Uh, good afternoon everybody. I got Stephen Hartz here with the H&H Impact. This is podcast number 18. And I have some outstanding guests with us today. I have Pat Songer and Charles Blankenship with us.

I’m gonna go ahead, you guys know all about me doing this for some time, but I’m gonna go ahead and let Charles introduce himself, and then I’ll let Pat go and introduce himself. So, Charles, tell us a little bit about you, buddy. So, Charles Blankenship, I’ve been in EMS for about 33 years, and currently president-elect of the National EMS Management Association. And also work my day job as a support services division chief for the Mobile Integrated Health System of Novant Health here in Wilmington, North Carolina. Awesome.

Thank you, Charles. Pat, reintroduce yourself. You were on a podcast earlier this year, but just to refresh everybody’s memory. Yeah. Surprised you asked me back.

I’m Pat Songer. I’m the EMS chief for Central Valley Fire District in Belgrade, Montana, just outside of Bozeman. I’ve been in EMS just a little bit longer than Charles, about 34, 35 years. Um, been in throughout my career through the hospital systems, flight systems, fire districts, and, uh, for-profit, non-for-profit, kind of been all over the place. Awesome.

And, and so our podcast today is one kind of a little personal to me. I want to talk about the earthquake I was in in Colombia back on August 10th. But, you know, we want to take that and then talk about how this leads into your emergency action plan that most organizations have and oftentimes how they don’t work like the way we hope they will. And then, you know, as leaders, how you have to be adaptable and flexible to those situations when they arise, because, you know, the best laid plans work until they don’t. We know that from the military and that’s what happens.

So we’ll start off by recapping. So on August 10th, about 7:30-ish, 7:34, I think exactly, I was in Pereira, Colombia, which is up in the mountains, and the earth started to shake. I didn’t notice it at first. My wife did. She actually jumped up.

We were sleeping and said, earthquake! We ran into Luciano’s room, my son’s room. He’s about 10 years old. Grabbed him, and by the time he got out of the bunk bed and we were going to try to head out, it started shaking so violently we couldn’t even walk. Um, to the point where we just basically braced ourselves inside a door jamb.

And it seemed to go on for minutes. You know, I tell my wife, I swear to God it was 3 minutes. But it just- the shaking did not stop and it started to get more and more violent. In Colombia, most of the properties are solid concrete. There’s no drywall.

There’s no wood. It’s all the buildings are built out of concrete. And I really started to internally be fearful when I started to see large chunks of concrete falling from the ceiling, from the walls. You start to see the walls in the, in the condo we were in actually start to separate and split. And my concern was the building was going to collapse.

And so after it had finished shaking and we had just enough time, I grabbed my cell phone Sandra and Luciano were still in PJs and we ran out and then down 9 flights of stairs out into the street. And by the time we had gotten into the street, we had saw several buildings around us collapsed. Um, one of the buildings to our right was owned by a pharmacist and the building had collapsed on top of her. You could see one of her legs exposed, uh, but she- it had- it was very clear that she had- was deceased. You still had the concrete in the air.

Uh, just that, that heavy thickness from all the shaking, uh, debris all over the streets. And then we saw the building across us from the park was a 4-story building had collapsed and just a cloud that was rushing towards us. Um, we probably waited 20, 30 minutes. We wanted to make sure that we weren’t having another tremor. They actually did around 8:20.

There was a 5.4 tremor. Uh, but once all that shaking had stopped, my wife and I realized that we had no way to leave the country without our passports. And so she ran back upstairs to grab our passports and, and a quick change of clothes for her and Luciano, came back downstairs. Um, fast forward about 2 and a half hours, we were finally able to get in touch with my, uh, brother-in-law. Um, cell phone service was sketchy.

Um, but we were able to get in touch with him and he was able to come get us. He was about 15, 20 miles away in the country. They felt it, but not to the degree as the city. He parked about 3 miles away and then trekked up to us to help get us. And then, you know, we proceeded to evacuate the area.

