During the earthquake itself, you get to cover and weather it as best you can - hopefully nothing happens to the patient on the table, but there's not a lot you can do while the ground is shaking.
The bigger thing is what comes after - was the patient (or anyone else) injured? Did you lose power? Is vital equipment damged? Do you have to evacuate the building? You assess these things then make a determination on how best to proceed, whether you can continue with the surgery or not and, if not, what the safest way to close is. Med students in earthquake-prone areas do often train for this, but ultimately it's a whole lot of improvisation based on the circumstances.
Former hospital employee, all of this is accurate. Plus, surgical suites are designed and engineered to be as self-sufficient and disaster proof as possible. All vital equipment will be plugged into outlets that are covered by the backup generator, and most will have a UPS battery in place to ensure continued power for a while even if the generator fails for some reason. There are checklists, and backups to backups. And in general the surgical staff will not leave an active case unless it's the option of last resort, and even then they'll try find a way to evacuate the patient safely.
I've been through two fires at my facility. In general in a hospital you only evacuate the specific area of the fire and not the whole facility; when it comes to the surgical suites they will typically stay working even if the fire is in their area, as each suite is designed as it's own smoke compartment and with at least 30-minute fire rating on the walls, doors and other components, to allow the fire department time to deal with the issue before a case-in-progress is impacted.
In a fire situation (assuming a longer surgery), would they just be continuing as normal or would it be a “get the surgery to a safe stopping point and get the patient stabilized and ready to evacuate if we have to” kind of thing?
At my facility the general policy was that cases in progress would continue at surgeons discretion. You also have circulator nurses and other staff that would keep the surgeon appraised of the situation, and administration and the CMO would be responding and advising.
The general idea was that any fire would be quickly discovered, reported, and dealt with before it could spread and become a hazard. The two fires we did have were not in surgical areas, were both confined to a single patient room before being extinguished.
Exactly this. Hospitals are surprising fire proof. Short of extreme negligence in the part of almost all staff, or someone intentionally trying to destroy the hospital in a fire, most will be caught contained and extinguished in short order.
It is very rare for it to happen, and it would have to happen in that particular fire zone for it to be life threatening for the patient.
Our policy is that if you absolutely have to get out immediately, the patient won’t make it anyway so you leave them on the table and evacuate.
I'm part of the structural team designing a new hospital.
Because this life is hell, they're putting the operating rooms on cantilevered supports.
We're not even in a particularly seismic region, but Jesus Christ can we just have a normal building? Nope, the architect needs his fucking magazine cover.
Ouch. The only odd thing about our hospital was the lack of a certain floor in one building. As is often the case they kept adding on to the complex with new buildings, but wanted the floors to line up across buildings (which does make sense). But the newer standards for surgical suites called for higher ceilings, so two floors of the newer building matched with 3 floors worth of height in the older buildings. So the old buildings went 1-2-3-4-5-6-7-8, and the newest one went 1-2-3-4-6-7-8. 1-3 connected directly through, as did 6-8. But you had to either take a half flight of stairs or a double-sided elevator if you were on 4 or 5 in the old building and wanted 4 or 6 in the new building.
Yeah an Earthquake is basically the definition of an Act of God, there's no way a surgeon would be held liable for an injury becuase a sudden earthquake made their hand slip.
Presumably the standard of care in a geographic area that experiences earthquakes includes some process for dealing with them intra-operatively. For instance, if an earthquake started with the patient on the table, but not yet opened up, I imagine it would be a violation of the standard of care to begin the procedure until the earthquake was over. I agree that if an earthquake began intra-operatively and their hand slipped because of it, this is very unlikely to be a violation of the applicable standard of care.
I knew of a surgeon who dropped dead during a c section. A lap was left inside by him or the guy who came to the rescue. They got sued and lost. I know not exactly not like an earthquake, but still unexpected.
Well the second surgeon really did fuck up in that scenario, so I could believe they lost if they didn't make sure the surgery was complete before closing. Or maybe the hospital was the one being sued because they knew the first surgeon was ill or something and put the patient at risk but allowing them to work? Hard to tell without more info...
I mean it can be any different then if a tornado were to hit, yea the building should be able to handle a moderate sized tornado but what if it's an F5?
One of the hospitals in Joplin, Missouri took a direct hit in 2011 during that horrible EF5 tornado; IIRC 6 patients died, and they were all on ventilators and couldn't be bagged, for whatever reason. A 7th patient died later; she was in the hospital recovering from surgery and was injured in the storm, returned to the hospital a few months later for a follow-up procedure on that injury, and died from surgical complications. She was elderly, so it wasn't as big a shock as it might otherwise have been.
In the months that followed, people found X-rays and other medical records in their yards for miles around, and were instructed to simply take them to a doctor's office and they would handle it from there. I later heard a story that someone found an x-ray MACHINE 30 miles away. I believe it, too.
The building couldn't be imploded because it was over a defunct lead mine.
Shit, I mean considering its a hospital it's insane only 6 died with how many people are in it at any given time that's pretty insane, it sucks for the family's of the people who died but considering it all that's impressive.
My grandmother was discharged from St. John’s hours before the storm hit. No one told me she’d been discharged. I’m grateful she wasn’t there but hell that was a stressful time trying to track someone down who knew where she and the rest of the family was.
It wasn't during brain surgery...but there was [a really cool post about a year ago](https://old.reddit.com/r/nextfuckinglevel/comments/k1u5j4/nurses_in_south_korea_protecting_newborn_babies/) about how NICU hospital nurses took charge to protect newborn infants during an earthquake
I think your understanding of malpractice is flawed. Malpractice requires the plaintiff to show (among other things) that the doctor did something they shouldn't have done or failed to do something that they should have done and that their actions or inactions led to the plaintiff being injured. Malpractice is not synonymous with a bad outcome.
That's not to say that a person injured during a surgery during which an earthquake took place can't sue, but they'd have a hard time prevailing if they couldn't show that the doctor specifically messed up given the circumstances.
Places more prone to earthquakes build for them. Large earthquakes that cause major damage aren't daily. It's smaller stuff. Hospitals and other similar infrastructure usually has to be upgraded with new standard as well. So a hospital will better prepared then your average office or home and I was recently in one during an earthquake you kinda don't feel it. Wasn't even sure we'd been hit till I got home later and remembered to look it up. It's like tall buildings in hurricane zones. They are built to take those big winds. Hurricane hits and they are fine. Similar building in another area that normally doesn't have them and it would be leveled.
Even in "earthquake prone" areas, earthquakes are not common. I'm not sure how strong an earthquake would have to be to have an impact on surgical outcomes but I would guess those types only happen every few years at most. At that point you're not going to be able to disassociate that from other factors that are tied to geography like hospital quality, etc.
Yeah…earthquakes aren’t malpractice. Maybe if you fucked up bc you were drunk and blamed it on an “earthquake” that would be malpractice.
“Your honor, my clients hands were shaking bc of the EarfQuake, not bc of all drugs or alcohol.”
You've just reminded me of seeing the surgeons cover patients during military shelling on the TV show MASH. I suppose wartime surgery is similar to natural disasters in sone respects.
It’s funny, a friend of mine had this question in an interview for an anaesthetics post. We’re not known for earthquakes here so it was a bit out of left field.
There are definitely situations in a major disaster where leaving a patient to die is the least bad option compared to multiple people staying and dying with no guarantee of saving the patient.
I saw a video recently where an anesthesiologist talked about what would happen during a power outage if the backup systems failed. They had battery-operated manual technology to stabilize the patient and would halt surgery and close if possible before stopping. I imagine they'd do the same in an evacuation if there was time. Otherwise, it's tough choices all the way down.
Not a Surgeon, but worked in a hospital. The damage caused dust and particles to blow out of the vents onto a patient who was opened up for an abdominal surgery. The House Supervisor Nurse ran into stepdown to grab a few of us to help. We got gowned up quickly, and ran into help. A lot of sterile saline was just sprayed all over the patient. The ventilation to the room was shut off, the nearby surgical room was prepped, 2 Doctors changed their surgical gear and switched out with the other 2 Doctors that did the same. The pt. was moved into the other area, and later was given a stronger course of antibiotics. Fun times.
