The Center for Community Earthquake Preparedness focuses on Earthquake Preparedness issues in Mississippi's Medical Community.

The Center for Community Earthquake Preparedness (CCEP) is one of the newest research centers at The University of Mississippi. The Center's mission is to perform structural, geotechnical, and geological research projects and implement this research through data collection, design, construction, and field investigation activities for the benefit of targeted communities with significant seismic hazards. Center projects focus on quantifying local seismic hazards, dynamic site response properties, and structural response characteristics for critical facilities in the community, and developing and implementing cost-effective mitigation strategies. Dr. Chris Mullen, P.E. and Associate Professor of Civil Engineering, is the Center's director.

On August 7, 2003 the Medical Aspects of Earthquake Response Workshop was co-sponsored by CCEP and the Central United States Earthquake Consortium (CUSEC). This event, attended by 24 people, was held at the meeting facilities of The University of Mississippi Field Station.

The workshop consisted of two major elements, first a morning session of presentations by experts in the fields of earthquake events and medical preparedness, followed by an afternoon roundtable discussion.

The morning session speakers included:

* Dr. Eugene (Buddy) Schweig, U.S. Geological Survey (USGS), Memphis, Tennessee 

* Dr. Gary Rhyne, Centers for Disease Control (CDC), Atlanta, Georgia

* Mr. John Cartwright, Mississippi Emergency Management Agency (MEMA), Jackson, Mississippi 

* Mr. Jim Wilkinson, CUSEC, Memphis, Tennessee

* Dr. Robert Galli, University of Mississippi Medical Center, Jackson, Mississippi

* Dr. Stephanie Van Arsdale, Nursing Consultant, Memphis, Tennessee

Dr. Rhyne opened the morning session with a discussion of the responsibilities of the CDC in the event of a major disaster and their likely response. Dr. Schweig discussed the role of the USGS in earthquake research and presented a short discussion of the liquefaction hazard and its potential for damage in the central United States. Mr. Jim Wilkinson described the role CUSEC plays in earthquake preparedness and how the seven state Board of Directors work for a regional solution to earthquake hazards mitigation and preparedness. Mr. John Cartwright described how MEMA will respond to an earthquake disaster and how MEMA will interface with other agencies.

Dr. Robert Galli, M.D. presented a slide presentation illustrating the damage sustained by the Olive View Hospital in California as a result of two major earthquakes and the measures that were necessary to deal with these disasters. Dr. Galli also described the need of prior preparation and of the required mental attitude necessary for dealing with an internal hospital disaster as well as the surrounding earthquake disaster. Dr. Stephanie Van Arsdale described the role of nurses in the event of an earthquake disaster in a hospital.

The afternoon session began with a presentation by Mr. Jimmy Allgood, Lafayette County, Mississippi, Emergency Manager. Mr. Allgood described a set of recent weather-related disasters in Mississippi and the consequences resulting from them, pointing out the differences between local weather events and regional earthquake events. Following Mr. Allgood's presentation, a roundtable discussion was held with four panelists:

* Dr. Christopher Mullen, CCEP Director, University of Mississippi

* Mr. Carl Magnum, University of Mississippi School of Nursing

* Mr. Jim Wilkinson, Executive Director, CUSEC

* Mr. Jimmy Allgood, Emergency Manager, Lafayette County, Mississippi

The following paragraphs represent a very brief summary of some of the roundtable discussion highlights. Additional information on these discussions is available through CCEP as Open-File Report CCEP-03-02.

* Groups expected to respond to an emergency need to have plenty of coordinated pre-disaster training, because communications are typically a real nightmare during and after the event. Public utilities and the news media are critical members of the communication network and must be included in the pre-disaster training. Emergency planners must also think in terms of what happens when the plans do not work, for example when the generators fail to function.

* Smaller or more rural areas get their emergency services taxed to the maximum very quickly, and will need assistance immediately. The result of a really big emergency, such as a large earthquake, on these areas is uncertain as most resources are likely to be directed toward areas of larger population. After publicly requesting donations, expect some strange things to show up, such as bowling trophies or winter coats during the summer.

* Mass care and housing recovery are going to be important issues in a large seismic event. Estimates are that in a 7.6 magnitude event there is expected to be up to 500,000 displaced persons, and this can only be dealt with on a regional scale. Transportation is another topic where the regional approach is definitely needed. Each state has a unique set of priority routes for evacuations, but often these routes do not match from state to state. Thus seismic retrofitting on a bridge may be of little use if the adjoining state does not treat this same road as a priority evacuation route.