But as we were walking out, the devastation was continuous block by block. Roads were closed. Ambulances couldn’t go from roads. You had a constant smell of gas in the air. There was everybody needing, not everybody, but a significant number of people needing emergency medical care in some way, shape, or form.

But you also saw things like the community coming out and, you know, starting to clean up immediately. People going through the rubble of partially collapsed or fully collapsed buildings looking for survivors immediately. My brother and I, brother-in-law and I helped an elderly man come down 7 flights of stairs in a wheelchair because his family didn’t know how to bring him down or what they were gonna do. And so there was a lot of that. And this, what I noticed there, and having been in EMS in the ’90s and then, you know, doing the search and rescue air medevac side later in my military career, was the plan that the city had had to have failed.

There was no way for the city to do what we would expect. They weren’t able to shut off gas or electricity. Quickly enough. All the ambulances and police were limited on how they can maneuver because so many streets were blocked and closed. So even some of the most in need weren’t able to get services.

The local hospital just sent nurses and doctors on gurneys running up and down the street looking for people to help. But it was just interesting to see that aspect of it because I hadn’t seen anything like that. You all have been in emergency medical services for, you know, between the two of you, greater than 60 years. I know you guys have been through natural disasters. I’d love to hear your perspective on natural disasters and what you’ve seen with, you know, the big plans that people try to put together to help.

I’ll start with you, Charles. Yeah, so, um, with my years of search and rescue, we got called into a lot of disasters, not actually being in them as they happen. But, you know, a lot of it is more, uh, floods and mudslides and wildfires. Um, not blessed not to have been in an earthquake. Um, but a lot of the things are the same, you know.

And most recently here in western North Carolina here, uh, they dealt with that with Helen. Um, fiber and cables and all were cut. They lost power. They didn’t have good water. Uh, and instead of damaged buildings, water cut everything off.

So, uh, it’s kind of the same kind of thing where, you know, you have most commonly what is really a mass casualty plan. Uh, it’s not really a disaster plan. And then most people don’t look at it as a total catastrophe. So, you know, you have to think about that, um, there’s a lot, and I’m sure it was there. I haven’t read everything, uh, from that incident yet, but, you know, hospitals can be impacted even just not having water.

Um, we had situations at our hospital where we would bring in tanker trucks just to run the chiller, uh, just to keep the hospital cool. And so, you know, if you are completely cut off from water, your natural gas supply is cut off, or those kinds of things, it Everything escalates. Um, and probably the biggest thing that, that people don’t plan for and be, you know, having to deal for in these situations is how do you communicate with your staff? You know, if your main comms is cut off, which is everybody relies on cell phone, um, how you going to communicate? And so we see that a lot and trying to improvise that on the go.

Yeah, I would reiterate that piece on the comm side because I saw, you know, cell towers typically go down, the electricity goes down. You know, I’d been in hurricanes before, I’ve been in earthquakes, real minor ones, you know, flooding and things like that. To me, the thing that was really unique about this is one, you have no forewarning. Like typically with a hurricane or big rain swells or sometimes even the fires, you have a little bit of warning. But the earthquake was just random.

And then you lose electricity, you lose water, you lose ability to communicate, and then you lose your structure. So, you know, the need to have a place to go. Later that night when we were driving back through the city, seeing so many people just pulled out their belongings and literally living on the street, you know, and open to the elements and everything. But those are great points, Charles. Pat, Let me throw it out to you ’cause I know you’ve seen some wildfires and everything where you’ve been at.

