'*' HanEdu'" CoursePacks

rM

Bibliography

"The City of Chicago and the 1995 Heal Wave (A)." Varley. Pamela. Case No. 1642.0. Published 0J/OI/2002, 2002. Revised 1/16/2002. John F. Kennedy School of Government, (34 pages).

"Developmental Network Questionnaire. Color Case." Higgins, Monica. Case No. 9-404-105. Published 02117/2004. Revised 12/20/2004. Harvard Business School Publishing, (16 pages).

"Carter Racing." Brittain, Jack W. pr. 1-2. 2000. (author) Brittain, Jack, Rightsholder Delta Leadership Inc. (2 pages). hltp://home.business.utah.edu/mgljwb/Carter Racing/Carter Racing.pdf. Reproduced by permission from Delta Leadershhip.

"Mount Everesl--1996." Roberto. Michael A.; Carioggia, Gina M. Case No. 9-303-0() I. Published 11/12/2002. Revised 01/06/2003. Harvard Business School Publishing, (22 pages).

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The City of Chicago and the 1995 Heat Wave (A)

Introduction

The heat wave that swept across the Creat Plains and Mid West in mid July 1995 was one of the deadliest in U.s. history and one of the worst disasters ever to strike the City of Chicago, where it claimed 522 lives by one count, and 733 by another. Yet within Chicago, the 1995 heat wave was not recognized as a disaster, nor even as a serious event, until almost after-the-fact.

Those who lived through the five days of punishing heat knew at the time that the combination of high temperature, high humidity, and bright sun had created miserably uncomfortable conditions-far worse than the usual Chicago summer hot spells. But it was not until after the worst days of heat had passed that Chicago political leaders, journalists and residents began to grasp the toll it had taken. In a macabre drama that drew national television coverage, residents of greater Chicago discovered that hundreds of their neighbors and relativesmostly old, frail and living in small urban apartments-had died. Police wagons, carrying the deceased in body bags, lined up for several city blocks outside the Cook County' Medical Examiner's building, waiting to deliver the bodies into the custody of a small, overburdened staff of medical examiners. In the end, the Medical Examiner had to borrow ten refrigerated trucks to hold all the dead in the parking lot.

After-the-fact, it also came to light that hospital emergency departments and Fire Department ambulances had been under severe strain during the heat wave, with resulting delays in medical treatment to residents suffering from the heat. The Illinois Department of Public Health later calculated that, of the 172 patients that had to wait at least 30 minutes for an ambulance, 12 were pronounced dead-on-arrival when they reached the hospital. Whether they would have died

Cook County comprised all of Chicago and a number of adjacent municipalities.

This case was written by Panicia Varley, Kennedy Schoo/ case writer, for Arnold Howitt, director of the Kenncdy School's Executive Session on Domestic Preparedness and the Taubman Center for Stale and Local Government. Funding was provided by the Office for State and Local Domestic Preparedness Support, US Department of Justice, and the Robert Wood Johnson Foundation. (0102)

Copyright © 2002 by the President and Fellows of Harvard College. No part of this publication may be reproduced, revised, translated, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the written permission of the Case Program. For orders and copyright permission information, please visit our website at www.ksgcase.harvard.edu or send a written request to Case Program, John F. Kennedy School of Government, Harvard University, 79 John F. Kennedy Street, Cambridge, MA 02138

The City of Chicago and the 19951-1eJt Wave (A) CI6-02-J642.0

anyway, no one ever knew for certain. By and large, the patients who called for emergency medical assistance did survive, though some suffered permanent adverse health affects. And the vast majority of the people who died of till' heat never called for help at all. But, at the least the delays in the delivery of ambulance and hospital services added to the distress of heat-sick patients and created grueling work conditions for emergency medical personnel. They also raised a flag about the way the emergency medical system was primed to recognize and respond to an unusual and unanticipated strain.

Once the heat had subsided and its toll on the city had grown dearer, the Mayor and his administration were left with a number of sobering questions. Chicago prided itself on responding well to emergencies, yet this one had caught the city unawares. How had a crisis that had claimed the lives of hundreds of city residents gone unrecognized until almost after-the-fact? And what, if anything, could be done to prevent another unanticipated emergency from killing or injuring large numbers of people before the city recognized the crisis and mobilized its forces?

Bracing for a Hot Spel1

Chicago was not the only city to suffer from the 1995 heat wave, nor was the arrival of the heat, itself, unexpected. On July 5, and again on July 8, the National Weather Service warned of a high pressure system and suffocating air mass moving slowly eastward from the Creat Plains, bringing temperatures above 100° to the City of Chicago by Tuesday July 11 or Wednesday July 12. In fact, i1S they braced for the heat, Chicago'S 2.7 million residents could observe its effect on the states just to the west of Illinois, where the heat wave had already hit. In Iowa, hundreds of livestock animals had died, and TV cameras showed bulldozers pushing the bodies into trucks for burning. In Nebraska, extreme heat caused a railway rail to buckle and that, in turn, caused a freight train to derail.

On paper, the City of Chicago did have a policy for dealing with extreme heat. The Chicago Forecast Office of the National Weather Service issued a "Heat Advisory" whenever it forecasted at least two consecutive days with a peak "heat index" of 105° or higher and i1 minimum heat index of 80° or higher at night. (The heat index Wi1S the "felt" heat level when temperature and humidity were considered in combination.) The NWS issued a more urgent "Heat Warning" whenever the heat index reached 120°. Whenever it issued either a "Heat Advisory" or a "Heat Warning," the NWS notified the city's Weather Center, an office in the Department of Streets and Sanitation. In turn, the city Department of Public Health could announce a formal citywide "Heat Emergency." In fact, public health officials say the plan for responding to a Heat Emergency was sketchy-a page-and-a-half in total length, with general instructions to open certain Department of Human Services buildings as "cooling centers" and to put out public advisories about coping with high heat-things the city did anyway during heat waves without a formal declaration of a Heat Emergency. Beyond these measures, "we didn't have

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a system set up to do anything if we declared it," says then-Public Health Commissioner Sf. Sheila Lyne. In point of fact, the city had not declared a Heat Emergency in anyone's memory, she adds; few city officials knew the policy existed.

As City Hall prepared for the heat wave of 1995, therefore, the city did not declare a Heat Emergency, but city officials did take their usual hot weather precautions: The Department of Public Health put out flyers and public service announcements advising residents to drink plenty of water, stay inside during the heat of the day, avoid strenuous activity, etc. . The Department of II urnan Services announced that several emergency assistance buildings wou ld be open as cooling centers for any residents who wanted to use them.