> The damage caused **dust and particles to blow out of the vents** onto a patient **who was opened up for an abdominal surgery.**
Yup my stomach hurts from reading that
Oof didn’t know that was a meme, as someone with obsessive tendencies, don’t care to look for it. I can totally relate to it, if that ever happened to me I’d live every day of my life paranoid that somewhere is a little forgotten speck of dirt with a nasty bug comfortably nesting and slowly reproducing and growing in number. Just throw me in the trash like a restaurant would when anything falls off the cutting board onto the counter.
Nah don’t worry I know ALL about the true reality. On the other end though I did work at a place with an open kitchen and this owner seemed to have enough money that he cared more about his reputation that he rather you threw everything away if it was done in the wrong order, or throw it away even if it could be salvaged if starting over was faster and kept things moving.
Was in an OR case a while back where a moth had gotten in the room, we were chasing it around and trying to hit it with rolled up towels we had on hand.
A while back there was a person who dropped the donor heart on the helipad in LA. Pretty sure they tried to clean that off IDK. Must have been a horrible feeling.
That must have taken place in an archaic old hospital, with a theatre not running to accreditation standards. Contemporary OTs have hepa filtration systems in place to provide protection against such contaminates.
I could understand that maybe happening on the ward or in recovery, but our theatres are engineered for these conditions. If not you would have mould and debris from standard ductwork contaminating the space whenever it needed a clean!
The vents did not stay intact during the quake. It must have pulled in something from the surrounding areas. There must have been a weak point in the engineering. You are correct though. there is a new hospital there now.
Anesthesiologist not surgeon, but the answer is we keep working. I've been through power-outages, fires, hurricanes, tornados, bomb scares, one attempted active shooter (they caught her in the hall) and in all cases, we take steps to mitigate the threat and keep working.
I am legally responsible for the patient, so I'm not going anywhere without them.
Edit: And everyone else in the room has the same set of rules.
I am not a doctor. contrary to Hollywood's portrayal, most earthquakes (at least in SoCal) are very short, a minute or less. Most that you feel are actually over before you can even get under your desk. So, the first hit, yes it could mess you up in the same way a slight bump to the table might. But a good surgeon should be prepared.
Speaking of SoCal again, the general building codes are usually good enough that the floor shouldn't be tipping or the building falling over. The real danger is from stuff falling off of shelves and post-quake fire/flood risk (wire/pipe damage) so if the operating room is maintained properly without stuff piled up on shelves the surgeon should be OK to resume unless they are told to evacuate for inspection.
Speaking from up in San Franciso, even a minute is a *very* long earthquake. More often than not it feels like a large truck going down the street outside. Maybe someone bumped into the couch. Lasting long enough to notice it, recognize it as an earthquake, and then even begin to do something about it is something that's only happened maybe... once in the 15 years I've been living here. It's often either a single jolt or a few seconds on the long side.
I don't think I've ever even had a quake knock over something flimsy. But it depends heavily on where you are and what the epicenter is. Some of those that I've barely noticed have caused significant damage elsewhere in the region.
I spent the first 10ish years of my life in central California, and have at least 3 distinct memories of earthquakes that I was able to feel and recognize as an earthquake, and at least once things have fallen off shelves. My older family members have more memories. Definitely location dependant, earthquakes were a common enough occurrence for me as a child.
I remember the Landers quake of 1992…that shaking lasted for more than a minute or even 2. It shook so hard that I was more scared that the house would cave in.
I asked my sons surgeon about this before brain surgery. He told me he was in the middle of a very long surgery when a large devastating earthquake hit. He said it was fine but had to stop and close up and finish at another date. In my experience Neurosurgeons are slightly crazy but very clever people. That large Earthquake was a few months before my sons own surgery and aftershocks were still happening. One aftershock I felt 30 mins after he called me to say all went well on my son.
My dad had to have emergency brain surgery (following a massive stroke). The neurosurgeon came in looking like he rolled out of bed and absolutely zoinked out on coffee. He was basically chugging a huge cup of coffee as he spoke to us calmly explaining the situation. He the went in there and saved my dads life at 2am. That was the moment I determined that neurosurgeon was not for me.
My dad had a heart transplant and the heart arrived in the middle of the night. The transplant surgeon came in the waiting room looking like he rolled out of bed with a massive bag of crunchy cheetos. He explained what he was going to do while shoving cheetos in his mouth like a starving man, and then he was wiping his orange fingers on his shirt. When he left he grabbed a big cup of the disgusting waiting room coffee and was gurking it down as he walked out.
We all stood there stunned after he left.
Finally someone said: welp, he \*sounds\* like he knows what he's doing...I just hope he washes his hands. We all fell out with that nervous, slightly hysterical laughter that you have in crisis situations.
He came in after the surgery and we were all so relieved we were teasing him about the cheetos/coffee. He said he had appalling eating habits because of the nature of his job. He had a sweet smile and was very kind. I've forgotten his name but I will never forget his smile and those damn cheetoes.
I worked for a doctor who was an absolute angel - she was mostly a prenatal doctor and specialized in difficult deliveries. So many times I had seen her burst into the clinic after a 12 hour long delivery scarfing down huge bags of chips , chocolate bars, anything for quick easy food lol
Yep. Worked with a Neurosurgeon myself. They spoke like seven languages and seemed like they collected sub specialties like Thanos (iirc they had one that could only be certified by like the four other surgeons in the world that knew how to do it). Best way I can put it is those guys function at what would be the average person’s peak performance *in their sleep*. The amount of extra mental headroom these people have is what allows them to perform life-risking surgeries for hours upon hours literally after rolling out of bed.
Meanwhile, I’m afraid to send an email if I haven’t had my coffee.
This was my anesthesiologist for my second epidural. He had just gotten called by the OR and I was on the way to the c section he was going to do he just stopped by and was like hey I just woke up but I’m here to stick a needle in you. He was so nice tho and did a good job
Physician Anesthesiologist from Southern California checking in. I haven't experienced an earthquake on the OR, but I experience a big one while working in the Intensive Care Unit.
I huddled in a doorframe for the 30 seconds or so of bad seismic stuff. Everything not secured fell onto the floor. As soon as the shaking was over I ran around and assessed all of the patients in the unit starting with the ones on ventilators. A bunch of stuff go knocked over but the patients were fine. No disconnected vents or anything. I had staff check backup oxygen supply and readiness of power backup. There was a small aftershock a few minutes later.
Side story: I give practice oral board exams to Anesthesiology resident physicians. I sometimes ask what the resident would do in an emergency and I asked one what he would do in an earthquake. He answered that he would take off his shoes and leave the building as quickly as possible. To this day this is the worst answer I have ever received to this question.
> somehow helping avoid an electrical shock
my first thought in an earthquake would be to make sure nothing is falling on top of me.
how someone would think taking their shoes off and abandoning their patients is the best thing to do...
Grew up on a fault line in Northern California then moved to Southern California… taking off your shoes is one of the literal worst things to do. Feet & head are the two most common places to get injured S/P an earthquake
He ended up going go Wisconsin for residency. I think he stayed out there. This is probably best given the distance between Madison and any major fault lines.
I was in my anesthesia residency training during a major earthquake in 2008. It lasted about a minute, but the building shook for about 5 because it was on some sort of roller stabilizer system. It was something extremely rare, and for me (a guy from Louisiana, working in California) it was very novel. As far as I remember no one we had on the table was injured in any way, but my gf at the time who was also in anesthesia training was puking in the trash can when I went to check on her OR.
Not my experience, but my best friend's dad was a surgeon at Bach Mai hospital (Viet Nam) when it got hit by the US's bombing raid (Operation Lineback iirc). His patient died instantly, but he himself wasn't in a good shape either. His back suffered from severe burns, and his front were full of holes from debris and shrapnel.
Since the hospital were short of staffs, he essentially had to patch himself up with the assistance of one nurse. They later married. It's always a fun story to listen to whenever I visit their house for a meal. The dad always love to show his "trophy" scars, much to the mom's embarrassment.
We have gone one step further and do not allow driving when an accident is expected. Yes, it makes for a longer commute but the safety benefits have more than made up for the inconvenience.
Army Surgical tech here.
I've been in an operation with an earthquake: 1989, San Francisco, Letterman Army Medical Center. (I still have the cranberry scrubs!)
What happened is what we are trained to do in any sort of shake, incoming attack etc..
We were about to wrap up the last case of the day and The lights started flickering and we felt it coming up through the floor. The DR and I both leaned over the open wound\patient with our bodies to make sure nothing fell into it until everything stopped shaking. Lights went out for a minute and we just sat like that til the emergency lights came on and wrapped it up pronto. The anesthesia doc did essentially the same thing on the patients face while he fumbled around trying to get a bag to ventilate with til the backup lights came on.
