Cascadia Rising: thoughts on a Seattle earthquake disaster exercise

BACKGROUND STUDY DESIGN AND METHODS The Cascadia subduction zone off the US Pacific Northwest coast produces a Force 9 earthquake once every 300 years. Cascadia Rising was a regional disaster drill modeled on such an event. Western Washington State has 5 million people and one Level I trauma center. The blood response of the trauma center and region were modeled under the conditions laid down in the disaster scenario. The scenario assumed structural damage to the 1931 reinforced concrete building housing the trauma hospital transfusion service with loss of electricity, data services, and water. The regional blood center, in a newer building located six blocks away, suffered less disruption. The regional blood inventory is in a blood component manufacturing facility 18 miles south of downtown. RESULTS CONCLUSIONS At best and at risk to life, the trauma center could issue universally compatible components at a rate of 60 components/hr from a damaged but still accessible transfusion service. Usable inventory would be expended in 4 hours with no clear mechanism and rules for resupply. The regional center has additional group O red blood cells and AB or A plasma to sustain that rate of usage for several more hours but no protocols for reestablishing communication or push resupply. Regional resources will be gone in less than a day. After a major Cascadia earthquake, blood resources may fail immediately, but even with luck, local resources used emergently at maximal issue rates will last 4 to 14 hours.(c) 2018 AABB