Yeah, I think, you know, listening to you and what you went through there and wondering, you know, what plan is in place to work, and I reflect on some of the disasters I’ve been through at a smaller local level, you know, we all are very keen on putting out the emergency operation plan, especially in hospital operations and county operation, and they’re well-baked plans. They’re, you know, a 4,000 And we find that what they are is just a living document and a living document at the time, but they’re a document that is best utilized as a reference guide to available resources, numbers, communications, where things are at, and not a plan that says you’ll go down the street 10 feet this way and turn right and go down the street 10 feet that way to be safe, or we’re going to set up the emergency operations center here because inherently that place is either destroyed or you can’t get electricity to it, especially in small rural areas. But listen, you know, then listening to Charles and what he’s saying there, I think the times I’ve been involved in these, everything always comes down to communications. Communications fail somewhere. And as we review and look at emergency operations plan, it’s that communications to your staff and to the staff’s family or our immediate family that is so vitally important in these operations.

And looking back on that text I received from you, Steve, that said, I’m okay, and I was like, what the heck is he talking about? I’m okay? Not knowing anything and not paying attention, but getting out just that one communication to- I consider myself part of your family, that immediate family- that everything’s okay. But that’s where I’ve seen failures happen, which creates this stress level to go up, anxiety, and then miscommunication on what resources we do need to get back in. So if I’m looking at like, you know, lessons learned from things is how do we immediately communicate with our staff in ways that we know that are going to- in other ways other than the ways we know that are going to fail?

And then how do we assure that they can communicate with their families so that their family knows that they’re okay? Because it becomes one big network at that point in time. Those are great points. I, you know, I think the challenge is most organizations don’t have redundancy in some way for communications. You know, when we were in the military, we were lucky.

We almost always had a battery backup. And then from there, you know, we had SATCOMs or other ways that we were able to communicate that just didn’t involve radio towers. But most organizations don’t have that capability. And if they lose just basic power in their communities, that typically takes down cell phone towers and then you’re out of luck. You know, the, the plain old telephone systems that we used to have back in the day that people were like, oh, they’re always a ring.

Most of those don’t even exist anymore. And I think that’s a huge piece. You know, I think the other thing that people forget is that, you know, when you start to lose all the basics and you start thinking about, well, you know, water, electricity, food, and then you start thinking about your families, it becomes very hard to concentrate on solving everybody else’s problems when you’re worried about your own problems, your own house. And that was prevalent here, is everybody also had damage to their own properties. Everybody else also had worried about their families.

And I thought that was unique and from what I had seen in other disasters, because everybody was facing the same thing, even those providing the services that we most often rely on.

Charles, I’ll throw it out to you. I know we talk about emergency action plans. Most of us have done tabletop directions. What I found out about this or what I thought was interesting is when those are done well and you really know how to execute that, it makes it easier when things don’t go the way you plan for, right? So you can flex pretty well and you, I know being a military man, you’re familiar with that.

Can you talk to me a little bit about the value of that and leadership on that ability to you know, strictly adhere to the way the plan’s supposed to be, but when it doesn’t, how do you adjust? How do you flex? Well, it goes to, uh, you know, there’s that old saying that says planning is everything and plans are useless. Um, and I had a great, um, gentleman from out in tornado country where the hospital actually did, in their EOC, rip apart, and literally the plans got sucked out the window. Um, but the thing that that saved them was that they had the plan and they had worked the plan.

So the key point is that you can have great plans. If they’re never exercised, if you never do a tabletop, if you never work with your partners within the organization, within the county, within the city, whoever your mutual aid might be, that plan’s useless. It’s the fact that you take that plan and you do a tabletop. In fact, for something like this that’s so out of the normal range, this would be a great time for leaders to take their leadership staff and do a tabletop and say, what if this happened in our city today? What would we do?

How would we handle these things? And walk through, like you said, walk through the communication, walk through the staff and staffing, walk through, you know, how do you get the basics? How do you get food? How do you get water? Hey, where do you have cash of supplies anywhere?

You know, are there facilities still operational you could take people to? Maybe they’re wiped out too, you don’t know. But it’s not just making the plan as a leader, it’s exercising that plan and it’s working together and the bigger working together as in a silo. So, for example, in our world that Pat’s very familiar with in hospitals, a lot of times the hospital will have a big drill or the county will have a big drill. Always have a continuity of bringing everybody together so that it starts in the field, it works with the hospital, through the hospital.