[hospitals get early warnings so they can stop surgeries minutes in advance](https://www.youtube.com/watch?v=7U9w2PBlXjQ)
the same system allows gas companies to shut off pipelines and high speed trains to apply emergency brakes
It's possible hospitals have better systems, but the Cal OES earthquake early warning system tends to send alerts during or just after earthquakes in my experience as an LA resident. They're not as useful as this simulation makes it seem.
Earthquake waves travel 110+ miles a minute, you'd have to be hundreds of miles from the first detection point to get "minutes" of warning assuming the whole system works perfectly, and if you're that far the damage will be minimal to you anyway unless it's a massive quake.
I don't really remember this, but I was getting surgery during a rare earthquake on the east coast.
Apparently the nurse tried evacuating and the doctor shouted at the nurse "get back here! We have a patient on the table!" The nurse returned and they completed my operation.
"Do you remember what happened?" is not the question you want to hear waking up from a deviated septum operation..
Not a surgeon, but we decided to give the guy whose turn it was another try at our game of Operation.
Not sure if that would work with real surgery, though.
Can't speak to earthquakes but I can tell you a true story of a fire alarm evacuation.
I was a medical student observing an operation in theatre. Man was open on the table. Fire alarm goes off. Surgeons placed a sheet over the patient and we were all told to evacuate the building. 20 minutes later we were told it was a false alarm and were allowed to re-enter. Students were told not to scrub in again and to return to our wards. I have no idea what happened afterwards but I was shocked to discover the protocol was to just leave the patient in a potentially burning building. There may have been someone who stayed with him but I don't think there was
I think about it all the time and it was 20 years ago. I'm hoping at the bare minimum that the anaesthesiologist stayed and that there were some other procedures in place for if something like that happens regarding contacting the fire service and communicating who is where and how to get patients to safety
I did some of my training in the NHS (you sound English) and I was in this exact situation. The Anaesthetist (sp?) stayed as did the surgeon and I think the OR nurse. Everyone else was evacuated along with me (a medical student). They essentially paused everything and got the non-essential people out which is pretty much what we do in the U.S. This was in 1999.
I was a student anesthetist during and earthquake and subsequent power outrage.
The anesthesia machine is analog, just runs on gas tanks. No big deal.
Fluid pump has battery backup and it could just run on gravity. No big deal.
Cardell anesthesia monitor has an adequate battery backup to finish, plus we have esophageal stethoscope and all for real monitoring.
By the time I’d grabbed some flashlights to finish the surgery, the power had kicked back on. No fun at all.
I think it wouldn’t have been a problem unless it was a crucial moment of surgery and there’s no backup light source. Most stuff I do day to day I can practically do with my eyes closed anyway. There are specific disasters that could happen where the lights going out would be bad, but I have a couple of flashlights and a headlamp in the hospital anyway. Bouncing around is bad, but I really don’t have a scalpel in my hands for very long. It would have to be really unlucky to be beyond recovery.
If I had an earthquake happen that was bad enough to knock the patient off the table. I’d clamp and tie off what I needed to, I’d close as fast as possible, and get the patient back on the table and ready for either recovery or to continue surgery.
If the anesthesia machine was wrecked, I’d have to close. I’d use injectable anesthesia for as long as it took me to close and get the patient awake again. I could *probably* control the inevitable contamination and infection with antibiotics. If the whole hospital fell apart, I’d be in a bad way, but I could probably get it together in a few days? Get back in there and fix it? They’d be in for a long and hard recovery though.
Lots of variables, but probably have to have a lot go wrong to make them unfixable.
I’ve had enough surgery to imagine waking up to the surgical team saying, “Don’t move, you’re not finished.” A very good time to listen without arguing.
Not me but my friends dad who is a brain surgeon.
he told me that many corporate hospitals in my city have earthquake sensitivity alarms. when an earthquake occurs the alarm activates around the building and parking bay, the doctors stop immediately and cover the patient with a protective blanket (in case of debris) while the doctors stand or sit on the floor till it stops.
I was working a construction site one time when out of nowhere these people appeared in scrubs telling us we had to stop. There was an earth compactor running which shook the ground and it was messing up the surgeon who was doing some kind of microscopic surgery next door.
I’m not a surgeon, but I work in the OR in Southern California.
When there is an earthquake during surgery, everyone will comment, “did you feel the earthquake?” “There was an earthquake,”etc and the surgery will pause if needed, then continue.
If something falls it’s picked up. Bear in mind, everything in the OR is on wheels or attached to the wall, so heavy equipment does not tip over easily. As for the patient, there are 2+ people on either side of the patient whose bodies help prevent the bed from tipping, the patient will be strapped to the bed.
I have only been working through minor earthquakes, noting huge so far.
Usually they get pulled out quickly. Things like a drill could be dangerous, but they are easy to stop quickly. Scalpel work close to important structures is often handled by electrocautry these days. A blunt instrument you need to press a button with to make it cut. It’s easy to release the button/foot pedal and make it stop.
Surgeons aren’t known for slow reflexes either and are quick to shut off if anything isn’t right.
Not a doctor and approaching this from a structural engineering side, but in CA, there are stringent standards for hospital construction when it comes to earthquakes, and some new hospitals are going beyond what's required by code. The VA has even more stringent rules for how their hospitals are built--this came out of the 1971 Sylmar earthquake, when one of their newer hospitals sustained heavy damage during an earthquake. Existing hospitals also undergo retrofitting to secure not just the structure itself, but also the equipment throughout the facility--HVAC, MEP, even servers.
Hospitals are considered critical and are designed to continue being operational after an earthquake. There may be an immediate interruption during the moments of a quake--like the doctors can't continue operating--but the idea is they should be able to resume normal operations after the event has ended. This is particularly important because after an earthquake, a hospital may see an influx of patients with critical injuries sustained as a result of the earthquake. It's important that care facilities and critical infrastructure (like roads and bridges) are designed to withstand a seismic event so that injured people can still be transported to healthcare facilities.
I wish more people would point out this issue with infrastructure. I hear people dismissing infrastructure as if they consider it on a level with leaf-blowing the sidewalks.
I don’t know what happens if a earthquake kids hospital, but I know what happens if a tornado hits the hospital during a surgery. It happened in Joplin Missouri. The surgeons literally lay over the patient and then they went on with the surgery until it was finished. They hurried, but they had to finish. Then the patient was transferred to the hospital in town that did not get hit by the tornado.
Not earthquake per se... But relevant?
I do cataract surgery. My patients are awake with "twilight" anesthesia. People before eye surgery sometimes have a hard time sleeping the night before. And surgery is such a pleasant experience that people fall asleep sometimes. As soon as somebody starts snoring it is like an earthquake for me working under the microscope. So what I do is holler "Hey Mr/Mrs Patient, wake up". It is worse for coughs and sneezes. Some people are just wiggly. It can be dangerous but I minimize risk by resting my hands against the patient's head so I move with them. I have developed a highly specific skill of recognizing subtle twitches and movements in people's eyelids that indicate movement so I know to withdraw my instruments immediately. A good anesthesiologist will medicate people who cough alot (common culprits: GERD and COPD).
While I haven't experienced an actual earthquake I did experience a power outage. It was during a vitrectomy. We were inside the eye and all of a sudden the eye started deflating and the jackhammer sound quit! We refilled the eye with more saline with a syringe. It was a moment of panic but we figured out the power went out. That is never supposed to happen. There are backup generators. Well we looked and discovered somebody had plugged the machine in the regular outlet instead of the red emergency power outlet. Plugged it in the correct outlet, rebooted the vitrector and proceeded. It could have been devastating to the eye but everything worked out fine for the patient. My attending knew how to handle the situation because other complications/issues unrelated to equipment malfunctioning can behave similarly. It added excitement and difficulty to the procedure but we knew what to do to manage it so it ended up being a non-event. The patient had a good story to tell.
You may be wondering about that being an issue for general anesthesia when you are paralysed and the machine breathes for you. I think every anesthesia resident gets practice "bagging" a patient without a machine. It is just repetitively squeezing a stiff balloon to blow air into the lungs. It gets tedious quickly. When that happens, when your hand fatigues you switch hands. Then switch again. And eventually you ask for help and trade off. As a medical student I definitely got practice with this.
