Statewide Disaster Medical Standards Development
Project
Submitted by:
Doug Buchanan, Deputy Director
Project Coordinator
Calvin Freeman
Project Consultant
Steering Committee
MEMBER AGENCY
Dave Abbott State DHS
Yolanda Baldovinos Alameda Co HCSA
Doug Buchanan Mountain Valley EMS Agency
John Celentano, MD Los Angeles Co EMS Agency
Paul Garrett Yolo Co. Health Department
Jeff Gidley California EMS Authority
Herbert Giese, MD Nevada Co. Health Officer
Darlene Isbell Los Angeles Co. EMS Agency
Art Lathrop Contra Costa EMS Agency
Linda Pryor State OES
Jeff Rubin California EMS Authority
Glennah Trochet, MD Sacramento Co. DHHS
Steve Andriese Mountain Valley EMS Agency
Diane Evans Santa Cruz Co. Dept. of Env Health
Wendi Dodgin State OES
Dave Herfindahl, MD Siskiyou Co Health Department
B.A. Jinadu, MD Kern Co. Dept of Public Health
Michael Osur Riverside Co. EMS Agency
Constance Perett Los Angeles Co OES
John Pritting Imperial Co EMS Agency
Advisory Group
MEMBER AGENCY REPRESENTING
Kim Zagaris, Asst. Chief Governor's OES State OES
Bob Petrucci, Disaster Spec. Santa Clara EMS Agency EMSAAC Multi-county LEMSAs
Dorel HarmsCalifornia Healthcare Assoc. Hospital Industry
David Herfindahl, MD Siskiyou County Health Dept. CCLHO
Steve Tharratt, MD Sacramento County
EMS EMDAC
David G. Jones Fresno,
Kings, Madera EMS MSAAC Rural
LEMSAs
Steven C. Wood San Diego
County EMS EMSAAC Urban
LEMSAs
Barbara Center Region II
RDMHS RDMHCs
Nancy LaPolla Santa
Barbara County EMS EMSAAC
Suburban LEMSAs
Carl Schultz, MD CAL/ACEP Emergency
Physicians
Sherlene Stepp ENA Emergency
Nurses
(Invited) CAA Ambulance
Industry
(Invited) FIRESCOPE Fire Service
Dave Abbott State
DHS Public
and Env Health
Project Staff
MEMBER AGENCY POSITION
Jeff Gidley State EMS Authority Project Director
Doug Buchanan Mountain-Valley EMS Agency Project Coordinator
Calvin Freeman Calvin Freeman & Associates Project Consultant
Introduction |
1 |
Section 1: Project Background and Rationale |
2 |
|
Project
Steering Committee and Advisory Group |
3 |
|
Priority
Setting |
4 |
|
Project
Products |
4 |
Section 2: Project Conceptual Framework |
5 |
|
Medical
and Health Function Descriptions |
6 |
|
Assignment
of Functions to LEMSA |
8 |
|
Overall
LEMSA Disaster Responsibilities |
9 |
|
Role
of County Health Officer |
10 |
|
Role
of the Medical/Health Operational Area Coordinator |
10 |
|
Proposed
Legislation |
11 |
|
Section 3: Draft
Standards |
12 |
|
Function
1: Assess Immediate Medical Needs and Initiate Response |
12 |
|
Function
3: Manage Patient Distribution/Evacuation |
15 |
|
Function
4: Support Hospital Emergency Services |
15 |
|
Function
5: Support the Provision of In-Hospital Care |
16 |
|
Function
6: Support Out-of-Hospital Care |
17 |
|
Function
7: Manage Medical Transport |
17 |
|
Function
9: Support Temporary Field Treatment Sites |
18 |
Section 4: Oversight Organization |
19 |
|
Appendices: |
20 |
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A: Disaster Medical System Functions and
Elements |
21 |
|
B: Glossary of Terms |
24 |
|
Table
5: Field Response Standards & Proposed
Regulations |
17 |
In cooperation with the EMS Administrators Association of
California, Mountain-Valley EMS Agency began a project in July 1999, funded by
the state EMS Authority, to develop disaster medical system standards to assist
local EMS agencies (LEMSAs) in the development of local response plans. A
multi-disciplinary Steering Committee and Advisory Group were formed from
local, regional, and state representatives, as well as many stakeholder groups
from throughout the state.
The committee identified 18 medical and health functions for
which local government currently has primary or significant responsibility:
|
1. Assessment of Immediate Medical Needs* 2.
Health Surveillance and Epidemiology 3. Disaster Medical and Health Resources * 4. Manage Medical Transport * 5. Manage Patient Distribution/Evacuation* 6. Coordinate Pre-Hospital Emergency
Services* 7. Support Hospital Emergency Services* 8. Support the Provision of In-Hospital
Care* 9.