Chicago City Hall did have one overriding concern about the impending heat wave-and that was the problem of the city's 43,000 fire hydrants. In hot weather, residents in neighborhoods all across the city opened thousands of fire hydrants to create impromptu water sprilys for children and teenagers. Under such conditions, the loss of water pressure could reach hazardous levels, leaving Chicago homes without running water just as they most needed it for drinking water and cooling showers. Even more worrisome was the possibility of inadequate water for Chicago hospitals and other medical facilities and, of course, inadequate water for fire fighting. Anticipating that the coming five-day blast of heat would provoke a rash of hydrant-opening, the city mobilized large numbers of city Water Department employees to travel around the city closing the hydrants, in some cases, with a police escort, as neighborhood residents were sometimes hostile to hydrant-closings.

A Sporting Attitude

Between Tuesday July 1 J and Wednesday July 12, Chicago'S high temperature rose from 89° to 97°, and the heat index hit 101 0. On Thursday July 13, Chicago'S official temperature was

The human body is designed to keep a steady temperature of about 98.6° Fahrenheit. Confronted by severe heat. the body of a healthy individual cools itself either by shedding heat to cooler air surrounding it via radiation. or by sweat and evaporation. When air temperature is hotter than body temperature. radiative cooling no longer works. When humidity is high. evaporative cooling is much less effective. Thus. public health experts recommend that under conditions of high temperature and high humidity, people should try to go to a cooler environment in order to lower their core body temperature -ideally, spending at least two hours in an air conditioned location or. at the least. taking a cooling bath. Furthermore, as the body ages, the mechanisms that maintain the body's internal temperature balance begin to break down. The body does not register temperature as well. Blood vessels are supposed to expand to cool down the body, but this requires the heart to pump the blood with more force a stress that a compromised heart may not be able to withstand. The body has fewer sweat glands and they work less efficiently. The hypothalamus does not respond as quickly to dehydration. And, if the patient is unable to care for him or herself: has a history of alcoholism, uses tranquilizers, or users any number or other medications, the risks may be far greater. (For example. if a patient is prescribed diuretics for a heart condition. this will exacerbate dehydration. ILl patient is taking anti-psychotic drugs, these can interfere with the body's physiological response to extreme tempcratures.) If the body temperature rises to 105°, the person is said to suffer from heat stroke. and the consequence is usually organ damage followed relatively quickly by death. Heat stroke can develop quickly. According to one CDC study, two thirds of people to suffer heat stroke were reported to have been ill less than one day before hospitalization or death.

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The City of Chicago and the 1995 Heat Wave (A) C16-02-1642.0

104° at O'Hare airport, though in southwest Chicago, at Midway airport, the mercury hit ]06", What's more, the humidity was stultifying: the heat index for Thursday was 123°. According to the National Weather Service, July 13 was the hottest day in Chicago'S recorded history,

Chicago was known for its weather extremes, however, and some city residents took a perverse pride in the excessive nature of this scorcher. Chicago Sun-Times columnist Richard Roeper and some friends decided, "as <1 lark," to spend time outside-in Roeper's case, in order to write "the definitive fun column on 'surviving' the hottest hour in our city's recorded history."

We were almost giddy out there on the deck. It was the July equivalent of plunging into Lake Michigan on New Year's Day; we were all quite proud of ourselves for being right there in the middle of the white-hottest Chicago sun experience any of us had every known. i

Thursday night brought little relief from the heat, with temperatures remaining in the 80"s, and on Friday, the heat was still intense; the official high temperature was 100", and the heat index, 115". Mayor Richard Daley held a press conference about the heat wave, but urged the media not to exagger<lte the situation: "It's hot. It's very hot. We all have our little problems, but let's not blow it out of proportion. It's like getting real cold weather. Yes, we go to extremes in Chicago, and that's why people like Chicago .... Lets just <111 work together and calm down.'"

Harbingers of Troub1e on Friday Night

After the fact, the Department of Emergency Medicine at Cook County Hospital would estimate that on Thursday, 575 people went to Chicago-area hospital emergency departments complaining of some form of heat sickness, such as hyperthermia, heat stroke, heat exhaustion, heat cramps and heat edema, On Friday, another 875 heat-sick patients went to hospital emergency departments and 725 more arrived on Saturday. " At the time, however, no one in city or state government realized that, by the hundred, people were falling ill and rushing to the hospital. The emergency medical personnel in individual hospital emergency departments knew they were under strain, but emergency patient load was, by nature, erratic. And it was no secret that the city was in the grip of a severe heat wave. Emergency workers therefore hunkered down and did their best to cope.

Chicago Sun Times, .luly 17, 1995. Chicago Sun-Times, July I fI, 1995

1995 Heat Crisis in Chicago: An Area Morbidity Study of Hospital Emergency department Treated Prevalence, May I 99f1, by Robcrt J. Rydman, associate professor and research co-director, Department of Emergency Medicine, Cook County Hospital/Rush Medical College, School of Public Health, University of Illinois, Chicago, IlL With Dino Rumoro, Julio Silva, and Tess Hogan, Department of Emergency Medicine, Resurrection Medical Center, Chicago, IlL

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One of those emergency workers was, in fact, the chid of Emergency Medical Services for the Illinois Department of Public Health, Leslee Stein-Spencer. Stein-Spencer made it a practice to keep one foot in the trenches by moonlighting as an emergency room nurse. At 7 p.m. Friday night, she arrived at till' emergency department of the Michael Reese Hospital near Chicago's South Side and was immediately struck by the crowded waiting room and long lines of patients awaiting treatment. "Our emergency department had an average waiting time just to be seen by an MD of 12 hours, and, amazing enough, people were waiting," she later wrote in a memo to the director of the Illinois Department of Public Health about the heat wave. Paramedics on Fire Department ambulances were becoming visibly exhausted, she noted. What's more, 11 of the city's 67 hospital emergency departments had announced a "bypass," which meant that the emergency departments had judged themselves overwhelmed by patient demand and were temporarily closing their doors to new ambulance patients (though they still accepted walk-in patients, as required by law).

It was not rare for a Chicago hospital to call for a bypass. Years of cost cutting, coupled with the nationwide nursing shortage, meant that many hospitals lacked the medical equipment and staff resources to cope with unusually high numbers of emergency patients. For 11 hospitals to be on bypass at once did put an added burden on the other hospitals and on city ambulances, which had to travel farther to deliver their patients. Even so, "at that point, I didn't see it as a big issue," Stein-Spencer recalls.