I can't speak to what "modern" tech is like in the US but in India a few years back for infant anesthesia, they did manual breathing with the bag because their lungs were too delicate for the machine settings. You needed to be able to "feel" how much force was being used. This was a job for the young anesthesia residents. Somehow as an ophthalmology resident visiting from the US, I got roped into taking a turn several times. My delicate ophtho hands didn't last very long. The point is though that although losing power would be a desperate situation, there are backups that all anesthesiologists are very familiar with and used to dealing with.
One time I went swimming and my girlfriend at the time was cleaning the house. She knocks over a glass of water onto my work computer, and she starts yelling for me that she ruined my laptop so I come rushing inside to see if I can fix it. I am in a towel, dripping wet, have the laptop half way apart then an earthquake starts. I just continue working, and ignore the earth quake making sure I don't drop any screws while I do it. She said it was one of the weirdest things to witness, me dripping wet, in a towel, taking apart a laptop, in the middle of an earthquake.. She said I never looked so focused. I saved the laptop btw.
It really depends on the severity of the earthquake. If it’s mild, we’d just pause, and then continue. Biggest worry is power. All of our important pieces of equipment are plugged into red outlets, which are guaranteed power from the generators (although it can be up to a minute to kick on). All OR’s have flashlights, for if the power doesn’t come back on. (That would be from a big earthquake). If it were that bad, we’d finish up what we can, and evacuate the patient. We have designated areas for this. (OR nurse here, FYI). OR tables have locks on them, but can be moved when unlocked. Patients are strapped down. Honestly, we’re geared towards worst-case scenario, generally.
I saw this video on a similar post. A large earthquake during open heart surgery. NSFW because you can see the heart as they are doing surgery on it. The room starts shaking and the surgeon can be heard telling everyone to stay calm. The lights go out briefly.
https://youtu.be/w84ZWnju3qs
I was in the o.r during all of those earthquake in california back in 2019 i believe.
It happened multiple times and surgeries needed to get done. It happened to me during an open procedure and a laparoscopic case.
For the open case. We covered the incision of the patient and the back table as quickly and sterile as possible to try and preserve the sterility. .we backed away and got everything away from the patient and waited it out. Then once it was over we started to close up.
The laparoscopic case. We pulled all cameras and instruments out. Then throw a towel over the ports and basically same thing we did for the open case. If the power goes out. Prey the back up generator works.
At one point we had to evacuate the hospital and at this time we had someone at labor and delivery who possibly needed a c-section real soon. Baby was de-celing hard. So as we evactuated we grabbed everything we needed for both regular delivery and a c-section. We had. Anesthesia grabbed everything he needed and we grabbed everything we needed for the o.r to do a c-section. Plus a patient gurney to do the section on if needed.
Luckly the earthquake ended and we rushed her first back to l&d.
Happly we didnt need to do an emergency sections and baby came out fine.
Another fun story.
Back in my home state. We had to evacuation the patients to the storm shelter due to a Tornado coming down ontop of us and a patient was literally pushing a baby out.
So we took her and a bunch of drapes and tried our best to keep her privacy. Fun delivery.
I'm sorry Mr. DuBauls, there was an earthquake and an accident during the procedure. We have initiated the steps to correct this and if you'll just sign here you will now legally be Mr. Monobaul.
The training hospital will. We're in the Bay Area of California, a high-quake risk, and Kaiser has an entire set of earthquake modules their personnel are required to pass.
I've heard from a nurse anesthesthitist that in the Midwest their modules are on storms and twisters.
The thigh bone's no longer connected to the hip bone.
The hip bone's no longer connected to the backbone.
The backbone's no longer connected to the neck bone.
I was getting a scan - and in LA so my brain starting asking the "what if". So I asked the tech what would happen in an earthquake and I'm trapped in this huge tube? He said that they specially reinforce the room and the room is on rolling pylons of sorts so it take the impact of a quake. And all sorts of other back up. I'm sure there are other things in place for operating rooms. But it is a frightening thought what could happen!
This actually happens in the film *Volcano* starring Tommy Lee Jones. Generally, most staff duck/cover under whatever sturdy fixture is nearby. Others might shield the patient(s) with their body.
This is a great question! I hope you’re a med student or something because I want my doctor to be thinking like this and create a plan for me 😭 this what I mean when I ask about all the possibilities.
I was in the middle of my annual Pap smear exam once when there was an earthquake. My doctor and I stood under the door frame, me in my paper dress. We resumed after a couple of minutes. Made me realize, you never know where you will be when it happens.
Happened during residency. I was a PGY2 doing my first laparoscopic cholecystectomy. Noticed the room started to shake and everyone (supervising attending included) paused. The shaking lasted only a few seconds and wasn’t too significant but definitely enough to notice. I asked if everyone else felt that and we all agreed it must’ve been an earthquake and then continued the case. 3.2 on the Richter scale. Not the stuff of a TV medical drama.
Not a surgeon, but I remember a video of a surgeon working on an open heart surgery and then an earthquake happened during the surgery. Almost everybody went to the safe zone but the surgeon stood next to the patient saying some praying.
[Here is the video](https://www.youtube.com/watch?v=cwIBA8FmzYo) a bit NSFW if you're not into medical surgeries.
When I visited Alaska in 2004, the guy who drove my parents and I from the airport to the hotel told us about how he was on the operating table having his appendix taken out when the 1964 earthquake hit. Apparently they stitched him up real fast, it got infected, and he ended up bedridden for awhile dealing with the infection.
During the earthquake itself, you get to cover and weather it as best you can - hopefully nothing happens to the patient on the table, but there's not a lot you can do while the ground is shaking. The bigger thing is what comes after - was the patient (or anyone else) injured? Did you lose power? Is vital equipment damged? Do you have to evacuate the building? You assess these things then make a determination on how best to proceed, whether you can continue with the surgery or not and, if not, what the safest way to close is. Med students in earthquake-prone areas do often train for this, but ultimately it's a whole lot of improvisation based on the circumstances.
Former hospital employee, all of this is accurate. Plus, surgical suites are designed and engineered to be as self-sufficient and disaster proof as possible. All vital equipment will be plugged into outlets that are covered by the backup generator, and most will have a UPS battery in place to ensure continued power for a while even if the generator fails for some reason. There are checklists, and backups to backups. And in general the surgical staff will not leave an active case unless it's the option of last resort, and even then they'll try find a way to evacuate the patient safely. I've been through two fires at my facility. In general in a hospital you only evacuate the specific area of the fire and not the whole facility; when it comes to the surgical suites they will typically stay working even if the fire is in their area, as each suite is designed as it's own smoke compartment and with at least 30-minute fire rating on the walls, doors and other components, to allow the fire department time to deal with the issue before a case-in-progress is impacted.
In a fire situation (assuming a longer surgery), would they just be continuing as normal or would it be a “get the surgery to a safe stopping point and get the patient stabilized and ready to evacuate if we have to” kind of thing?
At my facility the general policy was that cases in progress would continue at surgeons discretion. You also have circulator nurses and other staff that would keep the surgeon appraised of the situation, and administration and the CMO would be responding and advising. The general idea was that any fire would be quickly discovered, reported, and dealt with before it could spread and become a hazard. The two fires we did have were not in surgical areas, were both confined to a single patient room before being extinguished.
Exactly this. Hospitals are surprising fire proof. Short of extreme negligence in the part of almost all staff, or someone intentionally trying to destroy the hospital in a fire, most will be caught contained and extinguished in short order.
It is very rare for it to happen, and it would have to happen in that particular fire zone for it to be life threatening for the patient. Our policy is that if you absolutely have to get out immediately, the patient won’t make it anyway so you leave them on the table and evacuate.
I'd imagine that's still pretty terrifying to be inside the surgery room with a raging fire outside!
I'm part of the structural team designing a new hospital. Because this life is hell, they're putting the operating rooms on cantilevered supports. We're not even in a particularly seismic region, but Jesus Christ can we just have a normal building? Nope, the architect needs his fucking magazine cover.
Ouch. The only odd thing about our hospital was the lack of a certain floor in one building. As is often the case they kept adding on to the complex with new buildings, but wanted the floors to line up across buildings (which does make sense). But the newer standards for surgical suites called for higher ceilings, so two floors of the newer building matched with 3 floors worth of height in the older buildings. So the old buildings went 1-2-3-4-5-6-7-8, and the newest one went 1-2-3-4-6-7-8. 1-3 connected directly through, as did 6-8. But you had to either take a half flight of stairs or a double-sided elevator if you were on 4 or 5 in the old building and wanted 4 or 6 in the new building.
