Author: Robin Campbell- ENA Connection
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Only a fraction of the population of Paradise remains in the once picturesque northern California town, but one group of health care crusaders is making sure those who remain receive the care they need.
Photo credit: Robin Campbell, ENA.
With the town behind them still ablaze, an elderly man and his wife shuffled slowly into a pop-up rescue shelter. As a nurse looked over the couple, the man asked: "Is Paradise gone?" The nurse replied solemnly but bluntly, "Yeah." With apprehension in his voice, the man posed a second question: "Is the hospital gone?" The nurse replied again, "I think so."
They were talking about Adventist Health Feather River Hospital, the only full-service hospital in Paradise, California, that hours earlier burned as the Camp Fire ravaged the town and much of the wooded hills and valleys surrounding it.
The man and the young nurse began to cry. He wept because he had helped build the facility. The nurse wept because she had worked at Feather River for a decade alongside friends, mentors and even her own mother.
Like so many of her colleagues and friends from the area, Birgitte Randall, ADN, RN, lost her home and her hospital. Only six months out of nursing school, Randall cared for the man in that church shelter in November, but she called the 101-bed critical access hospital home as an emergency department admissions clerk, physical therapy tech and ED tech before becoming an emergency nurse last year.
Being a lifetime resident made the loss that much harder to handle. She grew up on what she affectionately calls "the ridge," the San Juan Ridge that runs east-northeast in the foothills of the Northern Sierra Nevada mountain range.
"We’re mountain people, and we understand mountain people," Randall said.
Larisa Pineda, checks out a patient during the May 18 clinic day, while volunteer Amy Evans documents personal information from another. Medspire Health Volunteers. Photo credit: Robin Campbell, ENA.
Medspire Health volunteers have seen and treated more than 100 patients from Paradise since the first free clinic day in March. Photo credit: Robin Campbell, ENA.
ENA President Patti Kunz Howard (right) speaks with Medspire Health Vice President Birgitte Randall about the mobile clinic’s success in treating patients in the area in and around Paradise, California, which was effectively leveled by wildfire in November 2018. Photo credit: Robin Campbell, ENA.
Medspire Health volunteers have seen and treated more than 100 patients from Paradise since the first free clinic day in March. Photo credit: Robin Campbell, ENA.
It’s for those people Randall and a dedicated group of friends and fellow Feather River and East Avenue Church shelter alumni refused to give up on Paradise and its people. Over the course of several months, the group talked about doing more for the town’s residents.
"We know it’s like a house of cards for these people — living week-to-week financially. And if you pull one of those cards — their home, their doctors — everything collapses," Randall said. "We banded together because we want to take care of these people."
Talk quickly became plans, and by March, Medspire Health was born. The volunteer-based mobile clinic, for which Randall serves as vice president, has a simple mission: provide free health care to the people affected by the devastation left by the Camp Fire.
"When we started cooking this up in December, there was no health care for these people. We’re really focusing on those folks who really have nowhere else to go," said Medspire President Elisabeth Tove Gundersen, MS, RN, ANP.
The Day Paradise Burned
The Camp Fire, the most devastating wildfire in California history, started around 6:15 a.m. on Nov. 8 when high winds knocked down a power line and ignited the unseasonably dry brush below. The fire quickly spread through the valley and northeast toward Paradise.
"I said, ‘We gotta get the hell out of here.’" — Feather River ED Charge Nurse Ed Beltran
Photo credit: Robin Campbell, ENA.
Photo credit: Robin Campbell, ENA.
"I knew when I heard the propane tanks exploding that this was going to be the destruction of Paradise. I knew there was no coming back," Randall said.
By 7:30 a.m. the fire reached Paradise. By 9 a.m. Randall’s home was consumed by fire and within three hours, 90 percent of the town was destroyed.
With little time to evacuate the town’s 30,000 residents, 85 people died in the fire, many along roadsides and inside vehicles amid a traffic bottleneck.
The last Feather River nurses and physicians evacuated their patients before seeking safety for themselves on that cold autumn morning as flames licked the side of the hospital building.
Feather River ED Charge Nurse Ed Beltran lost many of his commercial lavender crops to the Camp Fire. Amid the crops that rebounded or were replanted are scorched reminders of the devastating wildfire. Photo credit: Robin Campbell, ENA.
Feather River ED Charge Nurse Ed Beltran lost many of his commercial lavender crops to the Camp Fire. Amid the crops that rebounded or were replanted are scorched reminders of the devastating wildfire. Photo credit: Robin Campbell, ENA.
Ed Beltran, BSN, RN, CEN, MICN, was one of the last ones out. The Feather River ED charge nurse knew conditions were ripe for a wildfire and didn’t sleep much on Nov. 7.