So, all the way to the time they get to the floor. When you do those kind of exercises, regardless of whether it’s an MCI, or trying to plan for a major disaster like this, that’s what brings that utility together because you start to learn what resources your partners have, what skill sets they have, what knowledge they have. And it may be that, you know, that this guy over here, that, yeah, he’s an EM guy, but he used to work for Metropolitan Sewer and Water for 20 years before that. And when you’re trying to figure out how to get water around the city or how to get hygiene going, you know, trailers, porta-potties, any of that kind of stuff, you got a subject matter expert there. It’s not written in a plan, but you’ll never find that out if you don’t work with people.

And it’s got to be working with, with everybody across all the organizations in your jurisdiction to figure that out. And it starts with a tabletop. Awesome. I appreciate that, Charles. Pat, I’m going to throw that same question to you.

You know, when you practice and plan as a leader, You know, you see all the time you’re confined resources, right? You’re limited on time, you’re limited on resources, and then you want to throw training on top of that on something we don’t ever think is going to happen. You know, talk to me in your experience about the values of that planning and then how you’re able to- when you get punched in the face and the plan doesn’t work, how do you flex?

Oh, I got you on mute, Pat.

Nope, got you there. I think there’s a couple parts of this, uh, that is very important when you’re planning.

Um, leaders develop the plans, and sometimes we forget to push those plans down to the lowest denominator because it’s- in my experience, that disaster never happens unless you’re on vacation in your case, but that, that, uh, in our cases, that disaster happens when we’re on vacation And the people that are on the front lines sometimes are the lowest denominator in the pool. They’re the line staff, they’re the hard workers. And we forget sometimes that we need to push those plans out to them. We need to train with them. We need to have them pick them apart, do tabletops, as Charles said, with them so they understand how that plan works and how that plan’s a living document and that it’s not just black and white.

I think the other part about plans is we need to really educate that an EOP is something that can expand and contract as needed as the event folds out. One other thing I think as leaders we need to put out there is I found in my career that we’re sometimes reluctant to implement the plan, that, oh, it’s not going to get that bad. Oh, it’s just a start of something. And I think that we should as leaders consider implementing our plans and activating our plans sooner than later so that we can get 2 steps ahead, getting people back into our location. And as leaders, we need to be attentive to the fact that when we’re not there, we need to be there somehow.

We need to return to work. We need to come in and support. We need to be part of that supporting mechanism and not sitting somewhere in a cozy motel just thinking about other things that are happening out there. I think that’s a great point. You know, I think you bring up a Both of you bring up some really good points on both sides.

I think, you know, in my experience, and I use my military because it’s the most recent for me, we used to plan and exercise. If we were going to go execute a mission, we would do that mission. We would plan it and run it over and over and over again. And then our instructors would sit there and say, okay, now this helicopter is going to go down, or this commanding officer is now, he’s been taken out. And then learning how to flex to each point of that.

In my experience of working with plans and emergency action plans for either hospitals or EMS is I see a lot of times people look at the very basics. They don’t- willing to deep dive, to your point, on going a little farther or pushing it and flexing it. And then the other thing that I haven’t seen a ton of, at least in my experience, and most of this is with the rural, real rural locations, is the follow-up, the debrief after. And then what are you going to do to change your plan to put in that second, third, fourth contingency when things happen? I think having the plan and trying to run your plan as best you can, but then learning where your mistakes were, right?

Learning that, hey, we didn’t charge the batteries. Yeah, we thought all this equipment worked, but it’s not there. I can’t tell you how many times we’d run exercises on a ship and you’d go to grab something that’s supposed to be in that spot because that’s where it’s labeled, and then you go to grab it and it’s broken. It didn’t work. Nobody’s op-checked it.