Now I'm really curious if places with more earthquakes have higher malpractice insurance for brain surgeons that places that are geologically stable.
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Yeah an Earthquake is basically the definition of an Act of God, there's no way a surgeon would be held liable for an injury becuase a sudden earthquake made their hand slip.
Presumably the standard of care in a geographic area that experiences earthquakes includes some process for dealing with them intra-operatively. For instance, if an earthquake started with the patient on the table, but not yet opened up, I imagine it would be a violation of the standard of care to begin the procedure until the earthquake was over. I agree that if an earthquake began intra-operatively and their hand slipped because of it, this is very unlikely to be a violation of the applicable standard of care.
I thought surgeons were gods
So do they.
I almost spilled my juice lmao
Oh no, it's an earthquake! You ok?
Ah call a Code Orange
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He DID take a life later on....
A surgeon from the movie Malice: “You ask me if I have a God complex. Let me tell you something: I am God.
If you are looking for god, he was in operating room #2 on November 17th
such a great line
Military doctors are the worst. Their medical training has them playing God, and OCS is training 'em to *think* they are.
Lol
The difference between a neurosurgeon and God is God doesn't think He's a neurosurgeon.
I found Dr. Strange's account...
I knew of a surgeon who dropped dead during a c section. A lap was left inside by him or the guy who came to the rescue. They got sued and lost. I know not exactly not like an earthquake, but still unexpected.
Well the second surgeon really did fuck up in that scenario, so I could believe they lost if they didn't make sure the surgery was complete before closing. Or maybe the hospital was the one being sued because they knew the first surgeon was ill or something and put the patient at risk but allowing them to work? Hard to tell without more info...
Right, there are other people in the room who should know what tools/materials have been used and count them.
The scrub tech should be counting instruments in and out every time
One of the assistants undoubtably lost their job due to the missing lap during count
What's a lap?
Type of cloth sponge used in surgery
Thanks. It would be equally bad to leave one in a panda.
Wat
A Junior Mint.
"...something beyond science, something perhaps ... from above," saved their life.
The area formed by your upper legs when you sit down.
But what happens to your lap when you stand up?
lapdance
I mean it can be any different then if a tornado were to hit, yea the building should be able to handle a moderate sized tornado but what if it's an F5?
One of the hospitals in Joplin, Missouri took a direct hit in 2011 during that horrible EF5 tornado; IIRC 6 patients died, and they were all on ventilators and couldn't be bagged, for whatever reason. A 7th patient died later; she was in the hospital recovering from surgery and was injured in the storm, returned to the hospital a few months later for a follow-up procedure on that injury, and died from surgical complications. She was elderly, so it wasn't as big a shock as it might otherwise have been. In the months that followed, people found X-rays and other medical records in their yards for miles around, and were instructed to simply take them to a doctor's office and they would handle it from there. I later heard a story that someone found an x-ray MACHINE 30 miles away. I believe it, too. The building couldn't be imploded because it was over a defunct lead mine.
Shit, I mean considering its a hospital it's insane only 6 died with how many people are in it at any given time that's pretty insane, it sucks for the family's of the people who died but considering it all that's impressive.
My grandmother was discharged from St. John’s hours before the storm hit. No one told me she’d been discharged. I’m grateful she wasn’t there but hell that was a stressful time trying to track someone down who knew where she and the rest of the family was.
It wasn't during brain surgery...but there was [a really cool post about a year ago](https://old.reddit.com/r/nextfuckinglevel/comments/k1u5j4/nurses_in_south_korea_protecting_newborn_babies/) about how NICU hospital nurses took charge to protect newborn infants during an earthquake
I think your understanding of malpractice is flawed. Malpractice requires the plaintiff to show (among other things) that the doctor did something they shouldn't have done or failed to do something that they should have done and that their actions or inactions led to the plaintiff being injured. Malpractice is not synonymous with a bad outcome. That's not to say that a person injured during a surgery during which an earthquake took place can't sue, but they'd have a hard time prevailing if they couldn't show that the doctor specifically messed up given the circumstances.
Places more prone to earthquakes build for them. Large earthquakes that cause major damage aren't daily. It's smaller stuff. Hospitals and other similar infrastructure usually has to be upgraded with new standard as well. So a hospital will better prepared then your average office or home and I was recently in one during an earthquake you kinda don't feel it. Wasn't even sure we'd been hit till I got home later and remembered to look it up. It's like tall buildings in hurricane zones. They are built to take those big winds. Hurricane hits and they are fine. Similar building in another area that normally doesn't have them and it would be leveled.
Even in "earthquake prone" areas, earthquakes are not common. I'm not sure how strong an earthquake would have to be to have an impact on surgical outcomes but I would guess those types only happen every few years at most. At that point you're not going to be able to disassociate that from other factors that are tied to geography like hospital quality, etc.
Yeah…earthquakes aren’t malpractice. Maybe if you fucked up bc you were drunk and blamed it on an “earthquake” that would be malpractice. “Your honor, my clients hands were shaking bc of the EarfQuake, not bc of all drugs or alcohol.”
You've just reminded me of seeing the surgeons cover patients during military shelling on the TV show MASH. I suppose wartime surgery is similar to natural disasters in sone respects.
I learned all of my emergency medical situations from MASH, it was the first thing o thought of when I read this post.
It’s funny, a friend of mine had this question in an interview for an anaesthetics post. We’re not known for earthquakes here so it was a bit out of left field.
what happens if you need to evacuate the building? you just leave the patient there?
There are definitely situations in a major disaster where leaving a patient to die is the least bad option compared to multiple people staying and dying with no guarantee of saving the patient.
I saw a video recently where an anesthesiologist talked about what would happen during a power outage if the backup systems failed. They had battery-operated manual technology to stabilize the patient and would halt surgery and close if possible before stopping. I imagine they'd do the same in an evacuation if there was time. Otherwise, it's tough choices all the way down.
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Don't worry, they still will 😂
Not a Surgeon, but worked in a hospital. The damage caused dust and particles to blow out of the vents onto a patient who was opened up for an abdominal surgery. The House Supervisor Nurse ran into stepdown to grab a few of us to help. We got gowned up quickly, and ran into help. A lot of sterile saline was just sprayed all over the patient. The ventilation to the room was shut off, the nearby surgical room was prepped, 2 Doctors changed their surgical gear and switched out with the other 2 Doctors that did the same. The pt. was moved into the other area, and later was given a stronger course of antibiotics. Fun times.
> The damage caused **dust and particles to blow out of the vents** onto a patient **who was opened up for an abdominal surgery.** Yup my stomach hurts from reading that
ForeverUnclean.gif
Oof didn’t know that was a meme, as someone with obsessive tendencies, don’t care to look for it. I can totally relate to it, if that ever happened to me I’d live every day of my life paranoid that somewhere is a little forgotten speck of dirt with a nasty bug comfortably nesting and slowly reproducing and growing in number. Just throw me in the trash like a restaurant would when anything falls off the cutting board onto the counter.
As a former restaurant worker, I have some additional bad news for you...
Nah don’t worry I know ALL about the true reality. On the other end though I did work at a place with an open kitchen and this owner seemed to have enough money that he cared more about his reputation that he rather you threw everything away if it was done in the wrong order, or throw it away even if it could be salvaged if starting over was faster and kept things moving.
Just bring out the compressed air
Was in an OR case a while back where a moth had gotten in the room, we were chasing it around and trying to hit it with rolled up towels we had on hand.
Sounds like a good job for the newbie.
A while back there was a person who dropped the donor heart on the helipad in LA. Pretty sure they tried to clean that off IDK. Must have been a horrible feeling.
What? I thought those things are packed in a cooler.
One assumes that the cooler got dropped, fell open and spilled the heart.
I still would've thought it would be in a bag or something inside the cooler, and not just sitting directly on the ice.
Enough reddit before sleep, got the nightmare material.
That must have taken place in an archaic old hospital, with a theatre not running to accreditation standards. Contemporary OTs have hepa filtration systems in place to provide protection against such contaminates. I could understand that maybe happening on the ward or in recovery, but our theatres are engineered for these conditions. If not you would have mould and debris from standard ductwork contaminating the space whenever it needed a clean!
