1. Medical (DMAT) Response to S. CA Wildfires 2003 David Lipin Unit Commander DMAT CA-6

2. Overview: Medical Care at Wildfires 6 Distinct Areas of Medical Care:6 Distinct Areas of Medical Care: –Fire-line medical care –Ground evacuation & transport –Air evacuation & transport –Base camp medical care –Base camp medical dispensary –Civilian shelters

3. DMAT Mutual Aid Agreement (1/2) There is no federal or state mutual medical aid structureThere is no federal or state mutual medical aid structure CA DMATs work together under 1 teams 501c3CA DMATs work together under 1 teams 501c3 Agreement is with a private, 501c3 medical providerAgreement is with a private, 501c3 medical provider 501c3 provides pay, insurance to participating DMAT members as employees501c3 provides pay, insurance to participating DMAT members as employees 501c3 has contract with CDF, USFS as a private service provider (e.g., ambulance service)501c3 has contract with CDF, USFS as a private service provider (e.g., ambulance service) –Incident must meet certain minimum criteria –Can optionally respond if requested –Requesting agency pays for costs + overhead (no profit)

4. DMAT Mutual Aid Agreement (2/2) Agreement has specific resource requirements:Agreement has specific resource requirements: –1 MD/PA/NP, 1-2 RN, 1-2 EMT-P, 1 EMT –Expandable upon mutual agreement –Self-sufficient for 72 hours –Dependent upon requesting agency for logistics –Handle own specialty (medical, pharmaceutical) resupply –Handle own staff rotations, transportation, etc.

5. Integrating the DMAT (1/3) Local Command Structure (ICS):Local Command Structure (ICS): –DMAT members report to DMAT Team Leader –DMAT Team Leader reports to Medical Unit Leader Local operations (within approved DMAT scope)Local operations (within approved DMAT scope) Logistical support (except medical supplies)Logistical support (except medical supplies) –Medical Unit Leader reports to agency Logistics Section Chief

6. Integrating the DMAT (2/3) DMAT Command Structure:DMAT Command Structure: –DMAT Team Leader reports to DMAT Wildfire Program Coordinator Staffing rotation & issuesStaffing rotation & issues Medical suppliesMedical supplies Time & attendance, travel, etc.Time & attendance, travel, etc. –DMAT Wildfire Program Coordinator reports to CDF Sacramento Command Program availabilityProgram availability Response coordinationResponse coordination

7. Integrating the DMAT (3/3) Medical Authority:Medical Authority: –DMAT members report to DMAT Medical Officer Highest on-site medical credentialHighest on-site medical credential Can also be DMAT Team LeaderCan also be DMAT Team Leader –DMAT Medical Officer reports to Wildfire Program Consult Physician Off-site, available by phoneOff-site, available by phone Only if DMAT Medical Officer is not a physicianOnly if DMAT Medical Officer is not a physician –Oversight by Wildfire Program Medical Director –Review by 501c3 DMATs Medical Director

8. S. CA Wildfires Medical Response (1/2) DMATs responded to 5 firesDMATs responded to 5 fires Limited other private medical providers used (ambulances)Limited other private medical providers used (ambulances) Limited private-sector medical mutual aidLimited private-sector medical mutual aid –Equipment sharing organized through regional EOCs Fire/EMS systems reverted to Fire-only systemsFire/EMS systems reverted to Fire-only systems –Private ambulance backfill, but caused difficulties

9. S. CA Wildfires Medical Response (2/2) Stats:Stats: –5 missions at 8 sites –Response team: 12 elapsed/37 response days12 elapsed/37 response days 63 responders spent 261 days in field63 responders spent 261 days in field –482 patients treated –22 transported or removed from duty –82 prevented transports/ER visits –Value: Total cost ~ $130KTotal cost ~ $130K ER visits prevented @ $4K/visit (incl. transport) = $328KER visits prevented @ $4K/visit (incl. transport) = $328K

10. Lessons Learned (1/2) Disaster response; not a regular responseDisaster response; not a regular response –Didnt figure this out soon enough –No inherent concept of wildfire disaster Dont depend on local logistics for specialty resupplyDont depend on local logistics for specialty resupply Staffing flexibility worked wellStaffing flexibility worked well –Cant do open-ended, multi-week deployments Assignment flexibilityAssignment flexibility –Moving from one fire to another; one site to another

11. Lessons Learned (2/2) Traditional mutual aid arrangements break down in a larger-scale disasterTraditional mutual aid arrangements break down in a larger-scale disaster –Insufficient resources –Resource overlap –Resources held in reserve Operational prioritization medical prioritizationOperational prioritization medical prioritization –Proximity to hospital –Number of staff –Type of staff (engines vs. hand crews) Need hospital/clinical mutual aid mechanismNeed hospital/clinical mutual aid mechanism

12. Questions? David Lipin DMAT CA-6 dlipin@pacbell.netwww.emsa.ca.gov/dmatcdf.htm

13. Program History Initial contract in mid-summer 2001Initial contract in mid-summer 2001 Available for response in late summer 2001Available for response in late summer 2001 –Program postponed due to 9/11 First response in 2002 fire seasonFirst response in 2002 fire season –1 cache –4 missions Grew in 2003Grew in 2003 –2 caches –Simultaneous deployment to 2 missions –Longest/largest mission to date (80+ patients in single day) –5 missions prior to S. CA Wildfires

14. S. CA Wildfires Response (2/5) 10/27:10/27: –CDF requests simultaneous response to 5 fires –DMAT Program Coordinator meets w/ CDF Sacramento Command Determine fire prioritiesDetermine fire priorities –On-hold teams: Re-deploy to 2 firesRe-deploy to 2 fires Split 2 caches into 4Split 2 caches into 4

15. S. CA Wildfires Response (3/5) 10/28:10/28: –2 additional teams deployed to 2 fires –1 fire designated as primary resupply location –Remote admin team begins staffing availability collection & rotation –2 logistics teams launched to shuttle supplies

16. S. CA Wildfires Response (4/5) 10/29:10/29: –One mission increases DMAT staffing to 8 10/30:10/30: –2nd mission increases DMAT staffing to 10 11/08:11/08: –Final medical team demobilizes –Caches and Logistics Teams return