Nobody’s done maintenance on it for a while. And then all of a sudden your equipment’s down and now you’re you know, up the creek without a paddle. You know, I feel that, you know, in the EMS world, we do a pretty good job of addressing those things. I just think that there are opportunities to do it better. And I hope that people will take these kinds of lessons.

I think about, you know, Charles, where you were at in North Carolina, all the floodings you guys have had in the past. Pat, in the last 2 years when you were out in Washington, you had flooding, you had fires. I mean, it is nonstop. You know, if you had to give a couple pieces of advice for those leaders out there, you know, what would be the top 2 or 3 things that you would recommend for leaders to kind of take out of this podcast or these experiences to kind of take back to their houses, firehouses, police, you know, EMS? I will start with you, Pat.

I think these are great points. I think one thing, we all need to do is we need to make our failures opportunities, and we need to be really transparent about it, and we need to hot wash the event or do an after-action quickly after the event happens with the whole team, even the team members that were not involved in the event but are part of your team or part of your organization. And then we need to publish that. We need to get, get that message out there of where those opportunities are, and then we need to immediately act upon those opportunities. We didn’t have enough battery stocked up, we didn’t have enough water stocked up, if we didn’t- if we had failures in systems, get those systems corrected right away.

Don’t sit on them and contemplate on them and put a committee together that this all ends with death by committee and we don’t have a good setup for the next time this- the event happens and we can move forward as a stronghold. Awesome. Thank you, Pat. Charles, what are your thoughts? Well, number one is, uh, tying into what Pat was just talking about, is, is take the lessons learned.

Um, you know, I always try to pick up at conferences and go to someone who’s been to some of these major disasters. There’ll probably be, uh, some good presentations on Helen still coming, and I’m sure post, uh, this, some of the task force guys that come back from USAR will have some good stuff in Columbia. And to, you know, take those lessons learned and could that happen in my community and how could I use that in my organization and try to apply that to it because everything is different. Um, you may not have, you may have drilled and drilled and drilled and been there in that county for 20, 30 years and we’ve never seen that, never going to see that. And then suddenly the winds changed literally and something different comes down and without having that exposure to experience, it doesn’t prepare you as well.

So read out there on, on some of the after-action reviews from some major incidents like that. Read up on- even if you, you don’t read after-action, just read what happened. Pay attention. Look at some of the, the video footage from these events and things and think about how can I make my plan. And, and, you know, all the way down to, hey, if we have to communicate by runner, what’s our system for doing that?

How do we, how do we get people And how do we get them in? Because that’s, that’s your first and foremost, is your staff and getting in and out of places. Um, the resources are things that, that you can problem solve either before an event, after event. But the other thing that I think is, is really important is we need to also look at when we run these tabletops and we get these after-action reviews from our drills, We need to be taking this to the next level and working with emergency management, emergency preparedness in our areas, and looking at some of these things that we discover and saying, you know, we could mitigate that. You know, we could prevent that from even becoming a problem if we did XYZ.

You know, sometimes it’s simple things. You talk about wildfires, and I know Colorado Springs, uh, went through some terrible ones there, but One of the things that they had learned was, you know, they did this little program and the fire department got the civilian populace to buy in and literally just picking up sticks in their yard, just a little extra debris and stuff, was a huge mitigation factor that, that played in when they had some of the major fires. So how can I take this disaster and take this tabletop or take this drill that we just ran And what are some of the things we learned that we could actually completely mitigate from happening? You know, you don’t have to deal with it if you can prevent it. So how is that?

Where is that possible? And, and that’s the biggest thing. And the last thing is, again, you’ve got to get out. You’ve got to exercise the plan. You’ve got to work with other organizations, people maybe that you wouldn’t think about working with.

