Refer to: Koegler RR, Hicks SM: The destruction of a medical cen-
ter by earthquake-Initial effects on patients and staff.
Calif Med 116:63-67, Feb 1972
Special Article
The Destruction of a Medical Center
By Earthquake
Initial Effects on Patients and Staff
RONALD R. KOEGLER, M.D., AND
"DEDICATION HELD SATURDAY
FOR OLIVE VIEW MEDICAL CENTER"
"Elliott L. Richardson, U.S. Secretary of Health, Edu-
cation and Welfare joined local dignitaries at ceremonies
January 9, 1971, in Sylmar that marked the formal dedi-
cation of the $28.5 million Olive View Medical Center.
An estimated 400 persons attended the dedication. Super-
visor Warren M. Dorn termed the six story, 888 bed hos-
pital as the County's largest and best equipped special-
ized general hospital."
-News report, January 10, 1971.
"QUAKEI"
"A killer quake that struck the Los Angeles metropoli-
tan area at 6:01 A.M. today apparently hit hardest in the
North San Fernando Valley area where loss of life and
property damage is staggering. Hospitals, especially Olive
View and San Fernando V. A. are scenes of death and
destruction. Supervisor Warren Dom visited Olive View
and described the new medical center as 'a total wreck'."
-News report, February 9, 1971.
ON FEBRUARY 9, 1971, an earthquake literally
destroyed the Los Angeles County-Olive View
Medical Center. The main hospital, a new six
story, $26 million complex, had been dedicated
on January 9, 1971; a few minutes after 6:00
A.M. on February 9 it was a twisted ruin (see
Figure 1).
We needed only "after" pictures to show the
effects on the main hospital building. There was
considerable damage at some points (Figure 1),
From Los Angeles County-Olive View Medical Center, Sylmar.
Submitted September 29, 1971.
Reprint requests to: R. R. Koegler, M.D., Community Mental Health
Center, Los Angeles County-Olive View Medical Center, 14445 Olive
View Drive, Sylmar, Ca. 91342.
SHELBY M. HIcKS, M.D., Sylmar
but the basic structure was intact (Figure 2).
However, the Community Mental Health Center
building looked quite different after the quake.
In a news picture after the event the building
appeared to be a one-story structure not badly
awry, with only overturned concrete benches
and a scattering of debris as aftermath of the
severe shake (Figure 3). But the same building
was shown in a picture taken before the quake
(Figure 4) to have not one story but two. Few
pictures of the Mental Health building appeared
in the news media after the earthquake for the
hurrying reporters did not realize that the lower
story had been crushed flat beneath the upper.
Since the majority of the staff had offices in the
crushed first floor, their awe when they arrived
for work at 8:00 A.M. can be appreciated.
There have been vivid newspaper, magazine,
radio and television accounts of what happened.
We thought that an additional report, one fea-
turing staff and patient reactions, would be valu-
able and of interest to the medical community
for several reasons. First, the media accounts
varied from being incomplete to being grossly
inaccurate in their description of the actual
events. Second, reports by lay persons, even
when accurate, were not sensitive to the type
of observations which would be of value to phy-
sicians. Finally, persons familiar with the Medi-
CALIFORNIA MEDICINE 63
The Western Journal of Medicine

Figure 1.-An example of the destruction caused
at the main hospital building of Olive View Medical
Center by earthquake February 9, 1971.
Figure 2.-Overall view of the mnain hospital build-
ing at Olive View Medical Center after the earthquake.
cal Center (physicians in particular) were in a
better position to evaluate the physical and psy-
chological effects on the Center.
In this first report there is emphasis on mental
health patients because we were more familiar
with these patients and could better evaluate
changes in their behavior.
Immediate Effects
At the time of the quake, 6:01 A.M., all pa-
tients were either on the second floor of the two-
story Community Mental Health Center or on
the third through sixth floors of the six-story
main hospital building.