Friday Night for the Cook County Medical Examiner

Emergency medical workers were not the only people in Chicago to see, first hand, the toll of the heat Friday night. In the office of the Cook County Medical Examiner, Friday has been a slightly busier-than-average day. The job of the Medical Examiner was to determine the cause of death of any Cook County resident who had died violently, in a manner sudden or unexpected or without medical attendants. On average, the county office examined 17 bodies a day, but on Friday, the office of the Medical Examiner had received 23-including the sad case of two threeyear-old boys who had died of the heat inside a closed sport utility vehicle. At home with his family at 9 p.m. Friday, Edmund Donoghue, Chief Medical Examiner for Cook County, received a call from one of his medical examiners. "He said, 'Dr. Donoghue, we thought we should call you because we have 40 cases scheduled for tomorrow," Donoghue recalls. This stopped the doctor in his tracks. "Never in the history of the Medical Examiner's office have we had more than 35 cases." I said, 'What's happening?' He said, 'They're dying of the heat."

That is, the Medical Examiner's office had never had more than 35 cases in a single day unless the city was in the throes of an obvious disaster, such as a train wreck or plane crash.

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Friday Night for Chicago Deputy Police Chief Frank Radke

Whenever a dead body was discovered in Chicago, the first officials called to the scene were officers of the Chicago Police Department. After an initial investigation, the police dispatched a "squad roll" -a police wagon specially equipped with stretchers, body bags, contamination gear, and so forth-to the scene and transported the body of the deceased to the Cook County Medical Examiner. Like the Cook County Medical Examiner, therefore, the Chicago Police were seeing a marked increase in dead bodies Friday night. Frank Radke, Deputy Chief of Patrol for the Chicago Police's Northwest Area, recalls that he was driving back from his son's freshman orientation at Michigan State University when, at 7 p.m., he gOL <1 call from a commanding officer in his area. His police officers, he learned, were responding to an unusually high number of calls reporting the discovery of dead bodies. In addition, responding to a number of requests for a "well-being" check on someone elderly or in poor health, police officers were finding the person dead on arrival. This spike in DOA calls had presented an unusual logistical problem: the police were running out of squad rolls. Across the city, there were about 25 squad rolls in active service; each of the city's 25 police districts W<1S assigned one, which did double duty, transporting prisoners to and from jailor transporting dead bodies to the Medical Examiner.' Now, all were being used to transport bodies lo the Medical Examiner's office-and still, there were not enough.

A Wild Weekend

Chicago got little relief from the heat Friday night, with nighttime low temperatures in the 80os, and Saturday dawned hot and muggy. The National Weather Service was reporting, however, that the worst was over. The heat index would hit 1150 on Saturday, but the high temperature would only reach 98°. By Sunday, the heat index would f<111 to 1()70, and the temperature would drop to 93°. On Monday, temperature and heat index were both forecasted in the livable mid SO° range. But for many emergency medical and public safety workers, the worst effects of the heat wave were yet to come.

The arrangement in Chicago to have police responsible for transporting the bodies to the Medical Examiner

was unusual. In many communities, the Medical Exarniners office, itself provided this transportation. In fact, tilt:

City of Chicago had long wished that Cook County would take over the body transport job in Chicago as well. The county had steadfastly resisted this idea. however, and Donoghue argues that in the case of the L 995 heat wave, the involvement of the Chicago Police was crucial. "If we 1 in Cook County I had to take over body transport, wcd be lucky if they gave us six vehicles to cover the whole city," Donoghue says. "The county will only budget you for what you routinely need-s-they don't budget for emergencies. The fact that these [police squad roll] vehicles have mixed use really protects the City of Chicago, because it allows you to have a lot more vehicles out there. If' the police had not been involved in the transport [during the 1995 heat wave I, this would have been a disaster."

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Hospital Emergency Departments in Trouble

By Saturday, hospital emergency departments- facing their third straight day of high patient loads- were severely overloaded, especially those that were suffering power shortages, which were affecting many parts of the city. Trinity Hospital, on Chicago's far South Side, for example, had already declared a bypass at 8:50 a.m, due to shortages of equipment and beds. Compounding this overload, the l'mergency department lost power at I] :30 a.rn. and had to function without air conditioning, computers, elevators, dumbwaiters, or x-ray equipment. "Within 45 minutes, temperatures in the emergl'ncy department rose from 72 to 90," says Julie Novak, Trinity's Emergency Medical Services coordinator."

With our dumbwaiters out of service, blood and urine samples had to be rushed to the lab by staff members who hand carried the samples up and down five flights of stairs. Without the elevators, patients could not be transferred to their rooms. We were forced to place them in halls and waiting areas. Without computers, the staff had to hand-write all the information in the patients' charts.

Walk-in patients "continued to stream in," Novak continues. Despite spending 11 hours and 20 minutes on bypass, the Trinity Hospital emergency department treated 117 patients on Saturday, 54 percent more than its usual patient load. Novak says:

The emergency department was forced to function as a MASH unit, with the staff focusing their energy on their patients and ignoring the conditions in which they were working. There was no time for the hospital staff to eat or take a break. Personnel were fighting off dehydration and heat exhaustion themselves.

Meanwhile, 63 blocks north at Reese Hospital, Stein-Spencer, again moonlighting as an emergency department nurse, arrived at 11 p.m. Saturday night to find the emergency department busier than the night before. To her dismay, she soon discovered that there were 18 Chicago-area hospital emergency departments on bypass simultaneously-vabout 25 percent of the emergency departments in the metro area. Virtually all the emergency departments on Chicago'S South Sidea large, densely populated, low income area of town-were on bypass. This meant patients and ambulances had to travel long distances to get to the nearest open emergency department. "Reese had just received a patient from 130th and Halsted [a distance about 100 blocks south of the hospital and 30 blocks west], as we were the closest available emergency department open," SteinSpencer wrote in her summary of the event. Right away, "I knew I had a major issue." She swiftly

Drawn from Novak's testimony at a hearing of the Illinois Senate Public Health and Welfare Committee on July 26, 1995.

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shifted from her role as emergency department nu rsc to that of Illinois' chief of Emergency Medical Services.

To have 18 hospital emergency departments on bypass was to plunge the city into dangerous territory. The more emergency departments on bypass, the more patient load shifted to the remaining emergency departments, increasing the likelihood that they, too, would collapse under the strain and have to declare a bYP<lSS. In addition to the domino effect on other hospitals, the bypass situation was by now putting enormous pressure on the city's ambulance crews, which were receiving far more calls than usual and having to spend far more than the usual amount of time on each hospital run. Stein-Spencer quickly called the Chicago'S Deputy Fire Commissioner in charge of Emergency Medical Service, Cortez Trotter, to let him know about the bypass situation. Trotter was predictably horrified, she recalls in her report. "He told me to do something-that his ambulances could not be going all over the city." Stein-Spencer assured Trotter that she was going to get the hospital emergency departments back in operation as soon as possible. To do so, however, was to move into uncharted waters.