Like I said, sewer and water folks that you don’t think you’re going to be working with on a daily basis, but There’s a lot of different departments within organizations that will cross over when it comes to a major disaster like this. So you need to know what’s there and who’s available. That’s a great point, Charles. You know, I was thinking about that is I remember we’ve run a lot of drills or exercises and we don’t necessarily include all the players. We do what’s in our mindset, but I remember, you know, some of the exercises we do, our evac or our quick reaction force is the Army.

Or a Marine Corps force that we never engage with. We never brought them into any of the drills, right? And so doing that cross-coordination, you know, if you’re EMS and you’re working fire in the hospital, who else can you bring in there? I thought water sewer is a great example. You think about even locally when you think about some disasters like school shootings, you know, we don’t see a lot of tabletop exercises that include the school on how they would respond and things like that.

It’s challenging, but I think a lot of times those things need to occur. So, well, listen, we got about 2 minutes left in the podcast, you know, and what I look at in these disasters is opportunities. I think Pat said it right. We look at these opportunities that we can evaluate what we can do better in your organizations, what we could do better as leaders. I think my big takeaway that I had from this experience is one, having a better understanding of being prepared.

I take for granted that, you know, they haven’t had an earthquake there in 20-some-odd years to that degree and magnitude. I feel pretty prepared most places, but I was lost, you know, at that moment. I wasn’t sure where I was going to go, what we were going to do, how we were going to get out. Our passports were spread out throughout the room. Our cell phones were all over the place, you know.

We didn’t even have a quick bag that we could just grab and go. And I know that may be immediate reaction on, you know, having a go bag. But, you know, I would ask you, you know, when you guys think of these exercises and these things that have happened, you went through the flooding out there in North Carolina, Patch, you’ve been through flooding and fires. What were your big immediate takeaways for your team that you were like, hey, these are the things I need to look at today? I’ll go with you, Pat.

I think it comes back to my statement earlier on communication. I think getting communication out quickly, obviously, on that, on an earthquake event where you’re limited on your communication ability and getting that out so quickly was extremely challenging. But on these other disasters that we see that there’s a little bit of a ramp-up time to, or that you at least have some bandwidth is get that communication out to your leadership, to your staff, to your support units as quickly as possible on how you’re gonna communicate and how things are gonna happen and how you’re gonna take care of them as part of your family and how you’re gonna help them take care of their family. Awesome. Thank you, Pat.

Charles, what are your thoughts? Multiply your workforce by training your civilians in your community. So the old civil preparedness mindset. Uh, there’s programs like community emergency response teams, but there’s some simple training. You, you know, some very basic stuff, whether you’re EMS, fire, hospital-based, whatever you are, you know, some basic first responder and first aid stuff that you could easily share.

You could, just like you were just talking about schools, you could bring it into the schools. You know, simple things like Stop the Bleed campaign and, you know, things, things that are very basic. That if all the community population was trained in, they become additional responders and they’re able to help you when you have a major disaster like this. So expand your workforce by bringing in the volunteers, by educating and working with your community. You know, that’s a great point to end on there, Charles, because I’ll tell you, when I was in Colombia, I saw that.

I saw communities become first responders when they were handpicking through gravel. When I see 20 guys pick up a ton square foot of concrete to save somebody’s life that they know is underneath it, to, you know, even people that were struggling, the local vendors were bringing food and water and stuff out to people because they saw that there was a need there. And I, I do think that’s a huge piece of it. We typically see some of the best of humanity when those issues and incidents occur. Um, but that mindset of kind of training your community to the best possible way to be able to support that is, is great.

So, well, gentlemen, I both, uh, appreciate both of you guys coming on this podcast, um, to kind of give a little, um, insight to this. You know, obviously it was a pretty big experience for me and my family. And, uh, you know, it’s awesome to have a platform to have great, uh, EMS leaders like yourselves to be able to step up and speak to our, our listeners about what we could do. So thank you guys both very much for taking your time to be here today. And for those of you listening in on H&H Impact, this is podcast number 18.

You can listen to us anywhere where you listen to your podcast stories. Thank you guys very much. Have a great day.