Epistemology of a disaster: a physicians's lessons from the Bay Area's October 1989 quake - in Oakland

Whole Earth Review, Fall, 1990 by Mark Renneker

Metalogue: What do doctors know about disaster medicine? Practically nothing - it's not taught in medical schools. Apart from mock-disaster drills at our hospital (which were only infrequently scheduled, and then usually canceled), Id only had advanced CPR courses and spent time in trauma rooms during residency - inadequate rehearsals for what I was facing now. And I couldn't imagine that it would be different for most other physicians. The irony is that, as physicians, we are always "on call" to our communities in the event of a disaster, but, in truth, we emperors have no clothes.

Into the Collapse

At my elbow, wanting to help, was a twelve-year-old black girl in a pink dress. I promised her that if any children were brought down, I'd use her to help comfort them, and she was willing and eager to do that. But in the following half-hour, no injured children appeared; in fact, no other victims were brought to us. It's not that they were being taken elsewhere either, there just weren't any. Those that had been hurt but could walk had simply walked away, and those who were still alive were trapped under the collapsed upper deck. When a paramedic called down for help with starting IVs, I decided to go up.

Was I afraid to go up there? Not exactly - it felt familiar to me. I am a surfer, with years of big-wave riding experience around the world, and while I'd been waiting uselessly below with my IV setups, I'd been imagining what it would feel like to be up there: the long concrete wall of the fallen freeway reminded me of a colossal ocean wave; the spills of concrete had the appearance of falling white water; the hanging metal bars, bent in all directions, seemed like spray being blown wildly back. If I were up there, and an aftershock caused it to collapse, I somehow believed that I could safely ride it out, as if it were real surf.

I went up a thin, wobbly ladder that barely reached the bottom of the lower deck, about thirty feet off the ground, slid in through a horizontal crack, then dropped down onto the deck. There was maybe four feet of headroom where I was, but the ceiling - the fissured underbelly of the upper deck - drooped elsewhere to within inches of the four-lane roadbed. I was crouched down on what had been the right-hand lane, and in the shadowy cold I could see only one trapped car, straddling the second and third lanes, barely visible between several hunched-over firemen and paramedics.

Communication Rescue

Everyone was talking at once, shouting ideas about what should be done. As I duck-walked over, a portable generator revved on, and a metal saw was soon sending off showers of sparks - illuminating rubble all around me, and allowing me to see the problem: a concrete beam had fallen across the car from the windshield forward, reducing the engine block to less than a foot in height, and bringing the dash down onto the legs of two young women.

I had to yell to be heard. The rescuers were glad that a physician had come to help, and there was a pause in the frantic pitch of the rescue as I squeezed in to examine the women. Both were conscious and able to speak (Spanish only, but a young Hispanic man was between them serving as a translator, holding their hands and reassuring them). There were no obvious major injuries and surprisingly little blood, other than from scratches on their swollen faces.