Ed Beltran, BSN, RN, CEN, MICN
Photo credit: Robin Campbell, ENA.
"When I gave up trying to sleep at 4:30 a.m. and decided to go in early, I could hear the winds whipping," Beltran recalled. "I thought, ‘Boy, we better get some rain soon.’"
When he heard the distress call go out over the radio, Beltran said he knew they had to start evacuating patients immediately.
"One of the last times I went out to look, debris was falling on me. A long piece of something charred landed in front of me. An oak leaf turned to ash in my hands," Beltran said. "I said, ‘We gotta get the hell out of here.’"
With the order to evacuate, Beltran and the nurses helped get every patient out and safely on the road. It was a challenge. Police squad cars, and even personal vehicles, were used to get patients off the premises.
"I couldn’t ask for a better group of nurses," he said. "They have great minds, they’re quick thinkers and they’re capable of handling things on their own. It saved lives that day."
With the patients gone, it was the staff’s turn. Each nurse who fled had a similar yet somehow uniquely harrowing experience.
Beltran and his wife, a respiratory therapist at Feather River, spent three hours weaving in and out of fire pockets as they tried to get to family members at home. Along the way, they drove past a person engulfed in flames on the side of the road. They later made it to nearby Chico, which became a haven for most who fled Paradise.
Paul Weingartner, MSN, RN, CEN
Photo credit: Robin Campbell, ENA.
Paul Weingartner, MSN, RN, CEN, set out for safety after the patients evacuated but soon found himself in a traffic jam. The fire quickly approached and surrounded his 2010 Toyota Corolla.
"Both sides of the road were on fire. The roar of wind and fire around me sounded like a jet engine. In my rearview mirror, I could see the flames licking the back of my car," Weingartner recalled. "That’s when I realized this might be it."
But then a familiar face jumped into his car. It was one of the telephone operators from the hospital. Motivated by the self-assigned responsibility for another human life, Weingartner took a chance and drove his car up an embankment. They got through and were re-routed by firefighters to a safe location.
As fate would have it, Weingartner and several others were re-routed back to Feather River, where they started a field hospital in the parking lot. Once again, the patients took priority.
Cassie LeRossignol, BSN, RN
Photo credit: Robin Campbell, ENA.
Cassie LeRossignol, BSN, RN, and a group of hospital friends also abandoned their getaway car and traveled by foot. The group hopped in and out of a car, and then a fire truck pulling a bulldozer and finally a deputy sheriff’s vehicle, which also became disabled. Walking blind through the smoke again, the worst thoughts crossed her mind.
"It quickly went from really bad to feeling like we were going to die," she said. "We were walking on the road with flames that were so close that my hair was burning. I had holes on my backpack. It was that close to us."
Out of the smoke, the bulldozer and a fire truck reappeared to take them back to Feather River.
"People started pouring into the hospital," LeRossignol said about the scene at Feather River. "So, we set up a makeshift triage area and we just started treating patients. We did what we do and watched the hospital burn around us."
Winds shifted, giving the hospital workers another chance to get the field hospital patients and themselves out of danger. The second evacuation presented its own frightening challenges.
"We were driving through walls of flame," LeRossignol said.
It took weeks to fully extinguish the fire, and even longer before Cal Fire officials would let residents back into Paradise.
Roughly 2,000 people returned and now live among the rubble in tent cities or in a few miraculously untouched homes. These determined and, in some cases, desperate Paradise residents live with few services and water lines contaminated with the carcinogen benzene.
These are Medspire Health’s patients.
Serving the Community
Since March, Medspire has held four free clinic days at the Magalia Pines Baptist Church in Magalia. There, Medspire’s team offers wellness checks, blood-pressure screenings, blood sugar checks, case management services, nutritional analysis and non-narcotic medications. The group has seen or treated more than 100 patients and even provided its first house call on July 2.
Paradise Nurses To Share Their Stories in Austin
A panel discussion at Emergency Nursing 2019 in Austin next month will highlight four nurses who worked at Adventist Health Feather River Hospital in Paradise, California, during the massive Camp Fire in November that killed 85 and caused more than $16 billion in damage. During the session, "The Day Paradise Burned," Feather River ED nurses Ed Beltran, BSN, RN, CEN, MICN, and Chelsea West, BSN, RN, will share their harrowing stories of survival during the evacuation, what they learned from the experience and how they are coping in the aftermath.
Medspire Health Vice President Birgitte Randall, ADN, RN, will also discuss the early days at the East Avenue Church rescue shelter that spurred a movement to provide health care to the residents of Paradise in the wake of the disaster.
The panel will be led by California ENA State Council Immediate Past President and disaster preparedness advocate Kathy Van Dusen, MSN, CEN, CPEN, NHDP-BC.