Main Hospital
There were 554 patients in this recently dedi-
cated structure: 225 adults with tuberculosis and
other chest diseases; 27, pediatric patients with
tuberculosis; 116 general medical; 9 non-tuber-
cular pediatric; 44 rehabilitation; 37 surgical;
and 96 mental health patients.
64 FEBRUARY 1972 * 116 * 2
.. ::
Figure 3.-The "one-story" Community Mental
Health Center at Olive View Medical Center after the
earthquake.
IL
Figure 4.-The two-story Community Mental Health
Center at Olive View Medical Center before the earth-
quake.
One of the medical nurses on duty described
the experience vividly: "There was a roar which
grew louder and louder. The building was shak-
ing and swaying. I couldn't stand up. The next
thing I knew I was on the floor-there was plas-
ter dust everywhere. No one panicked and I
didn't see any hysterical behavior. These were
all general medical patients and they came out
of their rooms after the initial shock and ap-
peared to be waiting for some orders or direc-
tions from the staff. My immediate thought was
to get the patients out of the building and at the
same time I was worried about whether some-
body had been injured.
"The elevators were not working-there was
no electrical power. I remember how dark and
unreal everything was as we led the patients
down the stairwell-it was twisted and broken.
I remember being frightened."
One hospital aide said: "I felt as if time had
come to a standstill. It seemed as if we were
the only ones alive in the whole world. No one
seemed to be very frightened at first. Everyone
immediately began to evacuate the patients.
Later on, as the aftershocks began, there was
more evidence of fear. The patients were very
cooperative and helpful."
The main hospital building remained twisted
but standing, except for the exterior stairwell
(fire escape) towers which broke away from the
main structure. Three of these six-story wings
toppled over, one carrying a heroin addict to the
ground, dazed but unhurt inside the building
after his six-story fall. He was still drug-free five
months later, so we may have discovered a new
(albeit expensive) way to treat drug addiction.
Community Mental Health Center
The second floor of the Community Mental
Health Center's two-story structure was occu-
pied by 55 patients on two wards. The quake
caused the second floor to sink, fairly intact,
crushing the first floor outpatient clinic and day
hospital to a pile of compressed rubble. For-
tunately, at 6:01 A.M. the first floor was unoc-
cupied. It was interesting that most of those on
the second floor had little or no sensation of
sinking even though the floor settled about eight
feet in a few minutes. A member of the staff
on duty there said: "At the time of the shock, I
was thrown violently across the room against
another staff member. We were unable to stand.
Dust seemed to come boiling up from every-
where. The noise was frightening. I had a feel-
ing of urgency and wondered if I had time to
do whatever was necessary to get the patients
out. The entire staff almost immediately began
to assemble the patients in small groups, having
them hold hands. We only had trouble with two
of the male patients who did not want to hold
the hand of another male patient." (All three
had previously been felt by the staff to be strug-
gling with homosexual urges.) "We could not
get the front door open and the patients were
led to a back stairway, where we found that the
stairway was crumpled and we saw that we
were at ground level and no longer needed a
stairway. We had not felt the building settling
and this was our first realization that our second
floor had descended about eight feet and the
first floor seemed to have disappeared."
Another aide said that the roar was extremely
loud, that the acoustical tiles fell from the
ceiling, and that the dust and darkness were
frightening. She said that patients rushed to the
nursing station and all those she saw were co-
operative and had not panicked.
"I woke up as I was falling out of bed onto
the floor," said one 27-year-old paranoid schizo-
phrenic. "Wow, man, the whole world was fall-
ing apart. All I wanted to do was get back into
bed, but the bed was sliding across the floor.
I managed to catch the bed and climb in, but
had to lie on my face and grab both sides to
keep from falling off. I heard a voice say,
'Everybody get in the doorways.' I remember
shouting back, 'Hell, I can't turn loose of the
bed!'
"When the shaking stopped I headed toward
the nurse's station and we joined hands and left
the building. I don't remember being scared."
(He did not place any paranoid interpretation
on the quake or personalize it in any way.)
The other patients also held up very well.
