Erica, in the striped dress, helped turn Aero Methow into an impromptu emergency room. Photo courtesy Aero Methow

By Laurelle Walsh

Nurse practitioner Erica White was driving home to Twisp from her shift at Three Rivers Hospital in Brewster, when she learned that the Washington State Patrol was planning to close Highway 153.

It was Thursday, July 17, and smoke plumes from the Carlton Complex Fire towered above the valley. The Cougar Flat Fire was racing toward Loup Loup Pass, and Okanogan County PUD had already switched off power to the valley because its transmission lines over the pass were in jeopardy.

“My first thought was if they close both highways we’re three hours away from the nearest hospital,” across the North Cascades in Sedro Woolley, White said.

Her second thought was that she would have no way to get to her job at the hospital the next day.

So White did what any brand-new emergency room ARNP would do — she was awarded her degree in May — she decided to open an ER in Twisp.

On Friday morning the valley was a disaster area. The fire had left a swath of destruction from the hills above Winthrop to Pateros, the power was out, and both Highway 153 and 20 were closed. The Methow was effectively cut off from the Okanogan Valley, Pateros and Brewster, which had also been dealt heavy blows from the wildfire.

Setting it up

After running the idea of a field hospital-type emergency room past Aero Methow Director Cindy Button, White texted her supervisor, on-call physician Dr. Jimmy Wallace, for permission to set up an ER at Aero Methow. “He said, ‘Stay as long as you need to,’” White recalls.

Next, she talked to Three Rivers CEO Scott Graham about getting needed medical supplies sent up to Twisp. “He said, ‘If this is what you need, we’ll do it.’”

Sheriff’s Deputy Ottis Buzzard contacted the state patrol in Brewster, who picked up needed supplies from the hospital, such as intravenous antibiotics, suture material and asthma medications, and drove them straight to Twisp through the still-burning lower valley.

With additional supplies from Methow Valley Family Practice and Ulrich’s Pharmacy, “We had the ER set up in half an hour,” said Button. “We had everything we needed to operate over the weekend.”

Powered by generator, the MASH-style medical facility was located in Aero Methow’s training room with cots and partitions to allow White and Aero Methow’s paramedics and EMTs to treat several patients at once.

Between Friday evening and Monday morning, they saw 13 patients, White said. “The EMTs took vital signs and did charting, and the paramedics started IVs,” she said.

“We managed most of the emergencies that came in,” Button said. Two patients had to be air lifted out of the valley, which required obtaining permission to fly through the Carlton Complex’s restricted airspace.

At one point there were four patients in the Aero Methow ER at once: one with a dislocated shoulder, one with breathing trouble, one with pneumonia and one who was “very sick,” according to Button.

Planning for future

“I’m very proud of the level of care we were able to provide,” said White. “I would feel confident going to any foreign country and delivering emergency medicine with this team of people.”

The team was aided by paramedics Kurt Hilt and Shaughn Maxwell of Snohomish County Fire District 1 and Dr. Richard Campbell of Evergreen Hospital in Kirkland, all of whom volunteered to help out during the emergency through the Disaster Medicine Project.

The Disaster Medicine Project is a 2-year-old organization, directed by Hilt, designed to “mind the time gap between disasters and medical response,” Hilt said. “The goal is to keep hospitals and EMS [emergency medical services] functioning” during large-scale emergencies, he said.

“We knew the valley was in trouble,” said Maxwell, who grew up in the Methow Valley and worked with Okanogan County Fire District 6 and Aero Methow from 1989 – 1991. “I contacted Cindy [Button] and said, ‘Let us know what you need and we’ll send it to you.’”

Two weeks after shutting down the Aero Methow ER, White was thinking about what she had learned from the experience. “We need to come up with an actual plan for dealing with future situations like this,” said White, who expected to discuss such a plan with Three Rivers’ CEO when she got back from a week-long training.

“I had talked to my colleagues before about how isolated we are in the Methow, but I had never discussed setting up an ER with Cindy,” said White. “My community needed help and this was what had to happen.”

“Everybody did what they could,” White concluded. “It makes me proud to be part of this community.”