The Emergency Medical Services Authority (EMSA) is tasked to plan for and coordinate State-level medical response to disasters. EMSA works in conjunction with the California Department of Public Health (CDPH) and the California Emergency Management Agency (CalEMA) to support local response efforts by providing supplemental medical sources utilizing private and public medical resources through a system of mutual aid coordinators and emergency contacts. Also included in this responsibility is the task of arranging for evacuation of injured disaster victims to hospitals in areas/regions not impacted by a disaster.

The primary concerns for EMSA during weather-related emergencies include the evacuation of acute and long-term care facilities threatened with flooding, emergency support to home health care patients and medical support to the medically fragile who are evacuated.

1. COMMUNICATIONS:

• Warning and NotificationCalEMA Warning Center: Initially, CalEMA will monitor the impact of any rainfall and its potential for flooding. If flooding is imminent, the EMSA Duty Officer (a member of the Disaster Medical Services Division) will be alerted by the CalEMA Warning Center to establish the Medical/Health Branch of the Regional Emergency Operations Center (REOC).
• Initial Notifications by Duty OfficerTo the Impacted Operational Area: Contact the medical/health coordinator to determine the extent of the situation and whether full activation of the medical/health mutual aid system may be required. (Operational Area (OA) is the term established by the State’s emergency management system and encompasses the county, cities and special districts within the geographic boundaries of the county. Operational Areas are grouped together into six mutual aid regions within the state.)

  To the Affected Region: Activate the Regional Disaster Medical/Health Coordinator (RDMHC) in the affected region. RDMHCs are county medical or emergency services employees under contract with EMSA and CDPH to coordinate mutual aid support within the mutual aid regions. If the RDMHC has not already done so, they are requested to establish communications linkages with the medical/health coordinator of the affected Operational Area. The RDMHC function is to continue monitoring the situation and to coordinate any immediate requests for medical/health resources from other Operational Areas within the region.

  To EMSA Staff: Alert the Department’s Director and Deputy Director and request authorization to activate the EMS Authority Departmental Operation Center (DOC). Contact the remaining personnel of the Disaster Medical Services Division and, depending upon the scope of the event, staff the REOC Medical/Health Branch and the EMSA DOC.

  To the CDPBH Staff: Although the CDPH Duty Officer will probably have been notified by the CalEMA Warning Center, the CDPH Duty Officer will be contacted by the EMSA Duty Officer to determine the need to establish the State’s medical/health Joint Emergency Operations Center (JEOC).

• Secondary NotificationsTo Augment Staffing: Contingent upon the size and scope of the emergency, other departmental staff will be assigned functions within the DOC as necessary to meet the expansion (or contraction) of the emergency. Commensurate with their training and experience, EMSA personnel may be assigned functions at either the REOC, the EMSA DOC or the JEOC.

  To the Unaffected Regions: Depending upon the location and extent of the event, alert one or more of the remaining RDMHCs to assist the State by providing resources for the response.

  To C.A.R.E.S.: The California Amateur Radio Emergency Services (CARES) will be alerted and placed on a stand-by status. Organized under the California Health and Human Services Agency, this group provides back-up radio support to all departments within the Agency in the event that voice communications systems are damaged.

  To the California Health and Human Services Agency: The Agency will be notified and appraised of the emergency and the status of the response.

  To Other Support Organizations: The CalEMA Warning Center will have alerted many of the other state response agencies; however, EMSA will establish contact with those other agencies and organizations that specifically support the medical and health response. These might include the California National Guard (CNG), University of California (UC) and other state departments (for medical supplies and personnel) and Department of Social Services (for shelter issues).

• Communications SystemsEmergency Alert System: EMSA will release for immediate broadcast, pre-prepared public service announcements on preparing for evacuation (reminding evacuees to take along their prescriptions, medical devices and equipment), where to get medical attention (locations) and tips on caring for vulnerable populations (disabled, elderly and children).

  Response Information Management System: The EMS Authority, utilizing the computer-based CalEMA Response Information Management System (RIMS) as a platform, will receive situation data from impacted areas and the mutual aid regions. EMSA will also access the RIMS to update reports on the status of the medical and health response. This system was developed and is available at most Operational Area emergency operations centers (EOCs), although it is not available at their supporting medical and health DOC.