There is a general belief that psychotic patients
become temporarily rational during emergen-
cies. We have some evidence that this is partly
true for some patients. There are interesting ob-
servations and comments concerning the pa-
tients' reactions. One patient, considered the
most mentally disturbed patient on his ward,
behaved in a more rational and concerned man-.
ner during the quake. He dressed another pa-
tient who was almost blind, protected him and
led him from the building. Observed shortly
after leaving the building, he appeared to be
in total contact; however, an hour later he was
back in his usual psychotic state.
In another ward there were several patients
who had been extremely violent. One patient,
especially, was considered the most violent in
the hospital. During the tremor he rushed into
the room of a young female hebephrenic schizo-
phrenic who had required nasal feedings be-
cause she had refused to eat. He took her in
his arms and carried her from the building.
In general, a number of acute schizophrenic
patients (but not all) did react more rationally
during this emergency. Some seemed to revert
back to their pathologic state within an hour or
two after the crisis. In a few regression took up
to two weeks, but none retained any definite
noticeable improvement longer than that. Sixty
percent (of the actively psychotic) showed no
change during or after the quake. Several agi-
tated patients actually became more excited. Pa-
tients with severe neuroses tended to react very
CALIFORNIA MEDICINE 65
The Western Journal of Medicine
rationally, efficiently helping in the evacuation.
The patients who did not seem to show any
change whatsoever were the severely depressed.
They remained severely depressed.
It was interesting to see the behavior of the
heroin addicts who were on methadone with-
drawal. They tended to continue to demand
medication, even immediately after the quake
when they knew that the pharmacy supply of
methadone was trapped under the rubble. Sev-
eral addicts had previously broken into and rifled
the ward cabinet of methadone and other drugs
before leaving the building. Four narcotic ad-
dicts used our inability to immediately give them
medication as rationalization to disappear into
the community, presumably to find heroin.
The Remainder of the Day
Medical, surgical, chest, tuberculosis, and pe-
diatric patients were transferred to Los Angeles
County-USC Medical Center, to Rancho Los
Amigos Hospital and to other county facilities.
Buses, private automobiles, helicopters and am-
bulances were used, and the transfer went well
with minimal discomfort for the patients.
Mental Health patients from both buildings
were taken to a grassy plot of ground adjacent
to the old unused dining room. As they assem-
bled here, each patient was interviewed by the
chief of the admitting emergency service. A de-
cision was made as to whether the patient could
go home or be transferred to some other facility.
Eighty patients were transferred to Camarillo
State Hospital, 24 to UCLA Neuropsychiatric
Institute, and ten to self-help narcotic programs,
and, as was previously mentioned, four narcotic
addicts disappeared into the community. Twen-
ty-three patients were discharged to home care.
One of the authors returned to the mental health
building and entered the second floor (now the
first floor) accompanied by a fire captain. They
removed the inpatient record files in order to
send them along with the patients to their new
hospitals. This allowed medication to be prop-
erly continued-extremely important in the case
of barbiturate addicts who were undergoing
withdrawal therapy. Outpatient records were in
the crushed first floor and could not be rescued.
Care of patients was only briefly interrupted
and transportation to other hospitals was quickly
arranged. During the first day there was little
66 FEBRUARY 1972 * 116 * 2
time for discussion of the earthquake and its de-
structive effects. Even after the initial shock
began to wear off the patients remained calm,
perhaps because they were with ward personnel
whom they knew. Patients accepted the reas-
surance of the staff without much questioning.
As they boarded buses on their way to other
hospitals, many patients smiled and waved to
staff members and to other patients, even though
they may have suspected that they would never
meet again.
"I Did It!"
Two paranoid schizophrenics assumed full re-
sponsibility for the disaster. One woman, aged
49, had been admitted against her will; while
in the hospital she had been frequently heard
shouting loudly, "God will destroy you all." She
openly implored God to destroy the building
and the staff because they wouldn't release her.
The earthquake frightened her and she became
hysterical. She cried, begging forgiveness of
God for the destruction of the building (which
she knew that she had caused). This tearful
self-recrimination continued afterward, even sev-
eral hours later, as she was boarding the bus for
another hospital.