Emergency Department Bypass Policy

Chicago-area hospitals had been granted the legal right to declare an emergency department bypass, or temporary resource limitation, under a policy adopted by the Emergency Medical Services Commission of Metropolitan Chicago in 1981. Before this policy change, hospital emergency departments had been required to accept and treat L'very patient that arrived by ambulance, by police transport or by his or her own means. Overloaded hospitals had been permitted -after the initial emergency treatment-to transfer a patient to another, less burdened hospital, but this process was bureaucratically involved and often time-consuming. In adopting the 1981 policy, the commission held been persuaded that patient care would benefit if overwhelmed hospital emergency departments were allowed to call for a bypass, which re-routed ambulance patients to the next nearest, and presumably less-burdened, hospital. The commission policy made it clear that hospitals were not to decide lightly to call for a bypass, but at the same time, the policy left the criteria for doing so "somewhat vague and open-ended," according to Stein-Spencer.

Over time, Chicago'S hospital emergency departments developed "personalities" when it came to invoking a bypass. Some prided themselves on never doing so unless the facility was in a state of real extremis-for example, the emergency department might reluctantly call for a bypass if an adjacent section of the hospital was on fire, but otherwise would stay open by any means necessary-pulling in staff, moving patients into other areas of the hospital, discharging patients early, turning the cafeteria into a waiting room, lining up gurneys in the hall. Other hospitals, however, were far quicker to announce an emergency department bypass for assorted reasons. Some called for a bypass if they were short of staff; nursing shortages in Chicago, as across the

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nation, had made it difficult to find replacements when staff members called in sick. Some called for a bypass because they had no more beds and nowhere to put additional patients. Some called a bypass when emergency department patients had to wait several hours to see a doctor. Emergency departments commonly called for a bypass when they had no open beds outfitted with cardiac monitors. It was always considered legitimate to call for a bypass when the emergency department had no access to monitored beds, but there were gray areas. For instance, was it legitimatl' to call a bypass if the emergency department had run out of monitored beds-but then' were open monitored beds elsewhere in the hospital? That was unclear. What's more, some hospitals fudged on the monitored bed standard. "They'll say, 'All our monitored beds arc full' but they've put a [patient with a] broken arm in a monitored bed, so it's really not a monitored patient," says SteinSpencer. "Or they go on bypass because they want to hold [some monitored] beds for [the patients of] their private attending [physicians I." Emergency departments that were thought to abuse the bypass policy were subject to grumbling from paramedics and other personnel in Chicago'S emergency medical system. Some joked about emergency departments that would go on bypass "for the Christmas party."

Such debate and comment were almost entirely confined to the world of EMS workers, however. The bypass policy had provoked no public controversy except in 1992, when a hospital emergency department on bypass refused the urgent appeal of a nearby ambulance crew attending a three-month old baby who was unconscious, near death, and in need of immediate care. The baby subsequently died. Whether swifter medical attention might have saved her life was never clear, but the case caused a public outcry. The state Department of Public Health's Emergency Medical Services division was called in to investigate the case, and concluded that, in the particular circumstances, the hospital had been wrong to refuse the baby. After this case, the state legislature had given the DPH's division of Emergency Medical Services the authority to assess a hospital's decision to go on bypass, to revoke the bypass, and to levy fines up to $5000 against hospitals that inappropriately called a bypass (or up to $10,000 if the bypass could have caused imminent harm or death).

In reality, the EMS division used this authority on rare occasions to investigate a questionable bypass decision after-the-fact. Day to day, the EMS division had a minimal role in overseeing hospital bypass decisions. That responsibility fell to the three EMS "Resource Hospitals" -Illinois Masonic, Northwestern Memorial and University of Chicago-which oversaw ambulance traffic from the scene of illness or injury to the 67 Chicago hospitals. Each hospital reported to one of these three Resource Hospitals, and each Resource Hospital governed a specific geographic region of the city. In a routine case, an ambulance was sent to the scene of illness or injury by an EMS 9-1-1 dispatcher. If the patient required hospital attention, the paramedics called the appropriate Resource Hospital to confer with a physician about the patient's condition and immediate care, and to decide which hospital emergency department the ambulance should head for-usually, the nearest. A Resource Hospital "telemetry" operator then notified the emergency department to expect the patient. When a hospital declared its emergency department on bypass, it

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notified the appropriate Resource Hospital," which kept an updated list of all the hospitals presently on bypass in the city. Thai way, if the paramedics were preparing to take a patient to a hospital that had just declared a bypass, the telemetry operators would divert them to the next nearest option.

Stein-Spencer believed the EMS Medical Directors, who were in charge of the EMS division of each Resource Hospital, should playa greater watchdog role, making sure that no more than one or two hospitals in anyone region went on bypass at the same time. As a rule, however, the EMS Medical Directors were uncertain of their legal authority in this regard and reluctant to refuse to honor another hospital's bypass decision. Across town, over the telephone, it was hard to judge the situation on the ground in another hospital. To second-guess a fellow-emergency department coordinator was seen as disrespectful and, perhaps, irresponsible.

In fact, the issue had never come to a head. Neither an EMS Medical Director nor the chief of the state's EMS division had ever forced a hospital to end a bypass. If push came to shove, no one was certain how hospitals would react to such an order. Thus, Stein-Spencer says, as she contemplated the need to re-open hospital emergency departments Saturday night, she tried to be "proactive ... but political at the same time."

Managing Bypass During the Heat Wave

Stein-Spencer's biggest priority was to re-open emergency departments on Chicago'S South Side, and she wanted to enlist the help of the South Side Resource Hospital-the University of Chicago Hospital-to do this. The UofC Hospital itself was on bypass, however, so SteinSpencer's first move was to persuade UofC to re-open its own emergency department and set an example for others. She decided, as a rule of thumb, to give hospitals two hours to reopen their emergency departments. "I didn't want to call them up and say, 'You have to go off bypass immediately,'" she says. "1 wanted to give them time." UofC re-opened its emergency department at 2 a.111., and shortly thereafter, UofC's attending physician agreed to help Stein-Spencer call the list of hospitals on to find the reason for the bypass decision and to tell them the state was requiring them to re-open.

While the emergency department directors did not flatly refuse to re-open, some did argue. In many cases, "The question came up, 'What are we supposed to do?'" Stein-Spencer says. The answer she gave them was, "Implement your internal disaster plan." Every hospital was required by law to have such a plan. That meant calling in extra staff, moving patients from one area of the hospital to another, discharging patients early to open up beds, halting elective surgery

The hospital on bypass also notified the EMS dispatchers for the Chicago Fire Department, so that paramedics. generally, knew all the hospitals on bypass in their territory. Because police officers sometimes brought patients to the emergency department. as well. the hospital on bypass also notified the dispatchers for the Chicago Police Department.

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procedures, maybe even renting additional equipment-doing, in other words, whatever they judged necessary to make their emergency department fully operational.

