US 50 Bridge Closure is an Immediate 911 for Gunnison Hospital

As chief paramedic at Gunnison Valley Hospital, CJ Malcolm deals with emergencies every day. But when his phone rang with an alert that U.S. 50 west of Gunnison was immediately closed due to a cracked bridge, Malcolm had a moment of breathtaking alarm.

I knew this was a huge, immediate deal with 911, Malcolm said. My first thought was: This is a disaster.

He didn't overreact.

Closing one of two highway accesses to an isolated town of 7,000 in a county of about 3,200 rugged square miles posed all sorts of life-threatening problems.

The April 18 shutdown halted regular ambulance transports to major western cities and threatened the overall operation of a small county-owned hospital that provides everything from deliveries to orthopedic surgeries, and handles an average of 20 emergency room visits within a day.

Gunnison Valley Health Hospital operates independently. Its mission as a Level IV critical care hospital is to stabilize patients in one of Colorado's largest counties, an accident-prone county due to an excess of remote and mountainous public lands, and residents and visitors who like to challenge themselves on this terrain.

But the hospital does not operate in a vacuum. It relies in many cases on other hospitals, healthcare providers and suppliers outside of the Gunnison Valley. Many of these tentacles extend westward, beyond the impassable bridge.

The exact number was quickly evident to a critical incident command team led by Malcolm and assembled with the help of hospital CEO Jason Amrich. They essentially set up a dual operating structure within the hospital. A system would resolve bridge issues while the hospital's usual chain of command organization would ensure daily operations run smoothly.

You can't deal with an emergency situation with a normal business approach, Malcolm explained.

Basement room transformed into command center

The morning after the largest bridge over the Blue Mesa Reservoir closed with no opening in sight, the hospital's new critical incident system was up and running. A room in the basement of the 24-bed hospital became an official command center. Teams were formed for operations, logistics, finance and planning.

Whiteboards listing priorities and goals bristled with colorful sticky notes. A large screen on one wall broadcast those who had to attend emergency meetings virtually twice a day or more.

Nicole Huff, Gunnison Valley's chief nursing officer, is among those who head to the basement several times a day to attend command center meetings that she calls brain dumps.

There's a lot of out-of-the-box thinking, she said.

CJ Malcolm, left, chief paramedic and incident commander at Gunnison Valley Hospital, leads a hospital emergency response team staff meeting Thursday for the closure of the US 50 bridge above of Blue Mesa Reservoir. Group members meet twice a day, sometimes more often, in a virtual conference with other staff members. (Dean Krakel, Special to the Colorado Sun)

Problems quickly flooded the whiteboards: Ambulances wouldn't be able to transport patients to hospitals in Montrose or Grand Junction for higher-level care. Such transports to outside hospitals, including Denver and Colorado Springs, occur about 300 times a year. Gunnison only has three ambulances, and longer transports east could expand their availability. Doctors and nurses who travel to Gunnison from the west would not be able to get to the hospital for their shift.

Usual Western suppliers could no longer provide everything from linens, sample vials and filtered water to blood, oxygen and chemotherapy drugs. Dialysis and radioactive patients would not be able to travel to Montrose for their daily life-sustaining treatments. Methadone patients could not travel west to receive their usual care. Medications destined for the hospital system's senior care center would have to be rerouted to another provider.

The solutions were posted on a board next to the problems: Dialysis patients could be sent east to Salida. Radiation patients could have priority over a county road detour into Montrose. Chemotherapy drugs from a foreign supplier could be imported by FedEx from the East rather than the West.

Blood products and oxygen could come from the east during the closure. Lab samples, including biopsies, could be prioritized to avoid the dirt road detour to Montrose labs. The county could potentially allow medical personnel to navigate the rugged detour outside of the early morning and late evening pilot car openings for local citizens.

Montrose Emergency Services could handle ambulance cases in the east end of Gunnison County. This happened on the first day of the shutdown when a seriously ill person was picked up by a care flight at the west end of Blue Mesa.

A whiteboard shows all the important links between hospitals and services across the West. Another diagrams tentacles to the east that could continue with trips on U.S. 50 over Monarch Pass. The arrows showed what could be moved in one direction.

We are super connected. This shows impacts across the entire Western Slope, Malcolm said.

June 1 of the summer tourist season is on the horizon

Less than a week after the Colorado Department of Transportation indefinitely closed the Middle Bridge over Blue Mesa due to serious safety concerns, hospital officials say they feel they have stabilized their 88-year-old hospital, just as they would for a patient rushed to the emergency room. Their triage efforts are working.

We're stable and we're looking at how we're going to be resilient long term, said Joelle Ashley, public information officer for Gunnison Valley Health.

Ashley is among those who meet daily in the incident command center that was last used regularly during the COVID pandemic.

Ashley said discussions at the command center sometimes focused on the hospital's luck that the bridge failure occurred when it did. It's off season in the Gunnison Valley. The ski season at Crested Butte Mountain Resort, 30 miles to the north, has just ended. The summer tourist season does not start until the beginning of June.

Ashley said this means the hospital has time to prepare for all eventualities when there are only about eight patients a day at the hospital.

June 1st is written on one of the whiteboards as a reminder of what is to come. This is when the influx of tourism normally hits.

It's scary, Malcolm said of that date.

Gunnison Valley Hospital supply chain manager Rick Vogel stands in one of two warehouses filled with supplies the hospital will use for emergency care when the U.S. 50 bridge closes above Blue Mesa Reservoir, April 25, 2024. Everything from linens to fluid bottles to water is a consideration as the hospital faces a transportation emergency. i (Dean Krakel, Special to the Colorado Sun) Hospital doesn't go it alone

The hospital alone does not carry the burden of being cut off from half of its normal world.

Gunnison County ensures its hospital is fully functional. Gunnison County commissioners declared a local disaster emergency last week that includes health care as a threatened service. The county also pushed hard to open a backcountry road that cuts detour time from six or seven hours to just under an extra hour.

The Colorado Department of Public Health and Environment and the Gunnison County Public Health Department are responding to help resolve the issues. The West Region Health Care Coalition, a collaboration of health and medical partners on the Western Slope, has been a resource with its network of hospitals, clinics, emergency flight providers, the American Red Cross and the Colorado Hospital Association.

Katherine Smith, the coalition's preparedness and response coordinator, released an emailed statement saying her organization is helping to mitigate impacts to patient care due to the bridge closure. One of them is helping coordinate dialysis clinics for Gunnison patients and staying informed of existing or anticipated needs of other regional health care facilities to avoid what could become medical emergencies.

Smith pointed out that Hinsdale and Montrose counties are also affected by the bridge closure.

During any type of emergency event, it is essential to maintain situational awareness and support between healthcare facilities, emergency departments and hospitals to ensure continuity of patient care, even if the potential impacts are not obvious at first, she wrote.

Gunnison is also helped by his normal independent attitude, Malcolm noted. The region's remoteness prepares it for a disaster like this. A years-long major highway project that required periodic shutdowns and delays on a section of US 50 in a canyon west of Blue Mesa served as practice for a complete closure of the highway that health officials say could last. months at least.

We have thick skin from being cut off from the world here, Malcolm said. Usually it was like an island here anyway. Now it was even more so. We can handle this.

Fixes:

This story was updated on April 29, 2024, at 8:12 a.m. to correct the square miles of Gunnison County. It covers 3,239 square miles, making it the fifth largest county in Colorado by total area, according to U.S. Census data.

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