The Northridge Earthquake 1994: A Tale Of Two Perfusionists

The recent earthquakes in Japan (April 15, 2016, 7.0 magnitude) and Ecuador (April 16, 2016, 7.8 magnitude) brought back the grim reminder of how fragile life is. From the death toll to the devastation of property, you may think you are prepared but, to paraphrase an old military truism: “All the best laid plans are forgotten with first combat”.

Ric Narvaez and myself have experienced some profound moments in our life. Moments that are etched in your memory to the point where that date, a certain smell or a musical chord will bring back a vivid reminder of where you were during that, more often than not, very unhappy and unsettling time. One of those events for the two of us was the Northridge, CA earthquake of 17 January 1994.

It started out for Ric a day earlier at Northridge Hospital, fifteen miles North of Los Angeles in the San Fernando Valley. He was the Perfusionist in charge, managing a very sick and fragile male undergoing a CABG for complex coronary artery disease. Each attempt to wean the patient from bypass would cause the heart to fail. The surgeon decided to insert an IABP while back on bypass. Again, the attempt was made to wean the patient from bypass only to witness ventricular function begin to fall. The surgeon decided to insert a Left Ventricular Assist Device (LVAD) to compensate for the failing LV. Initially, the LV showed signs of improvement. However, right ventricular pressure remained high and would not respond with conventional treatment. A  decision was made to insert a Right Ventricular Assist Device (RVAD).

This accomplished the expected unloading and the patient was stabilized and weaned from bypass. He was transferred to ICU with an open chest, right and left VAD plus IABP.

Ric took the night shift, monitoring the patient along with his attending machinery in ICU. On 17 January 1994, at 4:30:55AM, the Northridge earthquake began.

The earthquake had a duration of approximately 10-20 seconds. The blind thrust earthquake had a moment magnitude of 6.7 (if you have lived in Southern California for any period of time, you become familiar with the vernacular). The earthquake produced a ground acceleration that was the highest ever instrumentally recorded in an urban area in North American, measuring 1.8G, with strong ground motion felt as far away as Las Vegas, 220 miles from the epicenter.

The epicenter for the Northridge quake was literally walking distance from the hospital. The building began to shake violently, with mainly its movement going vertical.

The analogy that has been used for blind thrust quakes is that it’s like the effect of a bullwhip creating a sonic boom. The epicenter is the handle with energy traveling out to the tip. The “tip” in this case was fifteen miles out, where substantial damage occurred.

In the Intensive Care Unit at Northridge, along with most of Southern California, main electrical power went out. The IABP as one console, the BIVAD’s as another console…and the patient…all bounced in separate directions. The room without power, was rendered completely black…absolutely no visual cues. The ceiling tiles, along with the light fixtures, began to fall…along with thirty years of accumulated dust from the ceiling. Glass windows and partitions shattered. Monitors and televisions fell from their wall or ceiling mounts. Remember, this was well before flat screens.

Electrical power from the emergency generators came on, albeit, with a forty-five second lag, which felt like an eternity. Occasional “power outages” from the emergency generators would occur over the next six days. As mandated by California Code, although I believe this mandate is now nationwide, all equipment deemed necessary must be plugged into outlets marked with a “red dot” denoting it is attached to the emergency generator.

There were several thousand aftershocks in the ensuing days, some as great as 6 or better. The death toll came to 57 with more than 8,700 injured.

Ric had called me to see if I would cover call prior to the earthquake. I lived in Santa Monica and since Ric and I knew each other for over 20 years, I would occasionally cover call for him on the weekends.

For the first time in my life, traveling the 405 freeway North to Northridge was totally desolate and very surreal. The only other time I remember that feeling was the day of September 11, 2001.

Getting off the freeway at Roscoe Blvd felt like a scene from “War of the Worlds”. Water pipes that burst flooded the street while gas mains that exploded caused flames to shoot up through the water. Mix in the retirement homes that were struggling to move patients out on the street while the flooding and fires raged…and I thought of that line from “Airplane”: “I picked the wrong day to stop sniffing glue”.

When I arrived at the hospital, my first visual was that the building pancaked onto the first floor Emergency Room. As a result, they were triaging hundreds of patients in the parking lot. Little did I know that I would not go home for four days.

The CEO of Northridge was a true visionary. When plans had been drawn up for a new wing of the hospital, he insisted that the new wing be on rollers. Structures hoping to survive an earthquake require mobility and flex. If it’s rigid, a quake will destroy it. The hospital was designed so the new wing would separate from the old…and it did…by over 4 feet. The only problem was; the old wing contained the operating rooms and the new wing contained ICU. We had to place plywood boards for our makeshift floor. Ever wonder how much an ICU bed with patient, anesthesia, nurse and you weigh? Crossing 4 feet of plywood flooring two stories up? We will tell you collectively, with each crossing, we all felt it did wonders for our sphincter tone.

And, the coup de grâce: Our patient was weaned successfully from the IABP and the BIVAD’s and extubated.  He reached a point where he was wide awake and lucid and could sit in the ICU chair for extended periods of time. During one of these relaxing periods in the chair, his implanted pacemaker created a dysrhythmia, causing him to arrest…and he expired.

Please conduct and practice “what if” scenarios for anything your geographic locale could throw at you. You will never regret it.

“It is no small thing to stop a beating heart”

Chris Kyle 2013

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Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.