Kobe Prompts New Look at Quake Preparedness : Emergencies: Experts see need for a less centralized medical network. Casualties in major temblor would swamp current setup.

What will happen if a magnitude 7.5 earthquake ruptures a major fault under Los Angeles at midday, and tens of thousands of people try to call 911 at the same time?

Haunted by that specter, a Calabasas physician has spawned a plan that could become a model for reshaping California’s disaster medical care system. The key to quake survival, says Dr. Arnold Bresky, lies in creating a network of neighborhood emergency clinics that would sprout only during a disaster, making communities instantly self-sufficient.

Bresky’s prospective solution has yet to percolate through California. Most individuals and communities’ readiness to handle the injuries of a major earthquake--both minor and life-threatening--remain painfully inadequate, authorities say.

Preparations are complicated by a disagreement between many physicians and disaster-planning bureaucrats. Physicians like Bresky believe that the state’s plans depend too heavily on sharing resources among local, county and state governments, at the expense of self-sufficient and quick-response assistance in neighborhoods.

“We are in a state of denial,” said Bresky, an obstetrician-gynecologist who has set up a 10-foot trunk at a Calabasas tennis club, loaded with materials such as rolls of gauze, splints, antibiotics and quick-setting material for a cast. “The only way people can think about this huge problem is to make it small enough to deal with. So they make sure they have a flashlight even though the more critical question is: Do you know how to stop someone from bleeding to death?”

The January earthquake in Kobe, Japan, has added urgency to medical preparedness issues, prompting disaster-medicine officials to re-examine their plans to deal with “mass casualty” events in Southern California.

Here’s the math: Los Angeles’ paramedic squads are now stressed at 750 calls per day. Yet recent mathematical models developed for the insurance industry estimate that a magnitude 7.0 quake along the basin’s Newport-Inglewood Fault in the afternoon would kill 3,000 to 5,000 people, hospitalize 15,000 and send 10 times more to emergency rooms.

Experts were stunned at the disintegration of Kobe’s emergency care system when put under a similar load by the magnitude 6.8 quake that struck just before dawn Jan. 17.

Thirteen of the city’s hospitals and a quarter of all neighborhood clinics were destroyed. The remaining hospitals and clinics in the seaside town of 1.3 million people were crippled by the lack of water, electricity and staff. And roads to most hospitals and clinics were blocked by toppled buildings and cratered asphalt.

Could the same happen here?

“Count on it,” said Los Angeles City Fire Department Capt. Jim Denney, pointing to a City Hall map of the city’s 12 hospital trauma centers overlaid on a map of the area’s major earthquake faults and vulnerable lacework of freeways.

Because of the sheer scope of the expected emergency and the likelihood of blocked transportation routes, help from the city Fire Department’s 65 paramedic units is unlikely to quickly reach many seriously hurt victims, Denney said. And even if victims were able to travel, authorities question the ability of the county’s 79 emergency rooms to handle upward of 20,000 victims in a day.

The Northridge quake--a temblor that released just one-tenth the energy of the projected “Big One” under Los Angeles--nearly maxed out the entire Los Angeles County hospital system with 1,600 people hospitalized and 10,200 treated and released. When the flood of injured people reached its peak after the quake, only 70 critical care beds were left in the county.

David Langness, spokesman for the Healthcare Assn. of Southern California, said: “A quake just a point or two higher would have overtaxed our capacity.”

That is why experts say the most effective emergency planning focuses on decentralizing the delivery of medical care in the first few hours after a major event.

But how? Answers are coming slowly, as individual citizens and some fire departments hammer out innovative but underfunded programs on their own.

* In Calabasas, Bresky has persuaded 40 volunteer physicians to sign a contract obligating them to appear at one of three neighborhood emergency stations after a major quake. The city has spent $14,000 to equip the stations at a tennis club and at A.E. Wright Middle School; a homeowners association has put up half the $7,000 needed to install a third box at Calabasas High School.

* In Los Angeles, the city Fire Department trains 600 neighborhood and business volunteers a year in its intensive, seven-week Community Emergency Response Team program. A highly acclaimed approach, it has waiting lists a year long for individuals and two years for businesses. Yet its funding is under attack by city budget-cutters who are seeking to trim the department’s budget by 25%.

