7-22-97

To: David Summer, Safety Officer, Rainbow Incident
From: Dan Wood, Medical Unit Leader, Rainbow Incident
Subject: Summary Medical Report

Attached is the summary medical report for the Rainbow Family Gathering Incident. I have sent the resulting medical records to Dr. John Jui, Incident Medical Specialists Program Physician Advisor, as required.

I have also provided copies of this report to Pioneer Memorial Hospital, Prineville Fire Department, Saint Charles Medical Center, and Air Life of Oregon; all cooperators in this project. I have also attached copies of the letters used to transmit the report.

Thank you very much for allowing me to participate in this operation. It was enjoyable and I learned a lot.

INTRODUCTION

The Rainbow Family Gathering is an annual national event involving an estimated 20,000 self -styled "hippies" who met this year on Indian Prairie on the Ochoco National Forest. The focus of this years event occurred on July 4, with large numbers of participants arriving and departing for about a week before and after that date. The Central Oregon Incident Team was called to manage the event. The Incident team was augmented by considerable law enforcement resources from the Sheriffs Offices of Crook and Deschutes Counties, and the Oregon State Police. The Oregon Health Division was also present on the site throughout most of the event.

PURPOSE AND NEED

The City of Prineville, Oregon, with a population of about 6,000, is the community most near the gathering site. The cities medical and other resources were severely impacted weeks prior to the event by the hundreds, then thousands, of Rainbow Family event participants arriving for the event. Many of these early arrivals were homeless. The local Hospital Emergency Department and Fire Department Ambulance Service saw a significant increase in patients requiring their services. Inquiries to medical services in communities that previously hosted the event revealed serious impacts to these services in small towns similar to Prineville. Other hospitals and ambulance services reported losses of hundreds of thousands of dollars, due to unpaid services rendered, and increased risk to the communities they serve due to services occupied by Rainbow event participants.

Representatives from the local Prineville Fire Department, Hospital and Incident Team met in late June to discuss the medical issues related to the event. Specifically, these agencies were seeking ways to provide proper Emergency Medical Services (EMS) coverage to the community and Rainbow participants, and how to mitigate the economic impacts to the meager EMS budgets of the Prineville community. This group agreed and recommended that a temporary field medical unit located near the Incident would better serve event participants and Incident personnel. It was also felt that a medical unit would reduce the impacts to the community EMS through triage of patients, stabilization of more serious patients prior to ambulance transport, and treatment of minor first aid needs. The Incident Commander, Hospital Administrator and Chief of the Fire Department agreed with this recommendation and authorized the medical unit to be managed cooperatively by the parties involved.

THE AGREEMENT

A Memorandum of Understanding was developed and signed as a result of the meetings with representatives of the Prineville Fire Department, Hospital and the Incident Team. The agreement was intended to address the issues of providing adequate medical care to the community and to the event, and save money and resources of the local EMS agencies. The agreement included the following;

* Each agency would coordinate and cooperate to provide the best patient care possible and each would operate under their own authority and protocols.

* The Incident Team would provide an Incident Medical Specialist, a medical tent, a 100 person medical kit and communications (including portable radios and cell phone). The Incident Medical Specialist would be responsible for the administrative and record keeping needs of the medical unit. The medical unit was located at the Ochoco Ranger Station.

* Pioneer Memorial Hospital of Prineville would provide a Registered Nurse at the medical unit who would be the senior medical person in the unit, a Physician Liaison for the Incident, act as primary medical control for the Incident and provide medical supplies and equipment .

* Prineville Fire Department would provide Ambulance service to the Incident, a van for use of the medical unit, and some emergency medical equipment.

* Saint Charles Medical Center of Bend, Oregon also agreed to provide medical supplies for the unit, using an American Red Cross Aid Station inventory list as a guide.

*Air Life of Oregon coordinated with the Incident Command to identify helicopter landing zones and communications for the possible evacuation of critical patients.

CASE LOAD SUMMARY

The Incident Medical Unit was established on 6-27-97 and open to the public from 6-28-97 through 7-8-97. The hours of operation were publicized as from 10am to 10pm. Pioneer Memorial Hospital provided a Registered Nurse (Bobbie Bourne) during these hours. The Incident Medical Specialist was also on duty during these hours and was "on call" at the medical unit 24 hours each day except for July 7 and 8 when there was no after hours coverage due to reduced case load. Several patients were seen outside the 1 10AM to 1 10PM hours.

