Kansas City area has spent years planning for a disaster like this one. Is it ready?
Parked at hospitals and secret locations across the region, dozens of trailers are jam-packed with hundreds of cots, masks, gowns and other medical supplies.
Except for routine inspection, the doors to many are never opened and haven’t been widely used since Kansas City-area emergency planners acquired them nearly two decades ago with federal assistance. Only a few have ever rolled out. Once to provide aid after an ice storm in St. Louis, and once to help out New Orleans after Hurricane Katrina nearly 15 years ago.
Now, for the first time the hospital trailers — and all the planning and coordination in the bi-state disaster response process they support — might be needed for an expected surge in coronavirus cases in eastern Kansas and western Missouri.
Nine have enough beds in them — at least 960 combined, according to a report obtained by The Star — to outfit one or more temporary medical centers, if the health-care system became overloaded with patients who are suffering from COVID-19 but not sick enough to require a ventilator.
The cots could be spaced across the hard-surface floors of an arena or convention center — carpeted spaces are out, as they can’t be sanitized — then partitioned to provide patients with privacy.
“We could bring those trailers in with the beds and the equipment and quickly outfit that facility,” said Kansas City’s emergency planner, Chris Carroll.
The former Kemper Arena is one site under consideration, because it has showers and lots of open space.
“Sounds like they’re going to make a decision pretty soon,” Carroll said.
More than likely, though, the beds, IV stands and other gear purchased with federal dollars would be deployed in and around some of the region’s nearly 30 hospitals, emergency planning officials say.
Other beds would then have to be acquired to outfit “alternate care sites,” which is the federal government’s term for temporary hospitals like the ones New York City has set up at the Javits Center in Manhattan and the home of tennis’ U.S. Open in Queens.
In addition to Kemper, another possible site that has been mentioned is the Silverstein Eye Centers Arena in Independence.
With a bit of luck and social distancing, none of this might be necessary in Kansas City. Perhaps the surge will never come because the stay-at-home orders worked. No one knows for sure. It could also get much worse, which explains why Kansas City-area disaster planners have another trailer in their fleet: a 53-footer that is refrigerated and could serve as a temporary morgue should fatalities spike.
“It’s still too early to tell whether we’re bending the curve,” Dana Hawkinson, medical director of infection prevention and control at the University of Kansas Hospital, said Friday.
That lack of certainty in any disaster is why Kansas City-area emergency planners have for years been preparing for the very worst: a mass casualty event, be it from a terrorist attack, natural disaster or a pandemic that would stretch medical resources until they snapped.
How should government, public safety and health care officials in the metro area respond? Who would do what? How would that response be coordinated? What sort of supplies would be needed to take care of the sick and injured?
Two decades of planning, drills and report writing are now being put to the test as an anxious city waits to learn just how many people become sick enough from COVID-19 to require hospitalization.
“It is a system, and it is a system with a number of related parts,” said Erin Lynch, emergency services and homeland security director at the Mid-America Regional Council since 2003.
No single figure or government agency is in charge of the local response. Hospitals, public health agencies and governments on both sides of the state line are working together for the most part to plan for a surge in coronavirus patients in the same way that they plan for everything from killer tornadoes to mass shootings and nerve-agent attacks.
Despite that cooperation, some leaders worry that in a metropolitan area that crosses state lines, with numerous municipalities and governments involved, what is lacking may be leadership.
Who’s in charge?
Similar to the hospitals, local governments each have their own disaster plans, but work together through MARC, which was in the process of updating its voluminous Regional Coordination Guide for disaster response when the pandemic hit.
Michael Curry, Jackson County emergency preparedness director, said local officials are about as prepared as they can be for this unprecedented crisis.
“We handle everything from terrorism to tornadoes,” he said. “The only thing you can do is prepare for a disaster. Most of the time you don’t manage a disaster.”
While Curry said various agencies are in constant communication, he said coordination isn’t always easy.
“We’ve got too many cooks stirring the pot,” he said.
MARC takes the lead in managing resources, he said, but MARC doesn’t give orders. It facilitates cooperation.