* Some form of reliable identification for qualified volunteers is greatly needed. A similar system is needed so that qualified researchers (psychologists, sociologists, engineers, etc.) can collect necessary data without getting in the way of rescue operations.

* Hospitals will be experiencing their own crises during and after a disaster. Only the largest hospitals can afford a good internal security force. Many small hospitals have no such force, or if they do, it consists of people from plant operations who will be extremely busy elsewhere if a large disaster strikes. If a hospital is damaged, personnel may have to perform all emergency functions in a parking lot, which naturally upsets many people. People are willing to (temporarily) accept a lower standard of care during emergencies, but this has to be well organized prior to the need. The most seriously injured patients do not arrive right at first after a disaster occurs. These often arrive 12 to 24 hours afterwards, because individuals were trapped in collapsed structures and had to be extracted using equipment.

Recent CCEP modeling using the HAZUS-MH code (Hazards United States loss estimation code, multi-hazard version, produced by the Federal Emergency Management Agency) has allowed estimates to be made regarding the effect a major earthquake would potentially have on the North Mississippi medical community. These HAZUS-MH results corroborate the major ideas formulated in the August workshop. In support of MEMA's construction of a hazard mitigation plan for Mississippi, CCEP modeled a "worst-case scenario," i.e., a magnitude eight earthquake with its epicenter in the southern end of the New Madrid Seismic Zone (Marked Tree, Arkansas).

The modeling predicts that of the 105 Mississippi hospitals in the HAZUS-MH data base, only 74 are likely to be functional immediately after the earthquake. Only 41% of the total beds will be usable immediately after the event. This 41% must accommodate both the patients with injuries resulting from the earthquake as well patients occupying beds prior to the earthquake (some hospitals routinely have bed occupancy rates above 80 percent). The bed space problem is compounded by model predictions that hospitals nearest the epicenter may sustain 80+ percent structural damage which may require relocation of existing patients as well the earthquake-derived patients to other hospitals. The model estimates that after 30 days 84% of the beds will be back in service. This situation will be further complicated by the expected influx of out-of-state patients from Memphis and the surrounding heavily-damaged areas.

The HAZUS-MH code can also estimate deaths and injuries, which will vary according to the time of the earthquake. The estimates of Mississippi earthquake-related deaths vary from 55 with a 2 a.m. earthquake occurrence scenario to 136 with a 2 p.m. scenario. Injuries not requiring hospitalization vary from 1,592 in a 5 p.m. scenario to 1,196 in a 2 p.m. scenario. Patients requiring hospitalization vary from 265 at 2 a.m. to 495 in the 2 p.m. scenario. The number of patients requiring hospitalization with life-threatening injuries vary from 29 in the 2 a.m. event to 95 in the 5 p.m. scenario. Like the hospital estimates, these injuries and deaths reflect only those residing in Mississippi. Patients from adjacent states may be relocated into Mississippi, which will rapidly tax the capabilities of existing Mississippi health care facilities.

Many other parameters can be estimated by HAZUS-MH. Total economic loss, for example, is estimated for Mississippi at 3.05 billion dollars for this event. Damage and economic loss to the transportation infrastructure and utility lifeline losses are also parameters of interest to hospitals. The lack of potable water (lifeline loss) or the inability of patients and emergency transport (transport infrastructure) to reach a hospital (or patient) will certainly influence the operations of the facility. The HAZUS-MH code can evaluate these parameters as well as others and guide mitigation efforts.

The numbers generated by this modeling effort is based on default data presently contained in the HAZUS-MH code. Some of these HAZUS-MH default parameters are not completely appropriate for Mississippi. Mississippi, for example, is comprised of more than one soil type (different type soils may amplify or damp seismic vibrations) and liquefaction is not considered in the default HAZUS-MH analysis--despite liquefaction being a potentially serious threat in the "delta" region of western Mississippi. The areas mapped with damaging levels of peak ground acceleration seem unusually small when compared to historical records of the 1811-1812 New Madrid seismic events. This factor alone could significantly change the loss estimates. The CCEP hopes to work with MEMA to "fine tune" the basic HAZUS-MH data base to more accurately reflect existing conditions in Mississippi. Using the modified HAZUS-MH data base will surely change the preliminary results reported here. The important point, however, is that preparedness is of paramount importance and it must begin before the earthquake, not afterwards.

Terry L. Panhorst and Charles T. Swann

Center for Community Earthquake Preparedness

University of Mississippi, University, Ms 38677