Before giving the case load statistics for the Medical Unit, it is important to note that the Rainbow Gathering had their own various first aid and medical resources. Several people from the gathering introduced themselves as nurses, EMT's, and physicians. The accuracy of some of these claims were suspect but we do know there was some conventional medical training on site. In addition, there were many non-traditional medical practices we do know however, that the vast majority of medical needs were handled at the gathering and not at the Incident Medical Unit The Incident

Medical unit saw only a small percentage of medical cases generated by the gathering.

The Medical unit saw a total of 101 cases over the 11 days it was open. These included 97 people, one Law Enforcement dog and three Rainbow dogs. There were 10 cases referred on to the local hospital Emergency Department. Three of these 10 were taken to the hospital by ambulance.

A more specific listing of cases is as follows:

Lacerations, abras., etc.	29
Ankle injury	8
Burns	8
Sore throat	7
Headache	7
Cold and fever	5
Toothache	3
Diarrhea	3
Urinary tract infection	3
Rash	3
Asthma treatment	3 (patient furnished own meds and equip.)
Ingrown toenail	2
Insect bites	2
Upset stomach	2
Chest Pain	2
Diabetic	2
Drug overdose	2
Pneumonia	1
Vaginal bleeding	1
Dislocated finger	1
Blister	1
Grass seed in ear (dog)	1
Possible Scabies	1
Dog bite	1
Altered mental status	1
Request for Iyme disease treatment	1
Request for IV treatment	1

SIGNIFICANT CASES

One event related death occurred (motor vehicle accident) prior to the existence of the Incident Medical Unit.

There were 10 cases referred to the local hospital by the medical unit. Eight were released by the hospital after treatment, one required extended observation and one was eventually housed in the Deschutes County Jail.

These 10 cases included:

2 Drug Overdoses
2 kidney infections
1 severe ear and face laceration
1 second degree burn
1 pneumonia
1 diabetic
1 altered mental status (transferred to Redmond Hospital then to Deschutes County Jail)
1 vaginal bleed (held at Prineville Hospital for observation)

DIFFICULTIES ENCOUNTERED

Coordination between the agencies operating the medical unit was excellent, especially considering the long hours, confusion and the many opportunities for mix-information and misunderstandings.

The principle problem encountered was poor communications. The medical unit had excellent radio communications with Incident Command at all times. However, direct communication with on-line medical control (the hospital emergency department) was undependable. (This posses a significant problem to any field medical unit). The medical unit was equipped with a cell phone on the first day of operation but was unable to send or receive calls for two days. A new antenna and more powerful cell phone were installed so sending calls to the hospital was possible for the next several days but receiving calls was not dependable. The cell phone stopped working entirely for the last two days of the incident.

There were three cases where there was a jurisdictional dilemma regarding the transportation of patients 25 miles from the medical unit to the hospital. These three patients needed to promptly go to the hospital but did not have their own transportation, were unable to arrange transportation, and were not in a condition that required an ambulance. (The ambulance would not transport patients that did not require an ambulance.) These cases were the severe face and ear laceration, diabetic, and the possible pneumonia. Transportation of private citizens by the incident in this case posed considerable concern to Incident Command.

SIGNATURES

The following individuals operated the medical unit, collaborated in the preparation of this report and concur with its contents.

(signed) Dan Wood, EMT-1 7/22/97 Date
Dan Wood, EMT-I Incident Medical Unit Leader

(signed) Bobbie Borne, RN 7-22-97 Date
Bobbie Borne, RN Pioneer Memorial Hospital

July 22, 1997

George Drago
Director of Nursing
Pioneer Memorial Hospital
1201 N. Elm
Prineville, Oregon 97754

Dear George,

Enclosed is your copy of the final medical report for the Rainbow Family Gathering Incident, held on the Ochoco National Forest in June and July of this year. Please feel free to share it with the hospital staff.

We want to especially thank you for the personnel, medical equipment, supplies and medical advice provided by the hospital. The field medical unit was a great example of practical people doing what is reasonable to solve a problem; regardless of agency, jurisdiction and "red tape". I was especially pleased to have worked with Bobbie Bourne. She was very enjoyable and I certainly learned a lot .

And thanks for your leadership in making this all happen. We look forward to working with you in the future as we coordinate EMS resources for the benefit of the community.