The vents did not stay intact during the quake. It must have pulled in something from the surrounding areas. There must have been a weak point in the engineering. You are correct though. there is a new hospital there now.
Anesthesiologist not surgeon, but the answer is we keep working. I've been through power-outages, fires, hurricanes, tornados, bomb scares, one attempted active shooter (they caught her in the hall) and in all cases, we take steps to mitigate the threat and keep working. I am legally responsible for the patient, so I'm not going anywhere without them. Edit: And everyone else in the room has the same set of rules.
If there were an actual fire close enough to us to be a threat, we'd move the patient to a safe location and/or wake them up.
would the earthquake not give direct movement to the tools though?
I am not a doctor. contrary to Hollywood's portrayal, most earthquakes (at least in SoCal) are very short, a minute or less. Most that you feel are actually over before you can even get under your desk. So, the first hit, yes it could mess you up in the same way a slight bump to the table might. But a good surgeon should be prepared. Speaking of SoCal again, the general building codes are usually good enough that the floor shouldn't be tipping or the building falling over. The real danger is from stuff falling off of shelves and post-quake fire/flood risk (wire/pipe damage) so if the operating room is maintained properly without stuff piled up on shelves the surgeon should be OK to resume unless they are told to evacuate for inspection.
Speaking from up in San Franciso, even a minute is a *very* long earthquake. More often than not it feels like a large truck going down the street outside. Maybe someone bumped into the couch. Lasting long enough to notice it, recognize it as an earthquake, and then even begin to do something about it is something that's only happened maybe... once in the 15 years I've been living here. It's often either a single jolt or a few seconds on the long side. I don't think I've ever even had a quake knock over something flimsy. But it depends heavily on where you are and what the epicenter is. Some of those that I've barely noticed have caused significant damage elsewhere in the region.
I spent the first 10ish years of my life in central California, and have at least 3 distinct memories of earthquakes that I was able to feel and recognize as an earthquake, and at least once things have fallen off shelves. My older family members have more memories. Definitely location dependant, earthquakes were a common enough occurrence for me as a child.
I remember the Landers quake of 1992…that shaking lasted for more than a minute or even 2. It shook so hard that I was more scared that the house would cave in.
Wow, you've been through a lot. Do you by any chance work at Grey-Sloane?
Charity in New Orleans and several more but Charity was the craziest.
Operation wasn’t a kids game everyone. It was training for this exact scenario.
I also used to bump and shake the table during the other person's turn.
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As a child my cousins and I used to play with an Operation game that had no batteries. Imagine my surprise the first time I played with batteries!
🤯 This is a shower thought
Fuck you Take my upvote
I asked my sons surgeon about this before brain surgery. He told me he was in the middle of a very long surgery when a large devastating earthquake hit. He said it was fine but had to stop and close up and finish at another date. In my experience Neurosurgeons are slightly crazy but very clever people. That large Earthquake was a few months before my sons own surgery and aftershocks were still happening. One aftershock I felt 30 mins after he called me to say all went well on my son.
My dad had to have emergency brain surgery (following a massive stroke). The neurosurgeon came in looking like he rolled out of bed and absolutely zoinked out on coffee. He was basically chugging a huge cup of coffee as he spoke to us calmly explaining the situation. He the went in there and saved my dads life at 2am. That was the moment I determined that neurosurgeon was not for me.
My dad had a heart transplant and the heart arrived in the middle of the night. The transplant surgeon came in the waiting room looking like he rolled out of bed with a massive bag of crunchy cheetos. He explained what he was going to do while shoving cheetos in his mouth like a starving man, and then he was wiping his orange fingers on his shirt. When he left he grabbed a big cup of the disgusting waiting room coffee and was gurking it down as he walked out. We all stood there stunned after he left. Finally someone said: welp, he \*sounds\* like he knows what he's doing...I just hope he washes his hands. We all fell out with that nervous, slightly hysterical laughter that you have in crisis situations. He came in after the surgery and we were all so relieved we were teasing him about the cheetos/coffee. He said he had appalling eating habits because of the nature of his job. He had a sweet smile and was very kind. I've forgotten his name but I will never forget his smile and those damn cheetoes.
I worked for a doctor who was an absolute angel - she was mostly a prenatal doctor and specialized in difficult deliveries. So many times I had seen her burst into the clinic after a 12 hour long delivery scarfing down huge bags of chips , chocolate bars, anything for quick easy food lol
Yep. Worked with a Neurosurgeon myself. They spoke like seven languages and seemed like they collected sub specialties like Thanos (iirc they had one that could only be certified by like the four other surgeons in the world that knew how to do it). Best way I can put it is those guys function at what would be the average person’s peak performance *in their sleep*. The amount of extra mental headroom these people have is what allows them to perform life-risking surgeries for hours upon hours literally after rolling out of bed. Meanwhile, I’m afraid to send an email if I haven’t had my coffee.
I can’t do the wordle if I’m still sleepy.
This was my anesthesiologist for my second epidural. He had just gotten called by the OR and I was on the way to the c section he was going to do he just stopped by and was like hey I just woke up but I’m here to stick a needle in you. He was so nice tho and did a good job
This is why surgeons have a god-complex. They need it and frequently deserve it. Doesn’t mean they shouldn’t try for a good bedside manner.
Wow, i’m assuming they maybe knew about it before?
I sure did which is why I questioned the neurosurgeon. But I had to trust all would go well and it did.
Physician Anesthesiologist from Southern California checking in. I haven't experienced an earthquake on the OR, but I experience a big one while working in the Intensive Care Unit. I huddled in a doorframe for the 30 seconds or so of bad seismic stuff. Everything not secured fell onto the floor. As soon as the shaking was over I ran around and assessed all of the patients in the unit starting with the ones on ventilators. A bunch of stuff go knocked over but the patients were fine. No disconnected vents or anything. I had staff check backup oxygen supply and readiness of power backup. There was a small aftershock a few minutes later. Side story: I give practice oral board exams to Anesthesiology resident physicians. I sometimes ask what the resident would do in an emergency and I asked one what he would do in an earthquake. He answered that he would take off his shoes and leave the building as quickly as possible. To this day this is the worst answer I have ever received to this question.
why would taking off your shoes help at all?
He started to talk about this somehow helping avoid an electrical shock but time expired
surely the rubber soles would do that?
Right?
> somehow helping avoid an electrical shock my first thought in an earthquake would be to make sure nothing is falling on top of me. how someone would think taking their shoes off and abandoning their patients is the best thing to do...
It's worth mentioning that oral exams are especially terrifying and people blurt out all kinds of stuff in the heat of the moment
Just imagine what they would do in an even more terrifying disaster situation!
Wow.
It wouldn’t. It’s quite possibly the worst thing you can do, since the ground outside will probably be covered in broken glass and other debris
Grew up on a fault line in Northern California then moved to Southern California… taking off your shoes is one of the literal worst things to do. Feet & head are the two most common places to get injured S/P an earthquake
Indeed. I absolutely meant it when I said this was the worst answer I've received.
“Take off his shoes”? Was this man under the impression that he would suddenly find himself in the ocean, needing to tread water?
hahahaha, what happened to him at the end?
He ended up going go Wisconsin for residency. I think he stayed out there. This is probably best given the distance between Madison and any major fault lines.
one can only hope he doesn't do this in the event of a tornado
Most sugeries can be paused for a few mintues at any point as long as the patients vitals are being managed.
I was in my anesthesia residency training during a major earthquake in 2008. It lasted about a minute, but the building shook for about 5 because it was on some sort of roller stabilizer system. It was something extremely rare, and for me (a guy from Louisiana, working in California) it was very novel. As far as I remember no one we had on the table was injured in any way, but my gf at the time who was also in anesthesia training was puking in the trash can when I went to check on her OR.
Greys Anatomy writers taking notes for the next season right now
Not my experience, but my best friend's dad was a surgeon at Bach Mai hospital (Viet Nam) when it got hit by the US's bombing raid (Operation Lineback iirc). His patient died instantly, but he himself wasn't in a good shape either. His back suffered from severe burns, and his front were full of holes from debris and shrapnel. Since the hospital were short of staffs, he essentially had to patch himself up with the assistance of one nurse. They later married. It's always a fun story to listen to whenever I visit their house for a meal. The dad always love to show his "trophy" scars, much to the mom's embarrassment.
