SAN FRANCISCO - Nearly a year after the deadly Asiana Airlines Flight 214 crash at San Francisco International Airport, heads of various medical teams at San Francisco General Hospital reflected on the hospital's response during the mass casualty incident.
At an auditorium on the hospital's campus Monday morning, chief nursing officer Terry Dentoni, interim chief of surgery Peggy Knudson, emergency department medical director Malini Singh and the city's director of behavioral health services Edwin Batongbacal discussed how the hospital handled the influx of patients after the Boeing 777 crashed at SFO on July 6, 2013.
San Francisco police Chief Greg Suhr, along with other members of his command staff, attended the panel.
The panel started with a video that showed footage of the plane hitting a seawall. The crash injured more than 180 people and led to the deaths of three Chinese teenagers, one of whom was run over and killed by San Francisco firefighters who had responded to the scene.
Knudson said the surgical response was astonishing and unprecedented at the hospital. She noted that most commercial plane crashes have few survivors.
In the Asiana crash, there were 307 passengers on board and 181 were injured, 12 critically, she said.
Of those 12, 10 were sent to San Francisco General Hospital and the other two went to Stanford Hospital.
Nine hospitals in the region took in injured patients and 67 of them were sent to SFGH, she said.
While showing photos of the interior of the plane following the crash, Knudson said a majority of the plane held up fairly well, but many patients suffered chest trauma and broken sternums after being crushed by the seats in front of them.
She said by 12:30 p.m., about an hour after the botched landing, the first wave of patients with severe blunt trauma had come in.
Patients arrived with serious injuries that included brain injuries, burns, abdominal injuries, spine fractures, long bone fractures and others.
There were 36 adults and 31 children treated at SFGH.
Knudson also noted that several patients were in the hospital for months, including one patient who stayed for four months and endured 30 operations.
She said the death five days later of a 15-year-old girl who was classmates with the two other girls killed was hard on staff.
"Having a death on top of that was very traumatic," she said.
The girl was not ejected from the plane, but a door torn from its frame had struck her in the head during the crash, according to the National Transportation Safety Board, which investigated the crash and held a hearing on it last week.
Other patients are still healing and going through rehabilitation outside of the hospital, Knudson said.
She said that the one-year mark for the surgical team is just the beginning of end of the crash response.
She noted that in retrospect, certain details would have improved the hospital's response, including having triage tents already set up outside the hospital and anticipating that passengers were exposed to chemicals from fire retardants used to quell flames on the burning plane.
She said there was a reaction many patients had to the chemicals and it wasn't something that doctors noticed right away. She said the lack of research on plane crash victims made it hard to track smaller details.
Dentoni, the chief nursing officer, said the day of the crash started as a typical Saturday morning.
When she was alerted about the incident while at the gym, she didn't realize how big of a deal it was until she arrived at the hospital and saw countless ambulances pulling into the emergency bays.
"I thought, 'This is going to be big,'" she said.
According to Dentoni, the first priority was to make room for the influx of patients.
She said the cafeteria turned into a logistics hub and non-urgent patients and others were shuffled around or discharged or taken to other hospitals, such as the city's Laguna Honda Hospital. The cafeteria also opened up food service for all patients and staff.
Dentoni said a chef told her afterward, "I think I flipped more burgers than McDonald's," and said all departments of the hospital stepped up during the crisis.
Singh emphasized the importance of the new hospital slated to open in December 2015 and the impact the new facility and increased staffing will have on handling mass casualty incidents at its emergency department.
The new hospital will have 58 beds compared to the 27 beds and gurneys that line the hospital's emergency department halls currently.
She showed a rendering of the new emergency room and pointed out that there will be dedicated diagnostic tools, such as an X-ray machine and CT scan room, which she said "will improve care and access for all patients."
Before the crash that day, there already were four critical patients who had been treated that morning at the hospital, Singh said.
Once the passengers started coming in, she said the emergency department had to be cleared and tents outside the hospital were set up for minor injuries and to help organize incoming patients.
She noted that translation and interpreter services were critical on the day of the crash and in the following days. That is something that the hospital is prepared to handle, considering about 20 percent of the normal SFGH patient population speaks a language other than English, Singh said.
For mental health issues, Batongbacal spoke about mental health workers dispatched to the hospital and to the airport after the crash.
"In the flurry of all the helping, there are people who are traumatized," he said.
A team of 18 workers went to the airport, where survivors were sent to the United Airlines Club lounge.
He said the mental health team helped with passengers' trauma, which ranged from logistical issues such as missing luggage, uncharged cellphones and no money or passports, to coping with severely injured loved ones.
"Very little information was coming through about the safety and well-being of loved ones," he said.
The workers provided support and were a "pressure-free" point of contact, he said.
Batongbacal said eventually late that night, the NTSB arranged hotel accommodations and all passengers were put up at the Crowne Plaza San Francisco Airport hotel in Burlingame, which became a briefing and assistance center.
He said 31 mental health workers worked out of the hotel for the following week and helped family members who were arriving from abroad.
Many of the passengers on the plane were a group of Chinese high school students heading to a religious summer program in Southern California.
Last week at the NTSB hearing, the board found that the Asiana flight crew over-relied on automated landing systems and that the pilot lacked manual flying skills, leading to the aircraft approaching the runway too low and too slow with not enough time to correct the error.
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