Sincerely,

(signed) Dan Wood
Dan Wood
Incident Medical Specialist

July 22, 1997

Bob Schnoor, Acting Chief
Prineville Fire Department
500 N. Belknap
Prineville, Oregon 97754

Dear Bob,

Enclosed is your copy of the final medical report for the Rainbow Family Gathering Incident, held on the Ochoco National Forest in June and July of this year. Please feel free to share it with the rest of the Department.

We want to especially thank the Fire Department for the use of the vehicle, medical equipment, and great ambulance service they provided. We feel the field medical unit operations met the objectives of providing better medical service to the Rainbow family members and Incident Administrative staff, and easing the increased caseload burden on community Emergency Medical Services.

Thanks for your contribution to this effort. We look forward to working with you in the future as we coordinate EMS resources for the benefit of our community.

Sincerely,

(signed) Dan Wood
Dan Wood
Incident Medical Unit Leader

July 22, 1997

Marty Betsch
Team Leader/Manager, Emergency Department
St. Charles Medical Center
2500 N.E. Neff Road
Bend, Oregon 97701-6015

Dear Marty,

Enclosed is your copy of the final medical report for the Rainbow Family Gathering Incident, held on the Ochoco National Forest in June and July of this year. I thought you might find it interesting.

We want to especially thank you and your department for the invaluable medical supplies and moral support you provided. We feel the field medical unit operations met the objectives of providing better medical service to the Rainbow family members and Incident Administrative staff, and easing the increased caseload burden on community Emergency Medical Services.

Thanks for your contribution to this effort. We look forward to working with you in the future as we coordinate EMS resources for the benefit of our Central Oregon community.

