doors all over the region and they were all on the same frequency and all talking to each other within 10 minutes. That's what we want here," Wagner said.

SOME SYSTEMS STATE-OF-THE-ART

If they get the new radios, St. Louis County's first responders will have a system that will work with those in St. Louis city and St. Charles, Jefferson, Madison and St. Clair counties. The entire one-city, seven-county region already shares three other modern methods of communication. Two are already in place and another is expected to be up and running next year.

  • E-Sponder: tracks information, detects patterns and analyzes trends in real time; will be in use in 2010.
  • E-Team: keeps up with resources such as equipment and can operate as a virtual Emergency Operations Center; on line now.
  • EMSystems: tracks hospital resources such as supplies and bed counts; employed now in day-to-day operations and ready for emergencies.

One important feature of EMSystems is an electronic patient tracking program called EMTrack. Keeping up with patients electronically with bar-coded bracelets read by a scanner can shave the time it takes to triage, or prioritize a patient, down to 23 seconds, according to one manufacturer.
That's promising. But parts of EMTrack malfunctioned during its debut in an August 2006 simulation of a terrorist attack held in Olivette. A post-mortem by the St. Louis Fire Department recommended hospitals and EMS conduct more training with the equipment. Three years later, electronic patient tracking is used by many local emergency technicians and paramedics. Though all hospitals have EMTrack, a lack of training prevents most of them from using it.

"It has not had a real trial in the metro area. I would still label it as being somewhat untested." said Dennis Kiethly, chairman of the emergency department at St. John's Mercy Medical Center. He added that he knows of no testing currently scheduled.

It's not clear if the region can even hang on to EMTrack. A three-year software license that came with the program expires next year, and it costs $117,000 -- every year -- to purchase it. Without EMTrack, emergency and health-care workers would lose their ability to hasten the care of patients and to reunite them with their families more quickly. STARRS is appealing a rule that prevents using grant money to buy the license.

"If they don't allow us to do that, come Jan. 1, 2010, the local jurisdictions who are using patient tracking are going to have to pick up that cost -- or the system goes dark," Gragnani said.

ARE YOU READY TO HOLE UP FOR THREE DAYS?

Preparation is a bottom-up proposition, and it starts with the individual. According to the Focus St. Louis report, "The public mindset of 'waiting for help' must be replaced with an ability to self-sustain for a minimum of three days." Those words are echoed throughout the nation as each region deals with disaster planning.

"We've gone back to that 1950s and '60s style of civil defense: You need to take care of your family first so you can go out and help in the community," said Stan Szptek, a Mesa, Ariz., disaster preparation consultant who has worked in St. Louis.

Stashing food, water and flashlights in the basement is a no-brainer, but most people haven't really thought through the details of actually roughing it for three days. One only has to imagine the result of busted toilet plumbing coupled with a drinking water supply too precious to flush to realize the need for a large supply of plastic garbage bags. That kind of information is available at meetings and workshops requested by community organizations such as churches, synogogues or neighborhood watch groups.

But there hasn't been much demand lately, says Diedrich, the St. Louis County police's emergency management specialist. "I have one coming up on Nov. 14 at Webster Gardens Lutheran Church," he said. "I haven't done one for quite some time. We don't have a regular schedule, we just respond to inquiries of citizens and groups."

Often, facilitators find themselves preaching to the choir.

"Unfortunately, the people who come to those types of events are people who are already prepared," said Diedrich. "A lot of people say, 'I'm just trying to get from Monday to Friday and pay the bills, I can't be worrying about something you're telling me might happen.' "

Evidence of a lack of preparedness can be seen in the results of American Red Cross surveys that show only 4 percent of Americans are fully ready and 23 percent have taken no preparedness steps at all. In a 2007 local poll of Focus St. Louis members, 77 percent said they had no family emergency plan and 79 percent could not correctly identify the local emergency broadcast station. That failure is not so much of an issue anymore. While KMOX used to be the emergency station, now disaster planners tell residents to tune into any local radio station for updates.

A new $140,000 grant-funded awareness campaign of get-prepared messages plastered on buses and in other public places is expected to roll out next summer. But for people like St. Louis caterer David Schwartz, the extra advice won't matter: "I'm an optimist. I just don't believe anything bad is going to happen."

THOSE WITH DISABILITIES: PLAN YOUR OWN ESCAPE

In every emergency, triaging patients is a necessary reality.

In a small-scale situation like a two-car collision, the most severely injured are treated first. But in a mass casualty event, priorities reverse. With victims far outnumbering caregivers, assisting the critically wounded may mean a less injured person would die from neglect.