The other patient who felt that he had brought
on the disaster was a 28-year-old man. For sev-
eral months he had been saying that he had
access to supernatural powers which he was
"afraid to use." He fought against accepting
these powers from a powerful "person" who was
offering them to him. When the quake occurred,
he knew that in some way he had accepted the
power and through this power had destroyed the
medical center. Frightened, he was heard saying
over and over, "I didn't mean to do it," as he
was led from the wrecked building.
Humor among the Rubble
Despite the tremendous damage, only three
persons died at Olive View during the earth-
quake. Two patients with terminal chest disease
died when power failed and their respirators
stopped. One ambulance driver was killed when
he was struck by falling concrete while attempt-
ing to leave the building. All deaths were at the
main hospital, none at the Mental Health build-
ing.
There was a general feeling of relief as every-
one began to realize that patients and co-work-
ers were still alive. Slowly humor began to re-
appear. Some of it was of the gallows variety,
but there was also a reaction to genuinely hu-
marous incidents occurring during the tragedy.
Two examples come to mind. One incident
involved an alcoholic patient who was seen
leaving the grounds shortly after being evacu-
ated from the hospital. He walked 14 blocks to
a damaged liquor store, took a bottle of wine
and returned. It seemed funny at the time, but
(in retrospect) he may have been the most re-
alistic person among us. Another humorous in-
cident occurred when the surgical ward was
being evacuated. Attendants had a very difficult
time getting one patient to leave the hospital.
She had casts on both legs. and refused to leave
without her bed. Finally, over her protestations,
she was placed on a stretcher and carried out
through the interior stairwell.
There are, of course, many other incidents
which could be mentioned. The point is that
the gradual return of the ability to see humor
among the tragedies marked the beginning of
the ability to plan for solutions to the long-term
problems brought on by the destruction of the
hospital: What will happen to these patients?
What will be the long-term psychological effects?
How and when will the hospital be rebuilt?
How will the medical needs of the area be served
temporarily? How will the staff respond? The
answers will come as time passes.

EVALUATING NOISY BREATHING IN INFANTS

In infants with noisy breathing, the phase of respiration in which the noise
occurs depends primarily on the location of the obstruction. In lower respira-
tory tract obstruction where dilatation of the bronchi occurs during inspiration
and where contraction of the bronchi occurs during expiration, one tends to
hear the sound mainly on expiration....
On the other hand, when the lesion is in the upper respiratory tract, the
noise tends to occur primarily on inspiration. The diameter of the airway at
the level of the larynx does not alter significantly during inspiration and ex-
piration because of the bony and cartilaginous skeletons of the upper airway,
and partial obstruction in this upper part of the respiratory tract tends to
produce an inspiratory noise.
Just as the noise varies with the phase of respiration, so the relative length
of the two phases of respiration depends primarily on the site of the obstruc-
tion. With upper respiratory obstruction one has a prolonged inspiratory phase
and a relatively brief expiration whereas with bronchial obstruction one has a
prolonged expiration and a brief inspiratory phase.
This is best illustrated by the patient with croup who has a long inspiratory
phase and a very brief expiratory phase as opposed to the individual with
asthma, who due to the bronchospasm, has a prolonged expiratory phase
and a very brief inspiratory phase. Such individuals have very little difficulty
getting air in; they have a great deal of difficulty getting air out.
In the presence of lesser degrees of obstruction, one may not hear any
noise. The only thing one might observe is the difference in the length of the
inspiratory and the expiratory phases.
-JAMES B. SNOW, JR., M.D., Oklahoma City
Extracted from Audio-Digest Otorhinolaryngology, Vol. 3, No. 7,
in the Audio-Digest Foundation's subscription series of tape-re-
corded programs. For subscription information: 1930 Wilshire
Blvd., Suite 700, Los Angeles, Ca. 90057

CALIFORNIA MEDICINE 67
The Western Journal of Medicine