As chief of the Gunnison Valley Hospital paramedics, C. J. Malcolm deals with emergencies daily. But when his phone pinged with an alert that U.S. 50 west of Gunnison was being shut down immediately due to a cracking bridge, Malcolm had an instant of heart-stopping alarm.
“I knew it was a huge, immediate 911 deal,” said Malcolm. “My first thought was, ‘this is a disaster.’”
He wasn’t overreacting.
Closing down one of two highway accesses to an isolated town of 7,000 in a county of about 3,200 rugged square miles posed all kinds of potential life-threatening problems.
The closure on April 18 cut off regular ambulance transports to larger towns to the west as well as threatening the overall operation of a small, county-owned hospital that provides everything from deliveries to orthopedic surgeries and handles an average of 20 emergency room visits in a day.
Gunnison Valley Health Hospital functions independently. Its mission as a Level IV critical care hospital is to stabilize patients in one of Colorado’s largest counties — a county that is accident-prone due to a surfeit of remote and mountainous public lands, and residents and visitors who like to challenge themselves in that terrain.
But the hospital doesn’t operate in a vacuum. It has many tentacles of reliance on other hospitals and health care providers and suppliers outside the Gunnison Valley. Many of those tentacles reach to the west, beyond the impassible bridge.
Just how many was quickly evident to a critical incident command team led by Malcolm and assembled with the help of the hospital’s CEO Jason Amrich. They essentially set up a dual operating structure within the hospital. One system would deal with the bridge-related problems while the hospital’s usual chain-of-command organization would keep the everyday operations running smoothly.
“You can’t address an emergency situation from a normal business approach,” Malcolm explained.
Basement room converted to a command center
By the morning after the largest bridge over Blue Mesa Reservoir was shut down with no opening in sight, the hospital’s new critical incident system was up and running. A room in the basement of the 24-bed hospital became an official command center. Teams had formed for operations, logistics, finances and planning.
Whiteboards listing priorities and objectives bristled with colorful sticky notes. A large screen on one wall beamed in those who had to attend the twice-a-day — or more — emergency meetings virtually.
Gunnison Valley Chief Nursing Officer Nicole Huff is one of those who has been trekking to the basement several times a day for command-center meetings that she calls “brain dumps.”
“Lots of out-of-the-box thinking goes on there,” she said.
Problems quickly crowded the whiteboards: Ambulances wouldn’t be able to transport patients to hospitals in Montrose or Grand Junction for higher-level care. Such transports to outside hospitals, including some in Denver and Colorado Springs, happen around 300 times per year. Gunnison has just three ambulances, and the longer transports to the east could stretch their availability. Physicians and nurses who travel to Gunnison from the west wouldn’t be able to get to the hospital for their shifts.
Supplies of everything from linens and sample vials and filtered water to blood and oxygen and chemotherapy drugs could no longer be delivered from the normal western suppliers. Dialysis and radiation patients wouldn’t be able to get to Montrose for their daily life-sustaining treatments. Methadone patients couldn’t travel west for their normal care. The drugs for the hospital system’s senior care center would need to be rerouted from another supplier.
Solutions went up on a board next to problems: Dialysis patients could be sent east to Salida. Radiation patients could be given priority to get over a county road detour to Montrose. Chemotherapy drugs from an out-of-state supplier could be brought in by FedEx from the east rather than the west.
Blood products and oxygen could come from the east during the shutdown. Lab specimens, including biopsies, could be prioritized to get over the dirt-road detour to labs in Montrose. The county could possibly allow medical personnel to get through the rugged detour outside the allowed early morning and late evening pilot car-led openings for local citizens.
Montrose emergency services could handle ambulance cases on the east end of Gunnison County. That happened on the first day of the shutdown when a critically ill person was picked up by a care flight at the west end of Blue Mesa.
One whiteboard shows all the hospital’s important links to services to the west. Another diagrams tentacles to the east that would be able to continue with trips on U.S. 50 over Monarch Pass. Arrows showed what could be shifted directionally.
“We are super connected. This shows impacts all over the Western Slope,” Malcolm said.
June 1 of summer tourism season looms large
Within a week of the Colorado Department of Transportation indefinitely closing the Middle Bridge over Blue Mesa for serious safety reasons, hospital officials say they feel like they have stabilized their 88-year-old hospital just as they might a patient rushed into the ER. Their triage efforts are working.
“We are stable, and we are looking at how we are going to be resilient for the long term,” said Gunnison Valley Health public information officer Joelle Ashley.
Ashley is one of those meeting daily in the incident command center that was last put into use regularly during the COVID pandemic.
Ashley said talk in the command center has focused at times on how lucky the hospital is that the bridge outage occurred when it did. It is off-season in the Gunnison Valley. Ski season at Crested Butte Mountain Resort 30 miles to the north just ended. The summer tourist season won’t gear up until the beginning of June.
Ashley said that means the hospital has time to work out all the contingencies while there are only about eight patients a day in the hospital.
“June 1” is written on one of the whiteboards as a reminder of what’s to come. That’s when the influx of tourism normally hits.
“It’s scary,” Malcolm said about that date.
The hospital isn’t going it alone
The hospital is not carrying the whole burden of being cut off from half of its normal world alone.
Gunnison County is on board with insuring its hospital is fully functional. The Gunnison County Commissioners last week declared a local disaster emergency that includes health care as a service under threat. The county has also been doing all it can to open a backcountry road that cuts the detour time from six or seven hours to just under an extra hour.
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The Colorado Department of Public Health and Environment and the Gunnison County Public Health Department are stepping in to help solve problems. The West Region Health Care Coalition, a collaboration of health and medical partners on the Western Slope, has been a resource with its network of hospitals, clinics, emergency flight providers, the American Red Cross and the Colorado Hospital Association.
Katherine Smith, the readiness and response coordinator for the coalition, released an emailed statement that her organization is helping to mitigate impacts to patient care due to the bridge closure. One of those is helping to coordinate dialysis clinics for Gunnison patients and “maintaining awareness of other regional health care facilities existing or foreseeable needs to avoid what may become medical emergencies.”
Smith pointed out that Hinsdale and Montrose counties are also being impacted by the bridge closure.
“During any type of emergency event, it is vital to maintain situational awareness and support to and between health care facilities, EMS, and hospitals to ensure the continuity of patient care, even if potential impacts may not be obvious at first,” she wrote.
Gunnison is also aided by its normal independent attitude, Malcolm noted. The remoteness of the area has prepared it for a disaster like this. A years-long major highway project that has required periodic shutdowns and delays on a section of U.S. 50 in a canyon west of Blue Mesa has served as a sort of practice for a complete highway shutdown — one that health care officials have been told could last for months — at the least.
“We have a thick skin about being cut off from the world here,” Malcolm said. “Normally we’re like an island up here anyway. Now, we’re even more so. We can deal with that.”