Stein-Spencer did make certain allowances, as a matter of judgement. For example, one hospital was suffering a power outage, and she allowed this emergency department to remain on bypass. Also, in some sections of town, only one hospital was on bypass. That did not cause hardship to the overall EMS system, so Stein-Spencer did not ask such hospitals re-open to ambulance traffic.

By 7:30 a.rn. Sunday, the list of hospitals on bypass was down to eight with another two due to re-open by 10 a.m. After an exhausting night, Stein-Spencer reflected, the situation appeared to be under better control. But as the day wore on, she found that some hospitals were reinstating their bypass status, and some were going on and off bypass almost by the hour, which led to confusion, especially for ambulance crews. The Fire Department EMS division was pushing for a solution, and Stein-Spencer concluded that she needed to institute ,1 new policy to get through the remainder of the heat wave. In consultation with the Director of the Illinois Department of Public Health, she "made up a new policy on the fly." Under this stop-gap arrangement, hospitals could declare a bypass as they judged necessary, but-bypass or no-had to be prepared to accept ambulance patients in two circumstances: whenever a patient was critically ill and needed care urgently and whenever a Chicago Fire Department ambulance estimated that to honor the bypass and take a patient to the nearest open emergency department would take longer than 15 minutes. "I also said J wanted to be paged any time multiple hospitals were on bypass," Stein-Spencer says.

ln deciding to circumscribe the bypass option of city hospitals, Stein-Spencer was aided by Patrick Finnegan, the director of Clinical, Administrative, Professional and Emergency Services for the Metropolitan Chicago Healthcare Council, an advocacy organization for local hospitals. Though sympathetic to the pressures of the hospitals, and adamant that bypass be respected for any hospital suffering a power failure, Finnegan also understood that in a citywide emergency, the state had to be able to limit the number of hospital emergency departments on bypass. Under the auspices of MCHC, he sent out a broadcast fax to all MCHC hospitals to signal, "The policy's been changed. Leslees in charge." Although, on the books, Stein-Spencer had the authority to revoke any hospital bypass, "some hospitals believed it, others didn't," Finnegan adds. "Now it was clearcut: She's got it. She's doing it. She's got final word."

The implementation of the new policy was not entirely trouble-free. As Stein-Spencer later wrote, "Someone from the Fire Department started calling around the Resource Hospitals, misrepresenting state policy, saying that the state had said there could be no more than five hospitals on bypass citywide, and if that occurred, the Chicago Fire Department didn't have to honor [anyone's] bypass. That got people upset." But, by and large, both hospitals and ambulances cooperated with Stein-Spencer's compromise policy. And, by the end of the day Sunday, the heat

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wave was lifting anyway. A study would later estimate that the number of patients arriving in city emergency departments with heat sickness dropped from about 72S on Saturday to 2S0 Sunday and was down to 150 by Monday."

Fire Department Ambulances: An increasing strain

For years, the Chicago Fire Department's Emergency Medical Service ambulance crews had complained that the city's fleet of 59 ambulances was insufficient to serve the steadily growing number of emergency medical calls in Chicago. During times of high call volume, the paramedics felt the pressure keenly. On Thursday July 13, the Fire Department received 952 emergency medical cillls-45 percent above the usual call volume. On Friday July 14, there were 123R calls- 89 percent more than usual. On Saturday July 15, there were 1196 calls-82 percent more than usual. The increasing number of Chicago hospital emergency departments on simultaneous bypass-five on Thursday, II on Friday and 18 on Saturday-compounded the problem, as it dramatically increased the time necessary to transport L1 patient to the hospital. Especially timeconsuming were ambulance runs from Chicago's vast and sprawling South Side, where virtually no emergency departments were open, which meant ambulances sometimes had to travel several miles to the nearest hospital, and then sometimes had to wait at the hospital until they could hand off the case to the emergency department staff.

As both call volumes and time spent per call increased, so, too did ambulance response times. (See Exhibits 1-14.) The state Emergency Medical Services Act defined a range of response times that any emergency ambulance provider was expected to meet: 4 to 6 minutes in primary coverage areas, 10 to 15 minutes in secondary coverage areas and 15 to 20 minutes in outlying coverage areas. During the heat wave, however, a significant number of calls fell outside these parameters. In fact, the number of calls that did not receive an ambulance response for longer than 30 minutes increased from 18 on Thursday to 97 Friday, then back down to 56 on Saturday and three on Sunday. The medical consequences of these delays were never certain, but statistics showed that of the 172 EMS patients that received an ambulance after a delay of 30 minutes between Thursday and Sunday, 12 were pronounced dead-on-arrival when they reached the hospital and 8 were diagnosed with cardiac arrest, a condition in which speed of response can be crucial.

The more ambulances were tied up and unavailable, the more the EMS dispatchers sent out fire trucks as a "first response" with ambulances to follow as soon as possible, as provided under the department's "ambulance assistance" program. On Thursday, 57 percent of EMS calls

1995 Heat Crisis in Chicago: An Area Morbidity Study ofHospital Emergency department Treated Prevalence. May 199X, by Rubert J. Rydman. associate professor and research co-director, Department of Emergency Medicine. Cook County Hospital/Rush Medical College, School of Public Health. University of til inois, Chicago. Ill. With Dino Rumore, Julio Silva. and Tess Hogan, Department of Emergency Medicine, Resurrection Medical Center. Chicago. til.

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The City of Chicago and the 1995 Heat Wave (A)~~~~~~~~~~~~~~ C16-02-1642.0

received a fire truck first. On Friday, the number had increased to 72 percent, and on Saturday, 94 percent. However, unlike the "first responding" program in place in some cities, the Chicago fire trucks were equipped only with first aid equipment and the fire fighters were trained only in first aid and cardiopulmonary resuscitation (CPR). Thus, many fire fighters had neither the training nor the equipment necessary to stabilize the patients. According to testimony later presented at a state senate subcommittee hearing, there was at least one case in which fire fighters were in the position of performing CPR for longer than 40 minutes before ambulance backup arrived. Over the radios, the exchanges between the fire fighters on the scene and the dispatchers grew testy at times, recalls Jeffrey Rodrigues, deputy director for Fire Operations of the Office of Emergency Communications. "[The fire fighters would say, I 'We need an ambulance.' [The dispatchers would say,] 'We'll get you one when we can.' [The fire fighters would persist, I 'What number ambulance arc you going to send?' [The dispatcher would say.] 'We'll let you know." The frustration. he says, was evident.

One thing the Fire Department could have tried to do-but did not-was to call in additional ambulance help from the Chicago suburbs, under the area's mutual aid program, or from private ambulance companies in Chicago. Trotter, the Fire Department's top EMS official, has consistently maintained that the city did not call extra ambulances because it did not need extra ambulances. The EMS crews were able to handle the extra load, he says. Response times were sometimes long because of the number of hospital emergency departments on bypass. The answer to the problem was to get the emergency departments off bypass, he says-not to bring in more ambulances.

