California Disaster Medical Response System: Emergency Medical Services Authority Program Update

1. California Disaster Medical Response System: Emergency Medical Services Authority Program Update Disaster Medical Services Division

2. Disaster Medical Services System

3. California�s EMS System Emergency Medical Services are responsible for: Emergency health care response and treatment Transportation for acute medical or traumatic problems Day-to-day & disaster medical system management and coordination EMS: The intersection of public safety & public health

6. EMS Authority Mandate: Coordinate and integrate statewide activities for EMS Respond to medical disasters, mobilize and coordinate medical mutual aid Coordinate disaster planning and preparedness through various agencies Assist OES with EMS component of State Emergency Plan

7. EMS Authority Mandate: Provide leadership, regulation, and advocacy for quality, rapid and efficient patient care Work with local EMS agencies and EMS providers, both public and private Develop standards for trauma system; review Local EMS Agency trauma system plans Establish minimum standards for California Poison Control System

8. 31 Local EMS Agencies Serve California 7 Regional (34 Counties) 24 Single County

9. EMS Infrastructure

10. California EMS Infrastructure Ambulance services and first responders Ambulances > 3600 Private 73% Public 27% >2200 staffed daily EMT I about 70,000 Paramedics 14,500

11. California EMS Infrastructure Hospitals and trauma centers 450 hospitals 84% private 303 EDs 63 trauma centers 54 Levels I-III

12. DMS System Components Capacity and Capabilities Existing healthcare services and field deployable medical assets Integrative Processes Command (manage), control and communication within SEMS Training and Exercises Enhance medical provider readiness

13. EMSA Capacity Building-Rapid Tiered, Response 25 Ambulance Strike Teams (AST) with Disaster Medical Support Vehicles (DMSU) Mission Support Team (MST) Three California Medical Assistance Teams (CAL-MAT) California Medical Volunteers (Registry) Three Mobile Field Hospitals (MFH)

14. Ambulance Strike Teams

15. Ambulance Strike Teams Effective management of multiple medical transportation resources 25 DMSUs purchased to augment 25 statewide ASTs Training program for AST leaders

16. Ambulance Strike Teams at Del Mar

17. California Medical Assistance Teams (CAL-MAT)

18. California Medical Assistance Teams Three deployable teams MD, FNP, PA, RN, LVN, RT, Pharm.D., Mental Health Specialist, EMT & EMT-P, logistics and admin specialists Self-supporting for 72 hours (equipment, supplies and shelters) Volunteer training; paid in disasters

19. CAL-MAT at Del Mar

20. California Mobile Field Hospitals Pic#1- Access row between shelters for HVACs Pic#2- Front View from 100� Ladder Truck provided by Garden Grove Fire Pic#3- Electrical Distribution Box, HOBS oxygen distribution station, 2 EDOCS oxygen concentrators (25 H tanks each/24 hrs), one of seven 110Kw generators per hospitalPic#1- Access row between shelters for HVACs Pic#2- Front View from 100� Ladder Truck provided by Garden Grove Fire Pic#3- Electrical Distribution Box, HOBS oxygen distribution station, 2 EDOCS oxygen concentrators (25 H tanks each/24 hrs), one of seven 110Kw generators per hospital

21. Mobile Field Hospitals Three 200 bed Mobile Field Hospitals ER, OR, ICU, Med/Surg and negative pressure capability 72 hour on-site set-up Vendor managed warehousing and maintenance $18 million available #1- 222 beds each when counting ED & OR beds #2- 20 ED beds, 2 OR beds, 20 ICU beds, 10 Negative pressure beds & 170 ward beds able to be configured as needed for situation at hand #3- Complete 72 hour set-up from initial phone call anywhere in the state, can begin seeing ED/ICU patients in 48-52 hours #4- Vendor managed in state leased warehouses to prevent any federalization of assets #5- $18,000,000 for initial purchase and $879,000 annually for maintenance #1- 222 beds each when counting ED & OR beds #2- 20 ED beds, 2 OR beds, 20 ICU beds, 10 Negative pressure beds & 170 ward beds able to be configured as needed for situation at hand #3- Complete 72 hour set-up from initial phone call anywhere in the state, can begin seeing ED/ICU patients in 48-52 hours #4- Vendor managed in state leased warehouses to prevent any federalization of assets #5- $18,000,000 for initial purchase and $879,000 annually for maintenance

22. Mobile Field Hospitals Pic#1(Upper Left)- OR Suite w/Anesthesia Machine Pic#2 (Middle)- Overflow Ward Pic#3 (Upper Right)- Radiology Unit w/Digital CR X-Ray System and Dry Laser Printer Pic#4 (Lower Left)- ICU Unit during set-up Pic#5 (Lower Right)- ICU Bed w/monitor, suction machine Pic#1(Upper Left)- OR Suite w/Anesthesia Machine Pic#2 (Middle)- Overflow Ward Pic#3 (Upper Right)- Radiology Unit w/Digital CR X-Ray System and Dry Laser Printer Pic#4 (Lower Left)- ICU Unit during set-up Pic#5 (Lower Right)- ICU Bed w/monitor, suction machine

23. California Medical Volunteers

24. California Medical Volunteers Register, identify, notify, deploy, and tracking medical and health volunteers during a disaster deployment as individuals or groups in accordance with SEMS/NIMS System administration at the state and local group level Powerful notification engine capable of calling-up tens of thousands of volunteers

25. Mission Support Teams

26. Mission Support Teams Manage assigned personnel and teams - provide, safety, security and oversee health & welfare Establish a system of re-supply for medical field operations resources Interface/assist impacted jurisdictions Ability to operate in mobile or fixed facilities � four MST support vehicles

27. Constraints Private ownership of health care system Costs to hire a CAL-MAT for a �First Responder� role: one team (40 members) for 24/7 coverage ~ 170K per day! Relative size of EMS Authority vs. emergency responsibilities (EOCs, field, volunteer mgmt.) Legislative denial of three positions for pre-event coordination and liaison during response

28. Future Directions: Integrated disaster response system: 24/7 EMSA/CDPH Medical and Health Coordination Center (alert, notification, limited pre-event resource identification) Development of multiple response profiles for mobile medical assets Aggressive volunteer marketing recruitment Ongoing training and exercises

29. Future Directions: Plans, policies and procedures California Disaster Medical Response Plan & Medical Mutual Aid Annex; draft Disaster Medical Operations Manual Medical Mutual Aid Agreements Medical Shelter Toolkit (updates) Enhanced information management systems