Medical (DMAT) Response to S. CA Wildfires 2003

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Medical (DMAT) Response to S. CA Wildfires 2003

• David Lipin
• Unit Commander
• DMAT CA-6

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Overview Medical Care at Wildfires

• 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

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DMAT Mutual Aid Agreement (1/2)

• There is no federal or state mutual medical aid
  structure
• CA DMATs work together under 1 teams 501c3
• Agreement is with a private, 501c3 medical
  provider
• 501c3 provides pay, insurance to participating
  DMAT members as employees
• 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)

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DMAT Mutual Aid Agreement (2/2)

• 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.

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Integrating the DMAT (1/3)

• 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)
• Logistical support (except medical supplies)

• Medical Unit Leader reports to agency Logistics
  Section Chief

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Integrating the DMAT (2/3)

• DMAT Command Structure
• DMAT Team Leader reports to DMAT Wildfire Program
  Coordinator
• Staffing rotation issues
• Medical supplies
• Time attendance, travel, etc.

• DMAT Wildfire Program Coordinator reports to CDF
  Sacramento Command
• Program availability
• Response coordination

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Integrating the DMAT (3/3)

• Medical Authority
• DMAT members report to DMAT Medical Officer
• Highest on-site medical credential
• Can also be DMAT Team Leader
• DMAT Medical Officer reports to Wildfire Program
  Consult Physician
• Off-site, available by phone
• Only if DMAT Medical Officer is not a physician
• Oversight by Wildfire Program Medical Director
• Review by 501c3 DMATs Medical Director

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S. CA Wildfires Medical Response (1/2)

• DMATs responded to 5 fires
• Limited other private medical providers used
  (ambulances)
• Limited private-sector medical mutual aid
• Equipment sharing organized through regional EOCs
• Fire/EMS systems reverted to Fire-only systems
• Private ambulance backfill, but caused
  difficulties

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S. CA Wildfires Medical Response (2/2)

• Stats
• 5 missions at 8 sites
• Response team
• 12 elapsed/37 response days
• 63 responders spent 261 days in field
• 482 patients treated
• 22 transported or removed from duty
• 82 prevented transports/ER visits
• Value
• Total cost 130K
• ER visits prevented _at_ 4K/visit (incl. transport)
  328K

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Lessons Learned (1/2)

• Disaster response not a regular response
• Didnt figure this out soon enough
• No inherent concept of wildfire disaster
• Dont depend on local logistics for specialty
  resupply
• Staffing flexibility worked well
• Cant do open-ended, multi-week deployments
• Assignment flexibility
• Moving from one fire to another one site to
  another

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Lessons Learned (2/2)

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

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Questions?

• David Lipin
• DMAT CA-6
• dlipin_at_pacbell.net
• www.emsa.ca.gov/dmatcdf.htm

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Program History

• Initial contract in mid-summer 2001
• Available for response in late summer 2001
• Program postponed due to 9/11

• First response in 2002 fire season
• 1 cache
• 4 missions
• Grew 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

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S. CA Wildfires Response (2/5)

• 10/27
• CDF requests simultaneous response to 5 fires
• DMAT Program Coordinator meets w/ CDF Sacramento
  Command
• Determine fire priorities
• On-hold teams
• Re-deploy to 2 fires
• Split 2 caches into 4

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S. CA Wildfires Response (3/5)

• 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

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S. CA Wildfires Response (4/5)

• 10/29
• One mission increases DMAT staffing to 8
• 10/30
• 2nd mission increases DMAT staffing to 10
• 11/08
• Final medical team demobilizes
• Caches and Logistics Teams return