However, the Fire Commissioner at the time, Raymond Orozco, later indicated that EMS field supervisors were not alerting the Fire Department command staff to the problems in the field, and intimated that the department might well have decided to bring in additional ambulance help if they had fully understood the situation. He would later tell a Senate panel: "My command staff was not aware that there were 18 hospitals on bypass .... Nobody indicated that we needed more personnel or supplies .... Our field supervisors told us, 'We're holding our own.' ... We needed something to trigger the mechanism. Nobody pulled the trigger." 11

Other observers in the Chicago emergency medical service business, however, have suggested there were a number of reasons-philosophical, logistical and political -that militated against the Fire Department bringing in extra ambulance help. One was that the Chicago Fire Department had more resources, sophistication and experience than smaller suburban departments or private companies, and would not have thought to call on their smaller counterparts for help. "It's just not done," says Stein-Spencer; if anything, it was the smaller suburban companies that turned to Chicago when extra help was needed.

11

Chicago Tribune, July 2R, 1995.

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The City of Chicago and the 1945 [kilt Wilve (A) C16-02-1642.0

What's more, the mutual aid system among public fire departments had been created in anticipation of a specific emergency-for instance, an cxplosion= that caused mass casualties. The heat wave was not that kind of event. The entire metropolitan area was suffering through the heat wave, and EMS ambulances in the suburbs were under strain, too.

Finally, although there was il general understanding among public sector fire departments that they could call on one another for emergency back-up help, there was no system in place to make this an easy thing to do, says Rodrigues. If, for example, Chicago had decided it needed lO extra ambulances, the Fire Department's EMS division would have had to "free wheel and try to come up with 30 departments in the [mutual aid nctwork [v-thev would have had to call around and sec who could go," he says. That was a cumbersome proposition. In addition, once they arrived, suburban ambulances would be unfamiliar with the city and would require extra guid,lIlce to navigate.

There was a different set of impediments to calling in the private companies. Private ambulance companies had developed a market niche providing non-emergency transport for patients- for example, moving them from one hospital to another, or transporting them to a facility for medical tests. The Metropolitan Ambulance Association represented, together, some 300 basic and advanced life support ambulances in Chicago. The private sector paramedics were not accustomed to emergency work, but they had received the same training as the Chicago Fire Department paramedics, their advanced life support ambulances were similarly outfitted, they were farniliar with the city streets, and thus they could reasonably be expected to provide back-up emergency service if necessary. But the private companies operated by different rules and financial arrangements than did the public emergency medical service. Both charged fees to patients for the service, but the Chicago Fire Department did not demand up-front payment and ultimately absorbed a high rate of nonpayment. By contrast, the private firms often did demand payment upfront. They also charged patients according to different formulas. "111e privates might charge by the mile, charge for each [piece of equipment] they use-it's a whole different ball game," says Stein-Spencer. Thus, if the Chicago Fire Department had asked private ambulances to help out during the heat wave, it was unclear what rules and protocols would apply.

Finally, the Fire Department's EMS crew had long felt like an embattled minority among fire fighters who believed the Fire Department should not be in the EMS business to begin with. "We've been the bastard stepchildren of this department for 20 years," a paramedic had told a Chicago Sun-Times reporter in May 1994." The EMS division had long insisted that it was understaffed and under-equipped. The division also waged continuing battles against proposals to privatize EMS service, altogether. In this context, the EMS division did not relish the idea of turning to non-unionized private companies for assistance. "There's always a certain amount of

"

Chicago Sun-Times. May 27, 1994.

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The City of Chicago and the 1995 Heat Wave (A)~ _

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friction between the privates and the municipalities," says one well placed observer in the EMS system. "It stems from a view that the privates arc going to take over their jobs."

The Bodies

When Cook County's chief medical exarruner, Edmund Donoghue, had gotten the call Friday night, alerting him to the surprise arrival of 40 bodies, he decided he would work Saturday, although it was his day off. He also called in two other doctors and all the office's autopsy technicians. But when he arrived at the office Saturday morning, there were no longer 40 bodies awaiting him: there were 87. On Saturday, police would bring in another 110 bodies, and on Sunday, 100 more. This unprecedented situation-the sudden discovery of hundreds of dead bodies all across the City of Chicago" = created logistical problems for both the Medical Examiner and the Chicago Police. For Donoghue, the most pressing problem Saturday morning was the fact that he was fast running out of refrigerator space.

When a body arrived at the Medical Examiner's office, it first went to a "reception" area, where the body was identified and the personal effects of the deceased were inventoried. The body was then stored in the Medical Examiner's refrigerator until the doctors performed the medical examination and determined the cause of death-a procedure that generally took about 30 minutes. Afterward, the body was wrapped and refrigerated until it was either claimed by family members or buried by the county. The refrigerator at the Medical Examiner'S office had a capacity of about 200 bodies, "but it had a tendency to run kind of full," Donoghue explains, as the bodies were kept for some time in hopes that someone would step forward to claim them. Unless Donoghue could find a way to expand his refrigerator capacity quickly, his operations would grind to a halt.

Donoghue knew from experience that a standard refrigerated truck would hold about 38 bodies. If he could borrow several of these trucks and park them in the office parking lot, he reasoned, the office could transfer bodies from its own refrigerator into the trucks and open up more space for incoming bodies. "So," he recalls, "we were making phone calls attempting to find refrigerated trucks on one of the hottest days in the history of Chicago." Donoghue's staff managed to find two trucks on its own, but was eventually rescued by Chicago'S Commissioner of Streets and Sanitation, Eileen Carey, who had rented refrigerator trucks for city festivals in the past. Donoghue asked her for two more trucks. She sent six. "She probably knew from [past] disasters that you don't know what's going on, you can always LIse more, and you can always send them back," says Donoghue. "That was a godsend. Eventually we ended up using ten refrigerated trucks."

13

Under normal circumstances. the Cook County Medical Examiner examined about 25 percent of the bodies of those who died in Chicago: private physicians determined the cause of death in the great majority of cases. But the Medical Examiner examined the bodies of all those who died suddenly or without medical care, as had the vas! majority of the heat wave victims.