Support
Out-of-Hospital Care* |
10. Support Temporary Field Treatment Sites* 11.
Food Safety 12.
Manage Exposure to Hazardous Agents 13.
Mental Health 14.
Medical and Health Public Information 15.
Vector Control 16.
Potable Water 17.
Waste Management 18.
Communicable Disease Control |
Since the scope of this project was to provide assistance to
local EMS agencies, the group further identified the nine functions, identified
with an (*) in bold type above, as areas for which local EMS agencies have some
level of responsibility for preparedness, response, or recovery.
Project staff then grouped these functions into three
categories for purposes of planning and development: (1) Government/Cooperative
Assistance, (2) Hospital Support, and (3) Field Response. These functions were
then further broken down into multiple elements, based upon a statewide survey
of LEMSAs.
Both the Steering Committee and Advisory Group agreed that
there was a need for a single point for medical and health disaster plans
within each county, and proposed the need to assist local medical and health
officials to seek legislation which would list the eighteen functions and name
the Health Officer or designee as having primary oversight responsibility. The project has also developed draft regulations and guidelines
to assist LEMSAs with implementation.
Representatives from various local and state agencies have
unanimously recommended that the Department of Health Services undertake a
similar project to assist local public and environmental health officials to
establish statewide standards and guidelines and that an oversight body or
bodies be created to maintain and update the statewide medical and health
standards.
Project staff have recently submitted a request for second
year funding in order to continue to work with local and state organizations to
finalize the regulatory processes, and also to provide training and training
standards for local disaster medical services personnel.
·
In July 1999, the California EMS Authority made a grant
to the Mountain Valley EMS Agency to undertake a project to develop disaster
medical standards for local Emergency Medical Services agencies (LEMSAs). This Final Report provides EMS System
stakeholders and constituents with a summary of the Project’s progress during
its first year of funding.
These results represent the combined efforts of the
project’s Steering Committee, Advisory Group, staff, and consultant since July
1999.
The report is organized into the following sections:
·
Introduction
·
Section 1:
Project Background and Rationale
·
Section 2:
Project Conceptual Framework
·
Section 3: Draft
Standards
·
Section 4:
Oversight Organization Issues
·
Appendices:
A: Disaster
Medical System Functions and Elements
B: Glossary
of Terms
In early 1999, the Mountain-Valley EMS Agency undertook a
survey of local EMS agencies throughout California. A summary of the survey results is included as Appendix C of this
report. Of the 32 local EMS agencies surveyed, 25 responded. Survey responses indicated a lack of
standardization in the following significant areas:
· Only 60% of respondents have patient distribution systems consistent with neighboring jurisdictions.
· More than half of responding jurisdictions do not have formal plans for requesting and dispatching out-of-area ambulances.
· Almost 1/3 of respondents have not completed developing provisions for providing medical situation status reports to the state.
· Only 40% of respondents indicated that their plans contain criteria regulating the categories of triaged patients receiving facilities should receive.
· Twenty per cent of respondents do not have a formal process for ordering resources.
· About half of responding LEMSAs have separate plans for disasters and multiple casualty incidents.
The results of the survey coupled with the experience of disaster
medical planners throughout California clearly demonstrate that (1) many
jurisdictions have not completed development of comprehensive disaster medical
plans and (2) response systems are not sufficiently compatible in critical
areas where cross-jurisdictional responses require coordination.
The experience of response agencies following the Loma
Prieta Earthquake of 1989 and the Oakland Hills Fire of 1991 demonstrates the
potential communications, organizational, and operational crises that a lack of
standards can produce. Recent events, such as the floods of 1995 and 1996 and
the flu epidemic of the winter of 1998, indicate a continuing need for
standardized disaster medical systems in California.
The purpose of the project was to develop a set of standards
for LEMSAs, resulting in the establishment of effective and standardized
disaster medical systems throughout California. The project also addressed the creation of an organization and
process for the maintenance of the standards.
The term “disaster medical systems” refers to the plans, policies,
practices, procedures and management systems undertaken by government,
voluntary and private sector organizations, and agencies to minimize the loss
of life and suffering and ensure the protection of people and the healthcare
infrastructure following disasters.
The framework for the standards development process was
established by the project Steering Committee, while an Advisory Group assisted
with the development of specific standards.
The Steering Committee was appointed jointly by the California Emergency
Medical Services Authority and Department of Health Services. Its members represent the primary
disciplines and stakeholder organizations involved in the development and
implementation of disaster health and medical systems in California. It laid the foundation for this project by:
1)
Reaffirming the role of counties in preparedness,
response, and recovery from disasters with severe medical and health
consequences.