  California Amateur Radio Emergency System (CARES): CARES will, when requested, establish communications between state responders at the EMSA DOC, the JEOC and Operational Area EOC or DOC that have amateur radio capability. CARES has established radio stations in Sacramento, Berkeley, Fairfield and Los Angeles.

  Radio: Amateur radio groups such as Radio Amateur Communication Emergency Services (RACES), which are locally organized and coordinated through CalEMA, also provide on-site radio services at emergency operations centers and at hospitals, as needed.

  Other Systems: All EMSA Disaster Medical Services Division staff carry mobile cellular phones with the technology to page, forward and record messages, making critical information immediately accessible. Also available is a satellite telephone system, developed (in a limited capacity) with several Operational Areas in Southern California.

• MANAGEMENTEMSA’s emergency response system is organized under the Standardized Emergency Management System (SEMS) as required by Section 8607 of the Government Code. EMSA manages and coordinates mutual aid among mutual aid regions, between the regional level and state level, and serves as the coordination and communication link with the federal disaster response system. The Department Director serves as the State Disaster Medical Coordinator in directing the medical assistance to an impacted jurisdiction.
• FIRST ACTIONSThe following checklist constitutes the first operational activities to be conducted by EMSA staff after initial and secondary notifications have been made. All activities are contingent upon the scope and extent of the emergency:

• Establish an ongoing communications link with the affected area and gather information and other data to compile an initial assessment of the emergency.
• Receive initial requests from the affected county for disaster medical and health resources.
• Assign staff to the REOC.
• Open and staff the EMSA DOC and the JEOC.
• Activate mutual aid system through direct communications with the RDMHCs, CARES and other state support agencies as required and respond to initial resource requests.
• Develop the initial medical and health response action plan.
• Determine the need to activate and deploy liaison and/or field rapid assessment team into the affected area.
• Determine need to request federal activation of Disaster Medical Assistance Teams (DMATs). Contact CalEMA and the Federal Emergency Management Agency (FEMA) and the US Public Health Service to secure necessary approvals.
• Establish daily medical/health statewide interagency conference calls.
• Secure CalEMA mission numbers and logistical support as required for procurement, mobilization and transport of requested resources.
• EMSA STAFFINGOf the 24 EMSA personnel trained in disaster management response, approximately 18 have received SEMS training in EOC operations. The remaining six have received the basic introductory course. Additionally, many EMS Staff are veterans of previous disaster responses with EOC experience, having served at the REOC, the JEOC, the State Operations Center (SOC) or all three. Currently underway are plans to provide refresher training in EOC management operations and planning functions in anticipation of future flood emergencies.

  Additionally, several staff have participated in the California Specialized Training Institute’s Earthquake Management Course, which emphasizes EOC operations and concludes with an actual EOC exercise.

• FACILITIES

• STATE LEVELThe role of the State agency is to provide support to local government’s response to an emergency as requested by the affected county. These activities may be carried out from several operations centers.
• EMSA Department Operations Center:Response Function: The DOC establishes and manages the department’s policy(s) regarding the medical response to a disaster. The public information officer also coordinates media activities and responds to outside requests for information regarding the department’s response activities, policies and overall status of the emergency. The financial and administrative staff document and track all costs and other information associated with the Department’s response.

  Location:The DOC functions out of the EMSA facilities located near Highway 50 and Mather Field, CA.

  Joint Emergency Operations Center (JEOC):

  Response Function: The JEOC has dual functions. It acts as the State’s medical and health operations center as well as DHS’s DOC. The JEOC assesses the size, scope and need for medical/health resources and responds to and coordinates the acquisition of those resources, specifically the identification and procurement of medical, public and environmental health personnel, medical supplies, equipment and pharmaceuticals for delivery to the affected area.

  Location: The JEOC functions out of the CDPH offices located at 1615 Capitol Ave, Sacramento, CA.

  State Operations Center (SOC):

  Response Function: The SOC is established by CalEMA in the event there are multiple REOCs opened. The SOC mediates among multiple REOCs competing for limited State resources. EMSA may be requested to provide a liaison role on disaster medical issues.