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The City of Chicago and the 1995 Heat Wav(' (A) C16-02-1642.0

The next challenge was to bring in some additional manpower. The Cook County Medical Examiner's office was a relatively small operation with a total staff of 120 and Donoghue did not W<lI1t to work his autopsy staff round-the-clock, especially as he did not know how long till' crisis would last. He did bring in all 15 doctors to work, without days off, until the emergency was over. The biggest need, however, was for simple manpower to wrap the bodies and move them from one place to another. To that end, he brought in volunteers from a local school of mortuary science over the weekend, and volunteers from the county sheriff's community service program on Monday. In addition, to keep up with the paperwork on all the bodies, Donoghue asked some private sector funeral home directors to help, and also asked for help from a group of dentists who had volunteered to be on-call for dental identification work during mass casualties. ("Dentists are real good on details," Donoghue notes.) As the crisis wore on, and the visibly overwhelmed Cook County Medical Examiner's office became a featured part of local and national television news reports, some private citizens walked in off the street to volunteer their help, Donoghue says, and till' Salvation Army set up a canteen to support the Medical Examiner staff and volunteers. "The impact of that was the psychological boost," says Donoghue. "The food was okay. But the Salvation Army only goes out when important things are happening. You have to reassure your people that what they're doing is appreciated. There was also a camaraderie there. And fantastic press coverage-we were the center of attention-and that helps too."

The Burden on the Police

For the Chicago Police, the challenges were parallel in nature. The first task for Dep. Chief Radke and his counterparts in other areas of town was to increase the number of squad rolls available for body transport. To this end, they pulled all the spare wagons they could from the Police Department's emergency pool, which effectively doubled the number of squad rolls in service. Even so, the number of bodies soon overmatched the transport capacity. In part, this was because a bottleneck had developed in the Medical Examiner's reception area. While Donoghue could bring in extra doctors to conduct the examinations and extra technicians and volunteers to prepare and move the bodies from one place to another, "there's not much capacity to expand reception," he says. "You can only take in bodies so fast. Their personal effects have to be inventoried, they have to be identified. If you have a mix-up on a body, people can be upset."

Soon, there was a column of police wagons outside the Medical Examiner's office, each waiting its turn to transfer custody of another body to the county. "We had our transport vehicles lined up for blocks. With decomposing bodies. With no air conditioning," recalls Radke.

This bottleneck had other ramifications for the police, as well. For one, the officers waiting in line were not available for other police duties. In addition, the squad rolls themselves were tied up in line. As the police continued to get new DOA calls, it took an increasingly long time for each squad roll to unload the last body and come for the next one. Officers initially dispatched to the

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The City of Chicago and the 1995 Heat Wave (A)~~~~~~~_~_~~~~_

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scene were required by law to stay with the body until the squad roll arrived, which sidelined still more officers.

The spate of DOA calls, combined with the bottleneck at the Medical Examiner's office and the limited number of squad rolls, created a significant manpower shortage for the police. In response, the police did several things, Radke says. If a two-person vehicle was assigned to a death investigation, they divided the team up, so that one officer stayed with the body and drove the squad roll while the other continued routine policing duties in the cruiser. As the weekend progressed, top police commanders took several other steps to increase police manpower. First, they extended the tour of duty for many officers from 8 to 12 hours. When that eventually proved insufficient, they cancelled days off and pulled in extra officers.

The Chicago Department of Public Health

One of the responsibilities of the Chicago Department of Public Health was to be aware of any unusual outbreak of illness in the city, so as to minimize its spread and advise victims of the best course of medical care. On Thursday and Friday, an estimated 1450 people had turned up in the emergency departments of area hospitals complaining of some form of heat sickness, and, between 5 p.m. Friday night and 9 a.m. Saturday morning, 87 dead bodies, mostly heat victims, had been discovered across the city and delivered to the Cook County Medical Examiner-but none of this news had reached the Chicago Department of Public Health. On Saturday morning, John Wilhelm, the city's deputy health commissioner, was relaxing at home when he received a surprise mid morning call from his department's public information director. One of the TV channels had called and wanted to send a reporter over to do an interview with Wilhelm about the heat wave. This request was perplexing to both Wilhelm and the public information director. All week, Wilhelm had been interviewed by reporters about the heat and had delivered the usual litany of advice-to stay hydrated, to limit exercise, to remain indoors during the heat of the day, and so forth. It was not clear why, with the weather forecast showing a cooling trend, the heat wave was still a story. "But I was home, and they were coming to me, so it was no problem for me to go outside and talk," Wilhelm recalls.

On camera, I went through hydration, and look-after-the-elderly, and then [the reporter] said, "Dr. Wilhelm, I've just come from the Medical Examiner's office, and there's 70 police wagons there with bodies." 1 never saw the interview, so [ don't know what 1 looked like, but my eyes must have gotten very large. And what was racing through my head was, "Is there a gas leak in some neighborhood? Where did these bodies come from? Was it one city block? Was there an explosion?"

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The City of Chicago and till' 1995 He,lt Wave (A) _

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At the time, there was little Wilhelm could say, except, "I haven't talked to the Medical Examiner, so I really can't comment." Bul as soon ZlS the interview was over, Wilhelm recalls, "I ran upstairs and called Ed Donoghue and said, 'What's going on?'"

Information Systems at the Chicago Department of Public Health

Since 1990, the Chicago Department of Public} Icalth - previously devoted pri marily to the delivery of clinical care-had shifted its focus to research, prevention work, and the dissemination of public information. As part of this shift, the department had made a point of improving its ability to detect an outbreak of either communicable disease or food-borne illness in Chicago at tho earliest possible moment. To that end, the department's Comrnuuicable Disease division had forged relationships with the Infection Control divisions of local hospitals, and the hospitals were now "quite diligent" in fulfilling a state mandate to report any incidence of 54 specified diseases 10 the department, Wilhelm says. In addition, the Dopartrnents Food and Dairy section had developed relationships with Chicago'S 14,000 restaurants. The department actively encouraged restaurants or citizens to call the department if someone became ill as a result of eating in ZI restaurant. If either the Communicable Disease division or the Food and Dairy division of the Public Health Department learned of an unusually high incidence of any illness in Chicago, they were instructed to inform the commissioner immediately.

Heat sickness, however, was neither a communicable disease, nor a food-borne malady; it was simply a recognizable cluster of symptoms. Thus, although more than a thousand patients had turned up at hospital emergency departments all ZlCroSS Chicago with symptoms of heat sickness, Wilhelm says, "It wasn't a reportable condition-so it didn't get reported" through the department's established reporting mechanism. Nor had Wilhelm heard about the discovery of hundreds of dead bodies across the city from the Mayor'S staff in City Hall, because the Mayor's staff did not learn about the dead bodies until late Saturday morning, either.

The Office of the Mayor

With the weather forecast indicating a lingering heat through the weekend, but the worst of the heat wave over, Mayor Richard Daley had headed north to a lakeside vacation spot for the weekend of July ]5 and 16. On Saturday, at about mid day, the Mayor'S first deputy, Sarah Pang, who served as the mayor's liaison to the police, received a page from the First Deputy for the Police: "He said, 'We are getting a large number of dead bodies in apartments-senior citizenswe believe they are heat related," Pang recalls. "1 said, 'What is a large number?' He said, 'A hundred. Climbing quickly."