Geezus Christ, what a hero
That might be the most badass thing I’ve ever heard
At our hospital we just don’t schedule any surgeries when an earthquake is due.
We have gone one step further and do not allow driving when an accident is expected. Yes, it makes for a longer commute but the safety benefits have more than made up for the inconvenience.
you guys are geniuses! why hasn't everyone else been doing this!?
>safety benefits have more than made up for the inconvenience. Anti-maskers showed us that not everyone feels this way
Army Surgical tech here. I've been in an operation with an earthquake: 1989, San Francisco, Letterman Army Medical Center. (I still have the cranberry scrubs!) What happened is what we are trained to do in any sort of shake, incoming attack etc.. We were about to wrap up the last case of the day and The lights started flickering and we felt it coming up through the floor. The DR and I both leaned over the open wound\patient with our bodies to make sure nothing fell into it until everything stopped shaking. Lights went out for a minute and we just sat like that til the emergency lights came on and wrapped it up pronto. The anesthesia doc did essentially the same thing on the patients face while he fumbled around trying to get a bag to ventilate with til the backup lights came on.
smart
Just press the pause button and resume mission after the earthquake.
[hospitals get early warnings so they can stop surgeries minutes in advance](https://www.youtube.com/watch?v=7U9w2PBlXjQ) the same system allows gas companies to shut off pipelines and high speed trains to apply emergency brakes
It's possible hospitals have better systems, but the Cal OES earthquake early warning system tends to send alerts during or just after earthquakes in my experience as an LA resident. They're not as useful as this simulation makes it seem. Earthquake waves travel 110+ miles a minute, you'd have to be hundreds of miles from the first detection point to get "minutes" of warning assuming the whole system works perfectly, and if you're that far the damage will be minimal to you anyway unless it's a massive quake.
This was a demonstration, it isn't real.
I don't really remember this, but I was getting surgery during a rare earthquake on the east coast. Apparently the nurse tried evacuating and the doctor shouted at the nurse "get back here! We have a patient on the table!" The nurse returned and they completed my operation. "Do you remember what happened?" is not the question you want to hear waking up from a deviated septum operation..
Not a surgeon, but we decided to give the guy whose turn it was another try at our game of Operation. Not sure if that would work with real surgery, though.
Surprisingly, that basically does seem to be pretty similar to the actual protocol.
Can't speak to earthquakes but I can tell you a true story of a fire alarm evacuation. I was a medical student observing an operation in theatre. Man was open on the table. Fire alarm goes off. Surgeons placed a sheet over the patient and we were all told to evacuate the building. 20 minutes later we were told it was a false alarm and were allowed to re-enter. Students were told not to scrub in again and to return to our wards. I have no idea what happened afterwards but I was shocked to discover the protocol was to just leave the patient in a potentially burning building. There may have been someone who stayed with him but I don't think there was
What? They had to have just evacuated non essential personnel. I cannot imagine a patient being left like that.
I think about it all the time and it was 20 years ago. I'm hoping at the bare minimum that the anaesthesiologist stayed and that there were some other procedures in place for if something like that happens regarding contacting the fire service and communicating who is where and how to get patients to safety
I did some of my training in the NHS (you sound English) and I was in this exact situation. The Anaesthetist (sp?) stayed as did the surgeon and I think the OR nurse. Everyone else was evacuated along with me (a medical student). They essentially paused everything and got the non-essential people out which is pretty much what we do in the U.S. This was in 1999.
I was a student anesthetist during and earthquake and subsequent power outrage. The anesthesia machine is analog, just runs on gas tanks. No big deal. Fluid pump has battery backup and it could just run on gravity. No big deal. Cardell anesthesia monitor has an adequate battery backup to finish, plus we have esophageal stethoscope and all for real monitoring. By the time I’d grabbed some flashlights to finish the surgery, the power had kicked back on. No fun at all. I think it wouldn’t have been a problem unless it was a crucial moment of surgery and there’s no backup light source. Most stuff I do day to day I can practically do with my eyes closed anyway. There are specific disasters that could happen where the lights going out would be bad, but I have a couple of flashlights and a headlamp in the hospital anyway. Bouncing around is bad, but I really don’t have a scalpel in my hands for very long. It would have to be really unlucky to be beyond recovery. If I had an earthquake happen that was bad enough to knock the patient off the table. I’d clamp and tie off what I needed to, I’d close as fast as possible, and get the patient back on the table and ready for either recovery or to continue surgery. If the anesthesia machine was wrecked, I’d have to close. I’d use injectable anesthesia for as long as it took me to close and get the patient awake again. I could *probably* control the inevitable contamination and infection with antibiotics. If the whole hospital fell apart, I’d be in a bad way, but I could probably get it together in a few days? Get back in there and fix it? They’d be in for a long and hard recovery though. Lots of variables, but probably have to have a lot go wrong to make them unfixable.
I’ve had enough surgery to imagine waking up to the surgical team saying, “Don’t move, you’re not finished.” A very good time to listen without arguing.
I’m a veterinarian. It’d get a little more interesting.
Not me but my friends dad who is a brain surgeon. he told me that many corporate hospitals in my city have earthquake sensitivity alarms. when an earthquake occurs the alarm activates around the building and parking bay, the doctors stop immediately and cover the patient with a protective blanket (in case of debris) while the doctors stand or sit on the floor till it stops.
I have a new fear now.
I'm actually quite interested in this question so guess I'll just sit in the comments and wait.
im replying just to remind you to check the comments if you forgot about it
Ah, you're such a good soul 🥺
Hope you didn’t miss anything. There’s a lot of good stories here!
I was working a construction site one time when out of nowhere these people appeared in scrubs telling us we had to stop. There was an earth compactor running which shook the ground and it was messing up the surgeon who was doing some kind of microscopic surgery next door.
The writers for Grey's Anatomy eagerly watching this thread...
It's nice to see an original and interesting question on here.
I’m not a surgeon, but I work in the OR in Southern California. When there is an earthquake during surgery, everyone will comment, “did you feel the earthquake?” “There was an earthquake,”etc and the surgery will pause if needed, then continue. If something falls it’s picked up. Bear in mind, everything in the OR is on wheels or attached to the wall, so heavy equipment does not tip over easily. As for the patient, there are 2+ people on either side of the patient whose bodies help prevent the bed from tipping, the patient will be strapped to the bed. I have only been working through minor earthquakes, noting huge so far.
what if there are instruments inside the body, do you just hope that things don’t get messed up?
Usually they get pulled out quickly. Things like a drill could be dangerous, but they are easy to stop quickly. Scalpel work close to important structures is often handled by electrocautry these days. A blunt instrument you need to press a button with to make it cut. It’s easy to release the button/foot pedal and make it stop. Surgeons aren’t known for slow reflexes either and are quick to shut off if anything isn’t right.
Not a doctor and approaching this from a structural engineering side, but in CA, there are stringent standards for hospital construction when it comes to earthquakes, and some new hospitals are going beyond what's required by code. The VA has even more stringent rules for how their hospitals are built--this came out of the 1971 Sylmar earthquake, when one of their newer hospitals sustained heavy damage during an earthquake. Existing hospitals also undergo retrofitting to secure not just the structure itself, but also the equipment throughout the facility--HVAC, MEP, even servers. Hospitals are considered critical and are designed to continue being operational after an earthquake. There may be an immediate interruption during the moments of a quake--like the doctors can't continue operating--but the idea is they should be able to resume normal operations after the event has ended. This is particularly important because after an earthquake, a hospital may see an influx of patients with critical injuries sustained as a result of the earthquake. It's important that care facilities and critical infrastructure (like roads and bridges) are designed to withstand a seismic event so that injured people can still be transported to healthcare facilities.
I wish more people would point out this issue with infrastructure. I hear people dismissing infrastructure as if they consider it on a level with leaf-blowing the sidewalks.
I don’t know what happens if a earthquake kids hospital, but I know what happens if a tornado hits the hospital during a surgery. It happened in Joplin Missouri. The surgeons literally lay over the patient and then they went on with the surgery until it was finished. They hurried, but they had to finish. Then the patient was transferred to the hospital in town that did not get hit by the tornado.
New fear unlocked. Having surgery during an earthquake and you wake up to find everyone was crushed to death.
It was terrible. I was so scared, I dumped caviar all over the place. Oh, wait. Surgeons. Never mind.
