The trauma center knows it has to be able to care for patients under the most trying circumstances.

But now the disaster plan is changing, in light of Hurricane Katrina.

Harborview Medical Center's emergency room runs full speed. In a year, doctors here treat 90,000 ER patients.

In a disaster, even more people will turn to Harborview.

In Hurricane Katrina's wake, hundreds of first responders left their jobs to take care of their own families. That possibility now becomes part of Harborview's disaster plan.

"How do we support the worker so that they can work?" said Harborview Chief Operating Officer Johnese Spisso. "We're looking at other things like childcare needs; people to go check on their homes who are already in the community, so we don't have to displace our very valuable staff member."

The hospital is also prepared in case a computer virus wipes out electronic information. Staffers can go back to a paper system.

There are plans to discharge stable patients to handle a sudden surge of critical injuries.

"We know that 80 percent of patients in a disaster like Katrina will seek care directly in the ER," said Dr. Frederick Blum of the American College of ER Physicians. "They won't use EMS. They won't use the fire department. They'll use the emergency department."

Eighty people used Harborview's ER after the Nisqually Quake. Just this June, scientists predicted in a major quake here, 24,000 would be hurt and the roads badly damaged.

"Simultaneously, we can land three Black Hawk helicopters on our helipad," Spisso said. "You can transport 2 to 3 patients per Black Hawk. You can do landings and takeoffs within a few minutes of each other."

In case of a pandemic flu or smallpox, Harborview would funnel patients to a remote hospital to try to contain the virus.

The plans are constantly being refined, with lessons learned from the Nisqually Quake, Sept. 11, and now Hurricane Katrina.

Because when the worst happens, Harborview will have to be at its best.