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"We were truly a mobile clinic today," the group stated in a Facebook post that day.
Randall said the success of the clinic is a team effort and, in her case, a family affair. Tove Gundersen is Randall’s sister, and their mother, Denise Gundersen, RN, volunteers. Other co-founders include Whitney Hansen, ADN, RN; Katie Rosauer, BS; and Medspire’s medical director, Ted Muller, MD, who also served as Feather River’s medical director.
"Medspire’s been a really neat story," Muller said. "It’s just amazing. These people are such positive go getters. They’re such a supportive group of people."
In May, ENA President Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, visited Paradise to show support for the emergency nurses who lost so much, and when she heard the buzz about Medspire, she knew that would be her first stop.
"I’m really impressed that this group has taken the initiative to provide care for an underserved population, especially for those who have lost so much as a result of the wildfires," Howard said. "This is what being committed to care looks like."
On the 90-minute rainy drive north from Sacramento to Paradise, the devastation hit Howard hard. Approaching the base of the mountain range, about 15 miles from the clinic, she started to see the fire’s seemingly indiscriminate path, charred earth and trees left in its wake. Entering the mountains, looking over the highway into the scorched valley below, she whispered one phrase over and over: "This is unbelievable."
"I’m really impressed that this group has taken the initiative to provide care for an underserved population, especially for those who have lost so much as a result of the wildfires. This is what being committed to care looks like."
— ENA President Patti Kunz Howard
Howard’s disbelief and heartbreak only grew while traveling through Paradise. She was struck by the hollowed-out storefronts, parking lots of melted cars and piles of debris. Intact fireplace hearths and chimneys peppered the roadside as tombstones for the homes that once encased them.
Despite the cold weather, Howard was warmed by what she saw at the Medspire Health base of operations. Nearly two dozen volunteers — mostly nurses and nursing students — stood eager to treat whomever drove or walked up.
Howard listened to the volunteer nurses’ stories and made sure they understood ENA is behind them. She found them to be in high spirits, despite all they’ve been through.
Medspire Health volunteers were excited to welcome Howard to their second free clinic day on May 18
Photo credit: Robin Campbell, ENA.
Randall stands with her sister and Medspire president, Elisabeth Tove Gundersen, and her mother, Denise Gundersen
Photo credit: Robin Campbell, ENA.
"Their hope and resiliency are amazing to me," she said.
Howard brought two complimentary one-year memberships and two ENA Foundation conference scholarships as a show of ENA’s support. Hansen, whom Randall has been trying to poach from the ICU, received one of each. Chris Mulvaney, RN, another Feather River nurse and clinic volunteer, received the other conference scholarship.
The second membership went to Jacklyn Orozco, RN, a nurse in the ED at Adventist’s Rideout Memorial Hospital in Marysville, an hour south of Paradise.
Other organizations have been supportive as well. Adventist Health, the health system which employed 1,200 people at Feather River, provided an EKG machine among its donations to help further Medspire’s mission.
"We reached out to Adventist to see what they could do, and they’ve been fantastic. We’ve collaborated closely with them," Muller said.
Adventist also made good on promises to their former employees by offering three months’ pay and six months of uninterrupted health care coverage to help them during the transition to new jobs. Additionally, Adventist offered financial aid to those who lost homes in the fire or had to relocate.
An Unfillable Void
Once a staple in the community, Feather River provided ED, ICU, and medical and surgical services to residents of Paradise, Magalia, Concow and several other areas on the ridge. The facility, while still standing, suffered significant damage and remains dormant.
Most of the nurses who worked there have found jobs in surrounding areas. For some, those positions are place placeholders until Feather River is rebuilt and they’re asked to come back.
"We all want our jobs back. We want our lives back," said Randall, who’s currently a per diem nurse at Enloe Medical Center in Chico, which hired several displaced Feather River nurses, and Rideout in Marysville.
For some Feather River nurses, even coming back to Paradise on free clinic days stirs up the pangs of longing to return. Diana Anderson, RN, whose family lost two homes in Paradise, took a position at Rideout.
"I cried the whole way here today," Anderson said about her drive to the May clinic day.
The streets of Paradise are lined with debris and remnants of homes that once stood tall among the trees
Still, Randall, Anderson and the other displaced nurses know it’s unlikely Feather River will reopen anytime soon. Their only hope is a rumor that Adventist Health is considering bringing the facility back as a freestanding ED. The existing ED was largely untouched, so the potential is there. But with Paradise’s dwindled population, there’s concern the town can’t support such an endeavor.
"I grew up here. I plan to come back to the community at least, but if Feather River opens back up, I definitely want to come back," Anderson offered.