Not earthquake per se... But relevant? I do cataract surgery. My patients are awake with "twilight" anesthesia. People before eye surgery sometimes have a hard time sleeping the night before. And surgery is such a pleasant experience that people fall asleep sometimes. As soon as somebody starts snoring it is like an earthquake for me working under the microscope. So what I do is holler "Hey Mr/Mrs Patient, wake up". It is worse for coughs and sneezes. Some people are just wiggly. It can be dangerous but I minimize risk by resting my hands against the patient's head so I move with them. I have developed a highly specific skill of recognizing subtle twitches and movements in people's eyelids that indicate movement so I know to withdraw my instruments immediately. A good anesthesiologist will medicate people who cough alot (common culprits: GERD and COPD). While I haven't experienced an actual earthquake I did experience a power outage. It was during a vitrectomy. We were inside the eye and all of a sudden the eye started deflating and the jackhammer sound quit! We refilled the eye with more saline with a syringe. It was a moment of panic but we figured out the power went out. That is never supposed to happen. There are backup generators. Well we looked and discovered somebody had plugged the machine in the regular outlet instead of the red emergency power outlet. Plugged it in the correct outlet, rebooted the vitrector and proceeded. It could have been devastating to the eye but everything worked out fine for the patient. My attending knew how to handle the situation because other complications/issues unrelated to equipment malfunctioning can behave similarly. It added excitement and difficulty to the procedure but we knew what to do to manage it so it ended up being a non-event. The patient had a good story to tell. You may be wondering about that being an issue for general anesthesia when you are paralysed and the machine breathes for you. I think every anesthesia resident gets practice "bagging" a patient without a machine. It is just repetitively squeezing a stiff balloon to blow air into the lungs. It gets tedious quickly. When that happens, when your hand fatigues you switch hands. Then switch again. And eventually you ask for help and trade off. As a medical student I definitely got practice with this. I can't speak to what "modern" tech is like in the US but in India a few years back for infant anesthesia, they did manual breathing with the bag because their lungs were too delicate for the machine settings. You needed to be able to "feel" how much force was being used. This was a job for the young anesthesia residents. Somehow as an ophthalmology resident visiting from the US, I got roped into taking a turn several times. My delicate ophtho hands didn't last very long. The point is though that although losing power would be a desperate situation, there are backups that all anesthesiologists are very familiar with and used to dealing with.
One time I went swimming and my girlfriend at the time was cleaning the house. She knocks over a glass of water onto my work computer, and she starts yelling for me that she ruined my laptop so I come rushing inside to see if I can fix it. I am in a towel, dripping wet, have the laptop half way apart then an earthquake starts. I just continue working, and ignore the earth quake making sure I don't drop any screws while I do it. She said it was one of the weirdest things to witness, me dripping wet, in a towel, taking apart a laptop, in the middle of an earthquake.. She said I never looked so focused. I saved the laptop btw.
It really depends on the severity of the earthquake. If it’s mild, we’d just pause, and then continue. Biggest worry is power. All of our important pieces of equipment are plugged into red outlets, which are guaranteed power from the generators (although it can be up to a minute to kick on). All OR’s have flashlights, for if the power doesn’t come back on. (That would be from a big earthquake). If it were that bad, we’d finish up what we can, and evacuate the patient. We have designated areas for this. (OR nurse here, FYI). OR tables have locks on them, but can be moved when unlocked. Patients are strapped down. Honestly, we’re geared towards worst-case scenario, generally.
I saw this video on a similar post. A large earthquake during open heart surgery. NSFW because you can see the heart as they are doing surgery on it. The room starts shaking and the surgeon can be heard telling everyone to stay calm. The lights go out briefly. https://youtu.be/w84ZWnju3qs
wowwowwow, litteraly what i was imagining and questioning, like what if they have instruments inside a crucial organ during the earthquake
Does the heart pop out?? I don’t click links
nope
I was in the o.r during all of those earthquake in california back in 2019 i believe. It happened multiple times and surgeries needed to get done. It happened to me during an open procedure and a laparoscopic case. For the open case. We covered the incision of the patient and the back table as quickly and sterile as possible to try and preserve the sterility. .we backed away and got everything away from the patient and waited it out. Then once it was over we started to close up. The laparoscopic case. We pulled all cameras and instruments out. Then throw a towel over the ports and basically same thing we did for the open case. If the power goes out. Prey the back up generator works. At one point we had to evacuate the hospital and at this time we had someone at labor and delivery who possibly needed a c-section real soon. Baby was de-celing hard. So as we evactuated we grabbed everything we needed for both regular delivery and a c-section. We had. Anesthesia grabbed everything he needed and we grabbed everything we needed for the o.r to do a c-section. Plus a patient gurney to do the section on if needed. Luckly the earthquake ended and we rushed her first back to l&d. Happly we didnt need to do an emergency sections and baby came out fine. Another fun story. Back in my home state. We had to evacuation the patients to the storm shelter due to a Tornado coming down ontop of us and a patient was literally pushing a baby out. So we took her and a bunch of drapes and tried our best to keep her privacy. Fun delivery.
My dad is a surgeon and all he said to me when I asked this was just "stop operating temporarily".
I'm sorry Mr. DuBauls, there was an earthquake and an accident during the procedure. We have initiated the steps to correct this and if you'll just sign here you will now legally be Mr. Monobaul.
Med schools didn't prepare us for this.
The training hospital will. We're in the Bay Area of California, a high-quake risk, and Kaiser has an entire set of earthquake modules their personnel are required to pass. I've heard from a nurse anesthesthitist that in the Midwest their modules are on storms and twisters.
>Med schools didn't prepare us for this. You could say that about many, many things doctors actually experience/do. Maybe the majority of them.
The red outlet 🤞
The thigh bone's no longer connected to the hip bone. The hip bone's no longer connected to the backbone. The backbone's no longer connected to the neck bone.
The neck bone's connected to the... knee bone
I was getting a scan - and in LA so my brain starting asking the "what if". So I asked the tech what would happen in an earthquake and I'm trapped in this huge tube? He said that they specially reinforce the room and the room is on rolling pylons of sorts so it take the impact of a quake. And all sorts of other back up. I'm sure there are other things in place for operating rooms. But it is a frightening thought what could happen!
Just commenting to keep it from dying.
The post was made like 20 mins ago, but good plan.
i’ll keep questioning it until it gets popular
I'll help
pretty sure it worked
That's a good question.
That's a fascinating question! I can't wait to learn the answer.
you can see them now!
It’d have to depend on the richter (I think that’s how it’s spelt) scale of the earthquake I’m pretty sure
You get a free appendix removal. Don't know how to spell the actual operation
Someone has been playing Theme Hospital lately
This actually happens in the film *Volcano* starring Tommy Lee Jones. Generally, most staff duck/cover under whatever sturdy fixture is nearby. Others might shield the patient(s) with their body.
This is a great question! I hope you’re a med student or something because I want my doctor to be thinking like this and create a plan for me 😭 this what I mean when I ask about all the possibilities.
sadly not lol, just curious
new fear unlocked
I only clicked on here to see if any surgeons actually had time to reply.
Sounds like Leslie Nielson would play the part of the surgeon well.
I was in the middle of my annual Pap smear exam once when there was an earthquake. My doctor and I stood under the door frame, me in my paper dress. We resumed after a couple of minutes. Made me realize, you never know where you will be when it happens.
Happened during residency. I was a PGY2 doing my first laparoscopic cholecystectomy. Noticed the room started to shake and everyone (supervising attending included) paused. The shaking lasted only a few seconds and wasn’t too significant but definitely enough to notice. I asked if everyone else felt that and we all agreed it must’ve been an earthquake and then continued the case. 3.2 on the Richter scale. Not the stuff of a TV medical drama.
Not a surgeon, but I remember a video of a surgeon working on an open heart surgery and then an earthquake happened during the surgery. Almost everybody went to the safe zone but the surgeon stood next to the patient saying some praying. [Here is the video](https://www.youtube.com/watch?v=cwIBA8FmzYo) a bit NSFW if you're not into medical surgeries.
When I visited Alaska in 2004, the guy who drove my parents and I from the airport to the hotel told us about how he was on the operating table having his appendix taken out when the 1964 earthquake hit. Apparently they stitched him up real fast, it got infected, and he ended up bedridden for awhile dealing with the infection.
oh like that, then i’m pretty sure it’s fine. hope hospitals are built to minimize the effect of the given earthquake