Sincerely,

Dan Wood
Incident Medical Unit Leader

# of patients identified as attending Rainbow Gathering and seen in the ED: 74

# of patients initially seen at Medical Unit and referred to ED: 7

# of ambulance transports from Medical Unit to P.M.H. ED: 3

# of ambulance transports prior to Medical Unit being established: 3

# of patients referred from Medical Unit and admitted to P.M.H.: 2

# of patients admitted to P.M.H. prior to establishing Medical Unit: 2

# of patients transferred and admitted to St. Charles Medical Center: 1

1201 N. Elm Prineville, Oregon 97754-1299
503/447-6254 FAX 447-6705

M.R.#	DATE	TIME	PATENT NAME	CHIEF COMPLAINT	SEEN.AT MED.UNIT	AMBULANCE TRANSPORT?	ADMITTED TO HOSP.?	DISCH. TIME
88616	6/13/97	12:40	.	Spont. Abor.	no	yes	no	1545
88619	6/13/97	17:20	.	Poss. Gangrene (R) finger	no	no	no	1800
88636	6/15/97	14:55	.	Trauma MVA	no	yes-Airlife	yes-SCMC	1556
88640	6/15/97	17:12	.	OD - POISON Mushrooms	no	yes	yes	18:40
88653	6/17/97	21:15	.	Poss. Fx. (l) Clavicle	no	no	no	22:30
.	6/18/97	12:20	.	Sore throat, swollen glands	no	no	no	14:20
88467	6/28/97	17:40	.	Back Pain	no	no	no	18:20
88674	6/19/97	18:40	.	Swollen glands	no	no	no	19:03
88691	6/21/97	09:30	.	Blister on Arm	no	no	no	09:45
76950	6/22/97	19:25	.	Chest pain no	no	no	20:10
88712	6/23/97	03:50	.	Asthma Attack	no	no	no	05:05
88647	6/23/97	12:00	.	Swollen glands	no	no	no	12:30
88715	6/23/97	15:50	.	Painful gums	no	no	no	16:30
88718	6/23/97	16:45	.	(R) Arm Injury	no	no	no	17:30
88719	6/23/97	17:00	.	Cough, fever, Chills	no	no	no	17:40
88720	6/23/97	17:00	.	Cough, Congestion	no	no	no	17:40
88723	6/24/97	06:00	.	Rib injury	no	no	no	07:50
88733	6/25/97	06:15	.	Hematemesis	no	yes	no	08:20
88738	6/25/97	13:45	.	Difficulty Breathing	no	no	no	15:00
88740	6/25/97	16:45	.	Infected (L) Hand	no	no	yes	18:45
88741	6/25/97	17:00	.	Poss. Scratch (L) eye	no	no	no	17:50	>
88684	6/25/97	11:45	.	Toothache	no	no	no	18:40
88746	6/26/97	08:15	.	Sore throat, tick bite	no	no	no	?
88747	6/26/97	12:45	.	Dog bite	no	no	no	14:00
88750	6/26/97	15:40	.	Nausea, painful breasts	no	no	no	17:45
88758	6/26/97	00:30	.	Seizures	no	no	no	07:50
88759	6/26/97	04:30	.	2 1/2 mos. pregnant	no	no	no	07:20
88764	6/26/97	09:45	.	injured (R) wrist	no	no	no	13:25
88765	6/27/97	13:40	.	Cramps, bleeding	no	no	no	16:20
88768	6/27/97	15:70	.	Asthma	no	no	no	16:25
88770	6/27/97	17:30	.	N/V Cramping	no	no	yes	20:10
88771	6/27/97	19:30	.	Spider bite	no	no	no	20:45
88772	6/27/97	22:25	.	Vaginal bleeding	no	no	.
88774	6/27/97	22:30	.	Sore throat	no	no	no	23:05
88775	6/28/97	05:25	.	Rig injury	no	no	no	06:30
88777	6/28/97	13:05	.	Abd. pain, diarrhea	no	no	no	17:25
88778	6/28/97	15:30	.	Poss. std	no	no	no	18:05
88779	6/28/97	15:45	.	Sore Gums	no	no	no	16:45
88780	6/28/97	17:25	.	Poss.. OD.	yes	yes	OSP	18:50
88782	6/28/97	20:25	.	UTI	yes	no	no	23:50
88785	6/28/97	23:25	.	Poss. Crank OD	no	OSP	no	02:05
88789	6/29/97	16:10	.	Laceration (R) cheek	no	no	no	16:50
88790	6/29/97	19:53	.	mushroom injest.	yes	no	no	21:25
88782	6/30/97	11:35	.	UTI	no	no	no	11:45
88740	6/30/97	18:03	.	(R) Arm pain	no	no	no	18:50
88801	7/1/97	00:30	.	Abd. Pain.	no	no	no	01:45
88805	7/1/97	13:30	.	Bilat. ankle injury	no	no	no	16:05
88806	7/1/97	18:30	.	Ingrown (L) toenail	no	no	no	19:50
88809	7/2/97	01:30	.	(R) Ankle injury	no	no	no	02:35
88808	7/2/97	01:20	.	Diabetes	no	no	no	02:45
88815	7/2/97	14:20	.	Bike wreck	yes	no Forest Service	no	17:20
88823	7/2/97	22:58	.	Mental Health	no	?	no	01:00
88829	7/3/97	12:35	.	N/V	no	no	no	14:40
88831	7/3/97	15:05	.	Fever	yes	no	no	?
88823	7/4/97	01:25	.	Evaluation	no	no	no	02:00
88836	7/4/97	03:35	.	Moth in (L) ear	no	no	no	03:50
88837	7/4/97	04:25	.	(L) lower leg injury	no	no	no	05:30
88849	7/4/97	15:30	.	Poss. STD.	no	no	no	16:45
88851	7/4/97	16:30	.	OS injury	no	no	no	17:20
88855	7/4/97	18:30	.	Pregnancy, hallucinat.	no	no	no	22:20
88860	7/4/97	21:50	.	High Blood Sugars	yes	no (USFS)	no	07:05
67911	7/4/97	22:50	.	STICK POKED LEG	no	no	no	21:15
88863	7/5/97	03:45	.	Hyperglycemia	no	no	no	09:10
88865	7/5/97	09:10	.	UTI	yes	no	no	10:00
88872	7/5/97	17:35	.	N/V	no	no	no	19:00
88872	7/5/97	21:35	.	Abd. pain	no	no	no	06:00
82613	7/5/97	24:00	.	Abd. + Back Pain	no	no	no	10:40
88877	7/6/97	04:20	.	Vaginal bleeding	no	yes	yes	06:00
88878	7/6/97	09:15	.	Psych..	no	no	no	20:05
88885	7/7/97	10:10	.	Cough	no	no	no	10:40
88896	7/8/97	15:25	.	Inj. (R) Foot	no	no	no	18:15
88906	7/9/97	1530	.	Abd. cramps N/V. Diarrhea	no	no	no	17:55
88903	7/10/97	02:05	.	MVA	no	no	no	04:05
88909	7/10/97	02:05	.	MVA	no	no	no	05:00
.	.	.	.	Total 74	y -7	y-3 before Nm y-3	y-3 before Nm y-2

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