Contra Costa MRC Wild Fire Responses

1. Contra Costa MRCWild Fire Responses Lisa Vajgrt-Smith BSN, RN, MPH, CPH Contra Costa Health Services

2. Contra Costa MRC • Established 2009 • Lg Cache of equipment • Establishing Structure • Liability & Malpractice

3. Contra Costa MRC Re-engage More Community Outreach Training/attendance requirements Manageable size Deployments

6. Unit Capabilities

7. Co-located Medical Clinic in Red Cross managed shelter Expand capacity & capability Pharmacy Cache Repopulation planning Valley Fire 2015

8. Co-located Medical Clinic in Red Cross managed shelter Expand capacity & capability Pharmacy Cache Repopulation planning Valley Fire 2015

9. 2017 North Bay Fires: Napa Establish Clinics (2 shelters) • Medical management of chronic illness/Case management • Assessments with FAST/ADL support • ID medical emergencies & coordinate with EMS PFA, Behavioral Health Referrals • APS cases • Social services for re-population Assessment of Sonoma Co.* Cal Vets Home evacuation

10. 2018 Mendocino Complex: Lake County Establish emergency medical care for 5 shelters • Medical clinics in 2 largest shelters Serve medical needs of population Provider-script refills Assess medically complex Case management PFA MH, Social services referrals

11. Calistoga Clinic 2015

12. Crosswalk Shelter 2017

13. Lake Co. Shelters 2018

14. The right roster

15. Successes Pre-deployment assessment Effective use of affiliated medical volunteers Appropriate provision of care Team Work! MRC Coordination • Manage all aspects • Bridge between EOC, RDMHS and shelter • Clinical consultation/Ops Reports (24 hr, 96 hr & final) • Transition plan Regional Poling creates pollof volunteers with one coordinator

16. Challenges Understanding population demographics/needs (especially if not your OA) • Volunteer impact • Resources Evac of Hospitals/SNFs/ICFs created complexity of triaging appropriateness of setting Managing people with complex needs & the term “medically fragile” The cross section of ESF 6 & 8 • Red Cross Role, County Role, State resources • Donations • Animals • Security Filling shifts in fluid situations Paperwork SOPs and Scope California EmergencyDispensing (California Business and Professions Code sections 4062 and 4064 and Health and Safety Code 1116) Depth of MRC Coordinator-Not all MRCs are alike

17. CoCo MRC Improvements Pre-completed Resource Request for RDMHS Shelter WindshieldSurvey Form Regional MRC deployment and Coordination MRC Pilot Site • Pharmacy Operations/Cache • ACS/Shelter • Medical Volunteer Coordinator Field/DOC/EOC MRC Deployment Binder Revision • Forms/Checklist for Lead-Activation, demobilization • JAS • PCRs • SOP/Treatment Guidelines • IAP • Pharmacy Toolkit

18. Patient Care Reports • New Forms!!!!!! • Community Event Release At Scene Log • Clinic/ACS Sign-in (tracking board) • MRC PCR • Progress Notes • Insulin/Blood Glucose Form • Medication Administration Record (MAR) • Transfer PCR • Pharmacy Refill

19. Community Event Release at Scene Log • Community First Aid Stations/Events • Use: Capture Minor care provided that does not require extensive care or transport • Examples: Band-Aids, bee sting stick, ice pack • Helps capture contacts, and provides hold harmless section

21. Medical Clinic/ ACS Sign-In • Used at Alternate Care Sites and Medical Clinics established in Disaster or Other Event • Captures all people visiting clinic • Captures Chief Complaint • Tracks Order or People • Can be completed by Person or an MRC member assigned to Clinic Check-in/triage • If person receiving minor care (bandaid etc.) tracks visit • Assist with developing Clinic Visits Ops Report

23. Transfer PCR • Transfer PCRs are to be filled out for any patient requiring ambulance transport/EMS Activation • Collect/Provide as much information as possible for transport team • Documents care initiated prior to transport • May be completed instead of PCR, or in addition to • Can be used to send MD instructions to receiving facility

25. Patient Care Report (PCR) • Primary Documentation report for all people being seen by medical personnel that require an assessment, orders etc. • Assessments should be focused • Modified to include details for PCP, Pharmacy, ADLs, AFN equip, & shelter location • Room for treatment, Progress Notes for continued care/repeat visits • Has “add-in” components to form complete chart

27. Medication Administration Record (MAR) • Add to PCR if patient is receiving medications from clinic site/dispensed or assisted by Med staff • Includes dispensing OTCs, One time doses • Can be used to list out patient’s entire med list if it does not fit on PCR

29. Insulin & Blood Glucose Monitor • Track Patients Glucose Level and any Insulin given (by staff or self admin) • Use instead of MAR • Help track trends

31. Pharmaceutical Refill Form • Developed best practice processes for refilling patient medications • Use if patient being seen only for med refill • Helps collect key information needed by pharmacies • Helps track process • called in • Delivery/pick-up • Received by patient/rep

33. Clinic Ops Reports Helps provide snap shot of clinic operations to the DOC Details # of patients seen Key data points for planning and resource requesting Epi Surveillance Data gathered from reviewing Clinic Sign-in and PCRs May be assigned to shift leads (night)

34. Key Data Points

35. Pharmacy Refill Toolkit • Developed best practices to assist in the process of refilling patient prescriptions (Thanks Deb & Mary) • Pharmacy Refill Form • Access to Healthcare Ready RX Open • RN, Pharmacist, Non-Med Scribe • Team work & coordination

36. Considerations • MRC needs more support state/regional/local • Better Coordination of MRC teams • Depth of MRC Coordinators • MRC ‡ DHV

37. Spectrum of Care & Personnel Resources Cal-MAT, DMAT, DoD MRC, DHV, HCC Partners ARC, CERT, VOAD

38. Thank You! Lisa Vajgrt-Smith (925) 383-8852 Lisa.vajgrt-smith@cchealth.org