* In Orange County, emergency physician Carl Schultz trains 100 doctors and nurses a year to become walking neighborhood MASH units in the event of a disaster. A more ambitious plan to cache drugs and medical equipment throughout the Southland has been stymied by his inability to get a grant for a pilot project from any government agencies.

* In Northridge, anesthesiologist Steve Cantamout is urging the Los Angeles County Medical Assn. to adopt a satellite-linked identification system that would allow hospitals to grant non-staff physicians immediate working privileges during crises. Cantamout traveled with a Southland medical relief team to Kobe, and felt humiliated by the cold shoulder he received from municipal health officials. He realized that his Northridge Hospital Medical Center might do the same if it could not verify a doctor’s credentials.

To be sure, city, county, state and federal governments have elaborate plans to staff high-tech emergency operations centers during a major quake to coordinate mutual aid between neighboring jurisdictions.

A call for assistance from Burbank officials would go to Los Angeles County health officials, who would request help from peers in nearby counties.

Guiding their effort at the top of the California disaster management pyramid is the governor’s Office of Emergency Services. It coordinates medical resources through six regional administrators and the Emergency Medical Services Authority in Sacramento.

The authority can seek help from the Federal Emergency Management Agency, which marshals such forces as the nation’s Disaster Medical Assistance Teams--squads of 100 crack trauma care specialists that mobilize in six hours.

California’s complicated emergency medicine system largely worked well during the Northridge quake, which caused at least 57 deaths. But it may not be a model for the “Big One.”

Jeffrey L. Rubin, chief of disaster medicine at the Emergency Medical Services Authority, said: “We have not had a true medical disaster in this country since the Civil War.” Indeed, the nation’s greatest loss of life in a single day occurred Sept. 17, 1862, during the Battle of Antietam, when 4,800 soldiers died and 18,500 were wounded.

Some physicians say that today’s best-laid plans are little comfort when they consider a large temblor.

“Ever seen the (Office of Emergency Services) flow chart? It’s screechingly funny,” said Dr. Brian D. Johnston, 56, an emergency physician at White Memorial Hospital who has worked on disaster planning for Los Angeles County for years. “I don’t know how anyone can keep it in their head, much less implement it.”

The programs of Bresky, Schultz and the Fire Department, all agree, are providing state planners with an arsenal of new ideas.

Bresky has executed his plan with no assistance from state government. It calls for dividing his hillside town into seven sectors centered around emergency medical stations like the one installed at the tennis club. Each sector is divided into blocks headed by captains who must know first aid and carry two-way radios. Bresky plans to stage a citywide drill once a year.

“Kobe taught us that if our roadways are impassable, we cannot expect to receive help from outside for days,” he said. “We must be self-reliant.”

Schultz said his mobile MASH unit proposal in Orange County is predicated on the notion that after six hours, “people start dying who didn’t have to die.”

In his view, first aid is important, but so is critical care: Seriously hurt victims will need tubes inserted into airways, intravenous fluids, amputations and fasciotomies (the practice of cutting open the legs or arms of people suffering from massive crush wounds to prevent swelling muscles from cutting off the supply of blood to arteries).

Schultz trains professionals at weekend seminars to keep medical supplies in backpacks in the trunks of their cars. After a major quake, their mission would be to dig out of their own homes or offices, check their neighborhoods, then hike to emergency aid centers set up at five-mile intervals in communities--an hour’s walking distance from every citizen.

There each team would triage and treat 300 to 500 patients the first day, he said, using cached medical supplies.

The Los Angeles City Fire Department is preparing volunteers for the “Big One” in a complex of trailers next to its Sherman Oaks station. It is booked solid giving 14 seminars a year to Neighborhood Watch groups, homeowners associations and business people in the fine arts of instant leadership, triage and light rescue.

The mission before training leaders Steven Vizcaino and Louis Casas is vast: The fire captains are urging the department to designate the city’s 400 elementary schools as community emergency centers, and want at least 100 volunteers trained in each vicinity to guide their neighbors. That totals five times the number of volunteers than have been trained in the past eight years.

The potential for widening communications failures in a broader crisis puts a sharper focus on the grass-roots solutions of physicians like Bresky.

“We’re saying: Get yourself to the closest box,” he said, referring to his tiny Calabasas clinics. “Walk over! A mile is my goal. Anyone can do that. Anyone!”