Orange County Voices : COMMENTARY ON EMERGENCY PREPAREDNESS : What If the Big One Hit, and We Were Actually Ready for It? : Loss to life and limb will be great no matter what, but just imagine the difference thoughtful planning could make.

Picture this chilling scenario in earthquake-vulnerable Orange County. It could happen. It’s 1996, and the major Newport-Inglewood earthquake earlier this year left massive death and destruction along a 35-mile corridor stretching from Huntington Beach through Fountain Valley and Santa Ana, and well into Laguna Hills and Coto de Caza.

It killed 20,000 men, women and children. Most died instantly, but many were lost because they couldn’t be dug out in time. Over 500,000 were injured, 100,000 suffering severe life- and limb-threatening conditions.

The death and disability toll among the severely injured would have been much higher, more than doubled, but many thousands received on-the-spot advanced emergency medical care from hundreds of medical volunteers who were prepared to act without delay. The story of one victim, 14-year-old Anna, illustrates the events of that terrible disaster.

Anna was in class at the local high school when it hit. She was on the third floor when the building partially collapsed and heavy desks, file cabinets and debris were hurled cruelly about, killing or severely injuring 512 students and staff. The coroner later reported that all 150 deaths were virtually instantaneous due to massive head and chest injuries.

Anna and 361 others were badly hurt, mostly with crushed legs, concussions, major fractures and lacerations with severe blood loss. Anna’s right foot was mutilated by falling concrete.

As soon as the first quake stopped, most of the 2,000 uninjured students and faculty evacuate the ruined building. All of the staff and a group of seniors had been trained in first aid and the “simple triage and rapid treatment” technique. They deployed through the rubble finding victims and safely moving many of them to open ground. They knew the threat of aftershocks and worked swiftly and quietly.

Everyone knew “the Big One” had hit and that they would be on their own for the next few days. Within the first hour, concerned parents began arriving and were organized and put to work. Six nurses and two physicians were already at work.

Dr. Gray left her car and walked to the site from the smashed freeway two miles away, having identified the school as a pre-defined medical supply site from a special map issued to volunteers.

She had a backpack of supplies she kept in the car trunk since becoming a volunteer and treated the most severely wounded while rescue and sorting continued. Her backpack supplies lasted for about an hour, but with them she was able to relieve a collapsed lung, surgically open a victim’s windpipe, intubate the lungs of three unconscious concussion victims, and begin intravenous diuresis and antibiotics on two victims with crushed legs--one of whom was Anna.

Strong non-narcotic pain shots were administered to the most needy. The medical volunteers organized a disaster medical aid center and sent volunteers to bring them the area’s Medical Disaster Response supply modules.

In the next several hours more medical volunteers arrived, several from the local medical clinic bringing additional supply modules to supplement those stored at the school.

Additional victims were brought in from the surrounding neighborhood. The National Guard responded to prearranged landing zone signals on the soccer field, leaving an armed trooper on site to communicate with the growing numbers of available medevac helicopters. Several students were flown out to San Diego and Riverside hospitals for surgical treatment of severe internal injuries. They arrived in good condition thanks to stabilization at the Aid Center and will do well.

In the next 12 to 24 hours, the flow of victims slowed considerably, but the victims, laid side by side, covered the entire football field.

At night, a group of 13 physicians and 68 nurses labored under generator lights to surgically clean wounds, relieve pain and keep the severely injured stable. It is grim work in a battlefield setting but it paid off.

Over 400 men, women and children were stabilized for orderly evacuation outside the quake zone. Anna was resting pain-free in a camping tent after surgical cleansing of her wounds and powerful antibiotic treatment.

The day after the initial jolt there is a sense of calm at the aid center. More medical volunteers arrived from nearby undamaged communities, bringing their supply modules with them. Very few new victims arrived. The casualties are kept comfortable and are continuously re-evaluated, much like a hospital intensive care unit but without the electronics. When evacuation opportunities arise, the most needy go out first. Anna is comfortable and her mother is with her. The foot looks bad, however, and is showing signs of gangrene.

On Day 3, it’s business as usual. Food, shelter and security are under control. The hospitals within helicopter range are saturated and only a few roads are open so evacuation is slow.

Anna’s lower leg has to be amputated to prevent the spread of gangrene. The surgery is performed with anesthesia and without pain. The loss of her leg is tragic, but she survives without further disability.

By Day 7 all critically injured have been evacuated and the disaster medical aid center is now a tent city.

Epilogue: Anna’s leg had healed and she has adjusted to her artificial leg. Her classmates have all been helped with stress debriefing therapy by volunteer mental health workers. They get together every year for the rest of their long lives to commemorate the tragedy that could have been much worse. It is estimated that an additional 30,000 people would have died if the medical response had not been available.

So much for a scenario. The fact is that vital emergency medical care is not currently available through any of the existing county, Red Cross, Salvation Army, state or federal relief programs. Injuries like Anna’s will be fatal if the great quake strikes before a medical disaster response program can be implemented. She would likely develop blood poisoning and kidney failure within a few days. By the time relief arrives she would be dead or, at best, the ruined leg would be amputated and she would survive on renal dialysis for the rest of her shortened, chronically-ill life.

At this moment in real time, there exists a nonprofit volunteer group named Medical Disaster Response. More than 400 physicians and nurses and medical technicians have been trained over the past five years to respond in major disasters. But they can do little without supplies. To be truly effective, their supplies must be pre-packed and prepositioned and rotated regularly to ensure freshness.

The first MDR supply modules are already in place in Mission Viejo (there are three in that city), Disneyland, the Bristol Park Medical Building in Irvine, and Our Lady of Fatima Elementary School in San Clemente.

Forty backpacks have been distributed to specially trained physicians ready to be filled with life- and limb-saving supplies. Large-scale participation is in the works for the UC Irvine Medical School campus and a prominent medical group’s 10 facilities throughout the county. But we need at least 100 more supply modules and backpacks distributed around the county before we can expect to accomplish the recoveries in the scenario described above.

Our “Annas” deserve a fighting chance against preventable disability and death.