Pang immediately paged the Mayor'S newly appointed chief of staff, Roger Kiley, who had been on the job only a few days when the heat wave hit. "He said, 'What is typical on a Saturday?'" Pang recalls. "I said, 'Well, nothing like this.' It was unbelievable." ln addition, she

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The City of Chicago and the 199511eat Wave (A) C16-02-1642.0

could tell ambulance runs were up. "You could just hear sirens running in the street nonstop." Kiley and Pang quickly called in the Mayor'S staff, along with Police and Fire Department officials and tried to get a better purchase on what was happening. What was the pattern? Where were the deaths centered? Who was sick? Who was dying? City staffers were also preoccupied with complaints of power outages across the city. Commonwealth Edison, the IOGl1 power company, experienced a substation fire and several equipment failures during the heat wave that left thousands of Chicago residents without power at one time or another-sometimes for less than an hour, sometimes for as many as 20 hours. The hardest hit were 41,000 North Side residents who lost electricity Friday night due to the substation fire. An estimated 8500 did not have power restored until late in the day on Saturday. Power failures, too, had ancillary effects. For instance, if grocery stores lost power in their refrigeration units, food might spoil. The city needed to inspect food stores to be sure they were not trying to sell any potentially-spoiled food.

Into the night Saturday and into Sunday, as well, the Mayor's staff gathered information and responded to emergencies on an ad hoc basis. The role of Mayor Daley himself during this period was never made publicly clear. According to John Kass, City Hall reporter for the Chicago Tribune, the Mayor did not learn of the scope of the crisis until Sunday morning." In any event, the Mayor did return to the city on Sunday (111d did call an emergency meeting of his cabinet on Sunday afternoon at 3 p.m. After that meeting, the Mayor declared an official "Heat Emergency" and the city mobilized new resources. The Commissioner of Human Services rounded up eight vans and 60 staff workers to respond, on an ad hoc basis, to citizens who called City Hall asking for help. Staff from the Department on Aging began combing through lists of residents who participated in its programs and calling as many as they could to see if they needed assistance. The Chicago Department of Public Health sent out inspectors to check on temperature conditions in the two Chicago nursing homes without air conditioning and the 12 with only limited air conditioning. The "senior officers" for the Chicago Police-officers in each of the city's 25 districts with particular responsibility for elderly residents-began checking on the medically vulnerable residents on their own lists. In addition, the Mayor held a press conference in which he made an impassioned plea to residents to check on relatives, neighbors and friends who might be vulnerable. The city would do what it could, but the city could not do it all, he said.

Although the city set these responses in motion on Sunday afternoon, Pang notes that, by this time, "It was cooling off. It was over from the point that you needed to respond to it. So it was unlike anything we had ever experienced before. It was as if nobody had ever heard of a tornado, and it came through and wiped out a thousand people, and then you thought, 'What the heck was that?'"

On Monday July 17, Mayor Daley appointed an 18-member Commission on Extreme Weather Conditions, chaired by Wilhelm. The Mayor gave the new Commission several

14

Chicago Tribune, July 23, 1995.

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The City of Chicago and the 1995 Heat Wave (A) Cl6-02-1642.0

responsibilities: to determine the factors involved in making the 1995 heat wave so severe in Chicago; to develop an understanding of why so many people died, especially elderly people; and to develop a new plan for coping with extreme heat or extreme cold weather in the future.

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The City of Chicago and the 1995 Heal Wave (A) CI6-02-1642.0

Exhibit I"

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

2]

21

The City of Chicago and the lYY5 J leal Wave (A) _

C16-02- J 642.0

Exhibit 2'"

Provided courtesy ofthe Emergency Medical Services Division ofthe lllinois Department of Pub lie Health.

22

22

The City of Chicago and the 1995 I [eat Wave (A) C16-02-1642.0

Exhibit 3'c

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

23

23

The City of Chicago and the lY95 Heat Wave (A)

CI6-02-1642.0

Exhibit 4"

July 13, 1995

952 calls were received

1520811s were sam led and showed that .. 22 calls were within the 6 mInute Primary time frame

II 42 cans were within 1he 15 mInute Secondary time frame .. 6 caUs were within the 20 minute outlying time frame

II 15 caUs were over the 20 minute outlying ti me frame

II 44 caus used Fire Suppression longer than 15 minutes .. 13 calls using Rre Suppression longer than 30 minutes

Provided courtesy of the Emergency Medical Services Division of the Illinois Department ofPublic Health.

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24

The City of Chicago and the 1995 Heat Wave (A)~~~~_~~ __ ~~_~ __ CJ6-02-1642.0

Exhibit 5'c,

1"

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

25

25

The City of Chicago and the 199:') 1 leal Wave (A) _

C16-02-1642.0

Exhibit 6'"

20

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

26

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The City of Chicago and the 1995 Heat Wave (A) C16-02-J642.0

Exhibit 7"

July 14,1995

1,238 calls were received

_~1.~ cans were sampled and showed that:

• 17 calls were within the 6 minute Primary time frame

• 34 calls were wittlln the 15 minute Secondary time frame

• 9 calls were within the 20 minute Outlying time frame

• 23 calfs were over the 20 minute Outlying time frame

• 69 calls used Flre Suppression tonger than 15 minutes

• 35 cans used Are Suppression longer than 30 minutes

21

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

27

27

The City of Chicago and the ]9l)5 HeM Wave (A) CI6-02-1642.0

Exhibit 8"

27

Provided courtesy of the Emergency Medical Services Division of the lIlinois Department of Public Health.

28

28

The City of Chicago and the 1995 Heal Wave (A) _

CI6-02-1642.0

Exhibit 9"

2.3

Provided eourtcsy of the Emergency Medical Services Division of the Illinois Department of Public Health.

29

29

The City of Chicago and the 1995 I leat Wave (A)

Cl6-02-J642.0

Exhibit 10'~

24

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Pub lie Health.

30

30

The City of Chicago and the 1995 J-kat Wave (A) C16-02-] 642.0

Exhibit 11 .,

25

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

31

31

The City of Chicago and the 1995 Heal Wave (A) _

CI6-02-1642.0

Exhibit 12·"

20

Provided courtesy of the Emergency Medical Services Division of the Illinois Department of Public Health.

32

32

The City of Chicago and the 1995 Heat Wave (A) _

CI6-02-1642.0

Exhibit 13'

27

Provided courtesy of the Emergency Medical Services Division ofthe Illinois Department of Public Health.

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33

The City of Chicago and the J 995 Heat Wave (A) _

CI6-02-1642.0

Exhibit 14C'

2X

Provided courtesy of the Emergency Medical Services Division of the J lJinois Department or Public Health.

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