2)
Identifying and defining the eighteen medical and
health functions that local jurisdictions should address to develop
comprehensive disaster medical and health systems.
3)
Designating nine functions for which local EMS agencies
should have primary preparedness, response, or recovery (PRR) responsibility.
The eighteen medical and health functions, as well as the
subset of nine assigned to LEMSAs, are listed and defined in Section 2 of this
report.
The Advisory Group organized the nine functions for which
LEMSAs have primary responsibility into the following broad categories in order
to facilitate its work:
·
Government Response/ Cooperative Assistance Functions
·
Hospital and Other Facility Related Functions
·
Field Response Functions
Each function in turn is assigned a group of disaster
medical response elements. These
elements represent the specific actions or system components required to
establish the corresponding function.
System elements also provide sufficient specificity to serve as a basis
for the development of standards and proposed regulations. Functions, elements, and their related
standards are displayed in Section 3 below.
The Advisory Group
recognized that the project would not be able to develop standards for all
elements in a single year and that for many elements local flexibility was more
appropriate than statewide standardization.
It applied the following criteria for setting priorities for
standardization:
.
·
The importance of
the element for meeting an acceptable standard of performance for a
jurisdiction's disaster medical system.
·
The importance of
the element in promoting a coordinated inter-jurisdictional response.
·
The existing degree
of standardization for the element in California EMS systems.
·
The availability of
technical and financial resources and government authority for implementation
of the standard.
In most instances, the Advisory Group achieved consensus on
the recommended standard. For those
standards for which full agreement could not be reached, a footnote provides a
summary of issues discussed by the Advisory Group.
It is important to note that at the time of this writing
there is no parallel effort to develop standards for public, environmental, and
mental health functions.
The primary products of this project are a set of disaster
medical standards for LEMSAs. The
development of standards, in and of itself, is not sufficient to create the
system improvements envisioned by this project. To maximize the implementation of these standards by
LEMSAs, the Advisory Group recommended:
·
Developing legislation that establishes the framework
for local disaster medical and health systems and defines organizational and
leadership responsibilities.
·
Promulgating regulations that codify the standards for
LEMSAs.
·
Developing guidelines, descriptions of best practices,
training standards, and other tools that will assist LEMSAs to implement the
regulatory requirements.
In virtually every disaster, local government provides the
initial response and in most emergencies, the local response is sufficient to
meet the needs created by the emergency. While local governments may be
supported by State and federal government agencies or by neighboring
jurisdictions in major disasters, external assistance does not abrogate local
authority.
Reviewing the disaster response experience of government and
private agencies in California, the Steering Committee identified 18 medical
and health disaster functions potentially required to meet the medical and
health needs of impacted communities.
For nine of these 18 functions, the Steering Committee
determined that LEMSAs are the most appropriate organizational entity for
ensuring that systems, policies and procedures necessary for successful
preparedness, response, or recovery are in place. County government may choose, however, to assign these functions
to other organizational units or contract with external entities for all or
part of the related responsibilities.
The Advisory Group used these functions as the starting
point for its work and made some modifications in the LEMSA related functions
defined by the Steering Committee to frame the functions in action-oriented
language more conducive to standard setting.
Table 1 below lists and defines the 18 disaster medical and
health functions identified by the Steering Committee. It also identifies the nine functions for
which LEMSAs have or share a primary responsibility for preparedness, response,
or recovery.
TABLE 1: Disaster Medical and Health Function and
Descriptions
(Bolded
Functions are assigned to local EMS agencies.
Other functions are assigned to Public, Environmental, Mental and other
health agencies)
|
Function |
LEMSA Primary Responsibility |
Description |
|
1. Assessment
of Immediate Medical Needs |
Preparedness Response |
Establish a system to (1) provide
a rapid evaluation of the acute medical needs immediately following a
disaster and the ability of the healthcare infrastructure in the impacted
area to meet those needs; and, (2) notify the Disaster Medical/Health
Operational Area Coordinator and other entities required to activate a
response. |
|
2. Health Surveillance and Epidemiology |
|
An
evaluation system designed to provide information about the relative health
of the impacted population and to evaluate the potential for public health
consequences as a result of the disaster event. This process is ongoing during the response and recovery phase
of disaster operations. |
|
3.
Medical/Health Resources |
Preparedness Response |
Identify, mobilize, apply,
and deactivate medical and health resources needed for the response to
disasters. Resources include medical and health personnel, equipment and
supplies acquired from local, regional, state, or federal governments or
through contracts and agreements with the private sector. |
|
4. Medical
Transportion |
Preparedness Response Recovery |
Coordinate medical
transport assets including ALS and BLS ambulances, air ambulances and other
designated non-emergency medical transport assets. |
|
5. Patient Distribution/
Evacuation |
Preparedness |