  Location: The CalEMA Headquarters at 3650 Schriever Ave, Mather, CA.

• REGIONALRegional Emergency Operations Center (REOC):

  Response Function: The role of the Medical/Health Branch of the REOC is to provide a liaison and coordination function between the various branches at the REOC and the JEOC. EMSA acts as Medical and Health Branch Chief within the Operations Section and provides departmental liaison to the REOC manager. The REOC Medical/Health Branch assists the JEOC in carrying out its mission by coordinating information needs, logistical support, and mission requests. One or two EMSA staff may be required to report to each REOC.

  Location: The REOC will be opened in the region where the emergency has occurred. REOC sites have been established at Sacramento, Oakland and Los Alamitos in Orange County.

• OPERATIONAL AREAUnder SEMS, the responsibility for emergency management at the local level rests with the elected government officials. State agencies may be requested to provide liaison or response management support on-site at the Operational Area EOC or DOCs.

  Emergency Operations Center:

  Response Function: A Medical/Health Branch will be established at the Operational Area EOC. The Branch will coordinate the medical and health response within their jurisdiction and access the RDMHC for additional mutual aid resource support. The branch will also provide response situation assessments to the JEOC and participate in the daily inter-agency conference calls. If a DOC (health care agency or health department) is opened, some of the functions will move to this location. Depending on the scope of the event, the JEOC may provide liaison staff or other management support to the medical and health function.

  Location: Location determined by local emergency management officials.

  Department Operations Center:

  Response Function: Provides emergency management and response pertinent to the mission of the specific department. The DOC may assume some of the Operational Area EOC Medical/Health Branch functions and provide information to meet ongoing EOC needs. Dependent upon the scope of the event, EMSA may provide liaison staff or other management support to the medical and health branch.

  Location: Determined by local emergency management officials.

• RESOURCE PREPARATIONOperational Area medical and health officials may request specific or general medical resources to meet medical and health needs within their jurisdiction. These needs could include resupplying or reinforcing staffing for hospitals, skilled nursing facilities, primary care clinics, shelters, public and environmental health functions and facilities and pre-hospital care providers, as well as casualty evacuation. Initial requests for support will be coordinated by the RDMHC in the affected region. Additional requests beyond the region’s capabilities will be coordinated through the REOC and JEOC. Sources for these resources may include other state agencies, the private sector, unaffected regions and the federal government.

• Additional Staffing
• Emergency Medical Management AssistanceMedical management assistance will be provided to the REOC or the Operational Area EOC/DOCs by other local EMS Agencies to facilitate 24-hour staffing of disaster medical operations.
• Medical/Health Rapid Assessment TeamDHS and EMSA assisted by local EMS Agencies will deploy a Medical/Health Rapid Assessment Team to develop “real-time” assessments of the short-term and long-term medical and health needs of the impacted population and the disaster’s affect on the medical and health infrastructure of the area.
• Medical and Health Personnel (sources)State Agencies:
  • CNG
  • UC Hospitals
  • Department of Corrections
  • California Youth Authority (CYA)
  • State Hospitals

  DMATs: Preconfigured and trained teams of medical volunteers that have the ability to respond from jurisdictions within the state or from other states. California currently has four Level I teams able to deploy within 24 hours. Teams are activated by request through the federal government following a Presidential Disaster Declaration.

  Mutual Aid through RDMHCs – Unaffected Regions (sources):

  • Local health departments
  • Hospitals
  • Registries
  • Medical Societies
• Materials
• Medical Supplies, Pharmaceuticals and Equipment (sources)State agencies:
  • UC
  • State Hospitals

  Private medical suppliers and pharmaceutical vendors

• Other FacilitiesEMSA staff reporting to the JEOC and REOCs will be equipped with a portable computer to connect to RIMS and a cellular telephone for emergency back-up communications.
• State Offices at RiskEMSA operates one office located in downtown Sacramento. As necessary, EMSA will relocate its operations to the JEOC. EMSA will work with DHS to find an alternate location for the JEOC if the facility is endangered.

  The department has identified equipment and files that must be preserved

  to insure continued department operations. The responsibility of protecting, preserving and re-establishing department operations is tasked to the EMS Authority’s Administration and Finance Division.