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Medical (DMAT) Response to S. CA Wildfires 2003

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

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Medical (DMAT) Response to S. CA Wildfires 2003

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  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: • 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 structure • CA DMATs work together under 1 team’s 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)

  4. 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.

  5. 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

  6. 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

  7. 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 DMAT’s Medical Director

  8. 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

  9. 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 @ $4K/visit (incl. transport) = $328K

  10. Lessons Learned (1/2) • Disaster response; not a regular response • Didn’t figure this out soon enough • No inherent concept of “wildfire disaster” • Don’t depend on local logistics for specialty resupply • Staffing flexibility worked well • Can’t do open-ended, multi-week deployments • Assignment 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 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

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

  13. 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

  14. 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

  15. 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

  16. 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

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