Curry said his department reports to the Missouri State Emergency Management Agency, which in turn works with the Federal Emergency Management Agency.
And each city has its own emergency management team, as do suburbs like Lee’s Summit. Then there are local health departments and the Missouri Department of Health and Senior Services.
“Basically, we’re all looking at everybody. That’s part of the problem here,” Curry said.
Three of the area’s top local leaders — the mayors of the two Kansas Citys and the head of Johnson County government — all are hopeful that we’re prepared to meet the challenge of the surge that could be coming.
But like Curry, Kansas City Mayor Quinton Lucas has concerns about the confusion that can result when there are no clear lines of authority.
“Sometimes in situations like this, people work together very well. There’s still battles, turf wars and questions of who gets to decide what or whom,” he said.
“I do think life is made easier with sometimes larger directives, and sometimes they don’t need to be orders but need to be clear guidance because everyone is looking for guidance in times like this.”
He worries, for instance, that regional discussions are not addressing enough how to care for vulnerable or high-risk populations exposed to this crisis.
“If I had a criticism,” he said, “how do we make sure the decisions we are making are taking care of the communities most in need?”
Ed Eilert, chairman of the Johnson County Board of Commissioners, believes communities on both sides of the state line have worked well together so far, which could portend well for the future, should the crisis worsen.
“We continue to communicate and our public health officials continue to work together,” he said.
Kansas City, Kansas, Mayor David Alvey said mayors, school districts and clergy in Wyandotte County have been in daily communication, and his staffers have also been talking regularly with their counterparts in Johnson County.
But he has concerns with the state’s decisions on where and how resources will be directed.
“It’s not clear to us how that’s being allocated,” he said. “With KU Med, we’re serving people not only from Wyandotte County but people from Missouri and other parts of the metro. We have concerns about whether the allocations are going to get to the people who need care.”
Despite the confusion and concern about lines of authority, Dave Dillon at the Missouri Hospital Association is hopeful that the health care system is up to the challenge.
“The fact that we have basically since 9/11 been building better capacity for us is giving us a leg up,” he said. “This isn’t something we’ve been thinking about for the first time.”
9/11 a catalyst
Since the 2001 terrorist attacks and the anthrax scare that followed, MARC has been convening discussions among local officials in government and the private sector. They work together within a web of intersecting committees. They assess potential threats to the community and the best response to them, and produce reports and plans on how best to address something like the current pandemic to meet federal requirements.
But perhaps more valuable than the plans themselves is the planning process, said Elijah Thompson, chairman of the Kansas City Health Care Coalition at MARC. When disaster strikes, it’s good to know who to call.
“I think the biggest piece of this is relationship building,” he said.
Thompson is the director of safety, security and emergency preparedness at Overland Park Regional Medical Center. Hospitals fight for market share, even the non-profit ones, but they sometimes work cooperatively.
“On any given day we’re kind of fierce competitors, but when it comes to emergency planning,” he said, “we share policy, we share planning.”
Day in and day out, an interconnected communications system within the metro area lets ambulances know which hospital emergency rooms have room for more patients and when other ERs are maxed out, because the hospitals share those numbers.
And each year, they get together and perform an exercise whose aim is to prepare them for the very situation they could be facing with COVID-19.
It’s a surge test, and it goes like this: What would happen if four of the area’s hospitals had to shut down all at once because of some disaster? How fast could they evacuate their patients, from premature babies to gunshot victims in the intensive care unit?
And where would they go?
“What’s the ability of the other hospitals to support that and receive all these patients?” Thompson said.
Because they work on that, he says area hospitals are well practiced in preparing for what could be a 20 percent surge in COVID-19 patients.
Hospitals have each been updating their internal surge plans since hearing the first grim reports out of China back in January, said Lynch, the emergency services and homeland security director at MARC.
That was long before many began to recognize the scope of the threat and the impact it might have on lives and the economy, when Dr. Nancy Messonier at the Centers for Disease Control sounded the alarm in late February.
“We are asking the American public to prepare for the expectation that this might be bad,” she said at a news briefing that some at the time believed was hype.
We are about to find out how bad, and how well prepared we are.