Emergency room nurses are the best trained in disaster triage, but in a large-scale emergency with many victims, non-ER nurses and other health-care providers would get abbreviated, on-the-spot instructions, according to Joanne Langan, Saint Louis University associate professor of nursing. Similarly, when evacuating a high-rise building, those who can walk out the door will be rescued first, according to David Newburger, commissioner of the Office on the Disabled for St. Louis.

"We are at the bottom of the totem pole. We need to impress upon people with disabilities that we need to develop our own emergency preparedness plans," Newburger said.

Newburger is working to craft plans with local organizations that work with people with disabilities. The prospect of a power outage raises critical concerns, among them, how to keep respirators going and medicines refrigerated, and how to get out of high-rise buildings with no working elevator. Family and friends who live even a few miles away may not be able to reach a loved one with disabilities if roads are blocked or damaged so it's imperative to make an emergency agreement with someone who's close by.

Focus St. Louis recommended providing resources for nearly 190,000 people with disabilities in St. Louis city and county alone, leaving out St. Charles, Jefferson, Franklin, Monroe, Madison and St. Clair. But even that limited plan remains in the discussion stage. Already overwhelmed by the demands of planning for the fully abled, some find it difficult to even think about the more complex needs of those with disabilities.

"It's just that we don't know what to do," Diedrich said. "How are we going to get all those wheelchairs down? If it's one or two, we can do that, but if you start talking about 16 or 20, who's thinking about that?"

Working to meet so many community needs can be like herding cats: Planners focus on the ones they have a chance of corralling. "Honestly, it's like, 'Let's get to something we can do; let's have some victories before we start thinking of something else,'" Diedrich said.

PEOPLE IN POVERTY ARE ON THEIR OWN

"Of grave concern," the Focus St. Louis report states, are those whose health or poverty makes it nearly impossible to prepare for a disaster. "This is not an excuse but a reality," it states, adding that failing to help them will create "another internal crisis in the midst of a mega-disaster."

In St. Louis County, 87,000 people live below the poverty line; in St. Louis city, it's 79,000 -- or 23 percent of the city's population. Adding together the numbers of people with disabilities and those in poverty in the city and St. Louis County, which includes some cross-over, there are 356,000 people -- more than one-third of a million -- who need help but aren't getting it.

Money matters more than anything else when it comes to surviving a disaster, according to the book, "The Unthinkable: Who Survives When Disaster Strikes and Why," by Amanda Ripley. Events during the summer 2006 St. Louis-area power outage illustrate how the wealthy survive.

"A lot of the people in Chesterfield and other parts of West County could afford to go to a hotel for a few days. And some just went to the Lake of the Ozarks to their second home there," Diedrich said.

Emergency planners will focus on the needs of the poor after they work on those of the disabled, according to Wagner. They hope many will seek help from places of worship. This effort will be coordinated through the Missouri Faith-Based Disaster Relief Initiative. But that program has been slow off the mark.

The concept was announced in October 2008 by then-Gov. Matt Blunt. At the time, it was considered a cutting edge move and got national attention. But it took another year before Gov. Jay Nixon signed an executive order making it law. And it is still unfunded. Though some religious organizations are aware of the initiative, others with substantial congregations in St. Louis, such as Cote Brilliant Presbyterian Church and Central Reform Congregation, had never heard of it.

Churches, synagogues and mosques may also be responsible for giving out information during a disaster about where to get meals, tents and medical and other supplies. Several STARRS committees discussed providing poor households with battery-operated radios for emergency use. Though Gragnani still hopes to create that program, the idea was shelved for fear the radios would be sold by recipients.

"That they might show up on eBay is a concern of some people on our committees," Gragnani said.

In the meantime, people like Gloria Ezell of St. Louis, who recently spent an anxious day figuring out how to get the gas turned back on so her newborn grandchild wouldn't come home to a cold house, has too little money and too much else on her mind to think about getting a radio or stocking up on food and water: "I just don't have time," she said.

Ezell's mindset is all too typical, said Washington University professor of social work David Gillespie, who served on the Focus St. Louis report task force: "People who are struggling to make ends meet seem to develop fatalistic attitudes. What's the point of preparing if you think a disaster is going to overwhelm you anyway?"

No high heels

Who’s Most Likely to Survive Disaster?

  • People who are not overweight and have full physical abilities
  • Those who are not wearing high heels (almost always men)
  • The wealthy
  • Confident individuals
  • People with higher IQs

From “The Unthinkable: Who Survives When Disaster Strikes—And Why” by Amanda Ripley

Nancy Larson is a freelance writer in St. Louis.

Funding for this series on disaster preparedness came from the Enterprise Journalism Fund of the Press Club of Metropolitan St. Louis.

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