Regional Disaster Medical Health Specialists Fred Claridge , BS, EMT-P Coastal Region Bryan Hanley, BS, EMT-P Southern

1. Regional Disaster Medical Health SpecialistsFred Claridge, BS, EMT-PCoastal RegionBryan Hanley, BS, EMT-PSouthern Region Regional Pre-Hospital Coordination: The California Approach

2. California’s Pre-Hospital / Hospital Challenges • Diverse and Complicated • 58 County Health Departments • 3 City Health Districts • 33 Local EMS Agencies • 512 General Acute Care Hospitals • 37.6 M People • 2 RCPGP Areas

3. California’s Pre-Hospital / Hospital Challenges Major disasters are not uncommon

4. California’s Pre-Hospital / Hospital Challenges • Hospitals and beds continue to decrease • More than 200 acute care hospitals still have buildings that are in danger of collapse during an earthquake and must be replaced by 2013 • Post Catastrophic Earthquake 40-60% loss of capacity • Fragile & Aging Utility System

5. Cat Planning • Southern California Catastrophic Earthquake • San Francisco Bay Area Earthquake Readiness Response: Concept of Operations Plan • Cascadia Subduction Zone Earthquake and Tsunami Response Plan • Bio-threat MCM Planning • Urban Wildland Interface Fire Planning • Evacuation, Recovery, Risk Comms, …

6. Coordination Success Points • State Emergency Plan • EF-8 Public Health and Medical • Medical Health Operational Area Coordinator • Health & Safety Code 1797.153 • Authorizes county health officer and local emergency medical services administrator to jointly act as the MHOAC or appoint an individual to fulfill the roles and responsibilities • 17 Elements of Medical & Health Operations/Planning • MHOAC shall assist the OES operational area coordinator in the coordination of medical and health disaster resources within the operational area • Mutual Aid Coordination and Support • Operational Area = County Jurisdiction

7. Assessment of Immediate Medical Needs Coordination of patient distribution and medical evaluations Coordination of Disaster Medical and Health Resources Coordination and Integration with Fire Agencies Personnel, Resources, and Emergency Fire Pre-hospital Medical Services Coordination of out-of-hospital Medical Care Providers Coordination of the Establishment of Temporary Field Treatment Sites Coordination with Inpatient and Emergency Care Providers Coordination of Providers of Non-Fire Based Pre-Hospital Emergency Medical Services MHOAC Responsibilities -17- Provision of Medical and Health Public Information Protective Action Recommendations Assurance of Drinking Water Safety Provision or Coordination of Mental Health Services Assurance of Food Safety Management of Exposure to Hazardous Agents Health Surveillance and Epidemiological Analyses of Community Health Status Assurance of the Safe Management of Liquid, Solid, and Hazardous Wastes Investigation and Control of Communicable Disease Provision or Coordination of Vector Control Services

8. Statutory Coordination Points • Regional Disaster Medical Health Coordination • HS Code: 1797.152 • 6 Mutual Aid Regions • Regional EOC • State EOC • Ca HHS Agency (EF-8 Lead) • Joint EMSA/CDPH EOC

9. Statutory Coordination Points • Public Health and Medical Emergency Operations Manual • Foundational documents establishing Public Health & Medical coordination and support standards • Response Functions • Function Specific Topics • Establishes expectations • Everyone can find themselves

10. Function Specific Topics • 12 Major Public Health & Medical Functions • Describe role at each of the response levels • Day to day • Emergency • Identifies the key activities, response partners • Set expectations • Describes response activities specific to function • May be augmented by local / OA protocols and tools • Tactical and useful during response • Resource lists at the end of each section

11. “Smaller” disasters and day to day challenges San Bruno gas explosion Oikos University shooting Chevron refinery fire High call volumes – long “drop-off” times at EDs Systems are already stretched thin

12. One way to get EMS resources • Statewide Ambulance Strike Team program • Disaster Medical Support Units (DMSU) • Strike Team Leader qualifications and training • New Team Leader “certification” process • Many contracts with private providers have strike team requirements (timeframes) • Better use of myriad BLS resources needed

13. Regional MOA Development • Initial disaster response between counties happens “organically” • Assets can and often do move before regional/state system “gears up” • MHOACs in Bay Area region want an agreement – in writing – covering early movement of resources/mutual aid • Reimbursement is a big issue • MOA can be used for undeclared disasters

14. Bay Area UASI Initiative • Regional Medical Surge Planning Project • Research component for “best practices” • Present options to local planning partners • Create a library of useful information • Challenge of planning silos – grant funding structure can make regional planning more difficult – identify gaps • JPATS feasibility study – state is looking at this system too • Medical surge discussion-based exercise

15. Regional exercises • Both a strength – and a weakness • Counties do separate MCI and health related exercises – often based on grant funding streams • Some effective regional exercises have been done involving many jurisdictions and agencies • BayEX is a good example – tied in with regional authority (BART) – all levels of government

16. Los Angeles Solution • Formalizing Coalition • Los Angeles County Healthcare Coalition • 104 Acute Care Hospitals, 100s of clinics, almost 500 skilled nursing facilities, numerous ambulatory surgery centers, dialysis centers, home health, 58 EMS provider agencies • Policy developed: “To assist the healthcare system prepare, respond and recover…create an Emergency Preparedness Advisory Committee”

17. Los Angeles Solution • Healthcare Disaster Coalition Advisory Committee • In County Policy • Bylaws; voting members • Advisory to EMS Agency • Policy set 1100 - County Disaster Policies • Uses existing committees, projects and workgroups • Organizes and Legitimizes

18. Los Angeles Solution • Lines out Roles and Responsibility of each participating member group in: • Preparedness, Response and Recovery • Sets Expectations • Communication / Information sharing • Operational Guidelines • Training / Exercises • Equipment and Supply Cache

19. What was learned? • Unequal expectations • Need for setting standards • Minimum Data Elements • Essential Element of Information • Collaboration takes leadership from within • Locals want leadership and guidance • Autonomy, Home-rule, Local Sovereignty breeds difference and indifference

20. What’s Next • Continued improvement in: • Communication • Coordination • Competency • Statutory, Administrative Rule, Policy • Statewide Medical & Health Exercise • Statewide Training on EOM • Regional Training and TTX

21. Must exist in statute/policy • Sustainment must be Mandatory • In grained in system by Policy • Grants have a life-span • Building resiliency cannot • Build actions into policy/statute • Coalitions are only as strong as their authority to make change • They will live on if value is known

22. For more information Contact: Bryan Hanley Region I RDMHC program Bryanhanley@dhs.lacounty.gov 562-347-1500 Fred Claridge Region II RDMHC program Fred.claridge@acgov.org 510-618-2003