Disaster Response

The Los Angeles basin has two major operational areas for responding to a disaster: Los Angeles City, and Los Angeles County. Each area is responsible for developing and implementing its own response plans. Each manages its own response and controls its own assets. Coordination is achieved by having representatives at each of three Emergency Operations Centers (EOCS) (Los Angeles City, Los Angeles County, and Los Angeles County Department of Health Services) established when a disaster occurs. LAEMSA's Office of Disaster Medical Response is responsible for developing the County's plans for responding to medical disasters. A formal system for reporting damage to hospitals, and injuries to LAEMSA is operational, and is tested on a yearly basis. The LA County Sheriff manages the county's disaster response at the County EOC. "More than $90 million has been spent on the County EOC headquarters in Boyle Heights since the October 17, 1989 Bay Area earthquake, to improve [day-to-day and disaster] communications systems and inform the public on how to prepare for a similar shock" (San Gabriel Tribune, 1990.) The County Department of Health Services has established a separate Emergency Operations Center (DHS EOC) at Los Angeles County/University of Southern California Medical Center. They have been trying to obtain funding to upgrade the facility. A draft, but not approved, regional medical mutual aid agreement between Los Angeles County and four other counties has been prepared (Orange, Ventura, Santa Barbara, and San Louis Obispo Counties). The role and responsibilities of LADHS are defined in the "Medical Annex" of the "County Basic Emergency Operations Plan." The Annex was established to: Provide for the organization, mobilization, and coordination/direction of medical, health and mental health services, both public and private, in the event of a disaster. Delineate the authority, responsibility, functions and operations of all public and private agencies whose resources must be used if medical, health, and mental health care are to be provided to the population in the event of a disaster (LADHS, 1984). The plan states that: All resources, both public and private, required to render medical, health and mental health services in a disaster will be mobilized and coordinated by the Director of the Department of Health Services... (LADHS, 1984). The section of the plan on direction and control of the emergency medical response states that: The Chief, Medical and Health Services shall... be responsible for the countywide management of emergency medical and health services, including, but not limited to: countywide coordination of emergency medical and health programs, activities and functions, both public and private; and countywide allocation of medical resources and supplies, both public and private (LADHS, 1984). The plan applies to "any/all areas of Los Angeles County in which the delivery of medical, health and mental health services to large numbers of casualties is required... (LADHS, 1984)." It is assumed that most likely events responsible for causing such large numbers of casualties would be earthquakes, fires, flood, landslides or major accidents, including hazardous materials emergencies (LADHS, 1984). Civil disturbances is not listed. The scope of LADHS's Director responsibilities is actually limited to all resources directly managed by the department or falling under its jurisdiction during a disaster. This includes: public and private professional services, the coroner, hospitals, pharmacies, blood banks, free standing and emergency clinics, laboratories, American Red Cross, local and private ambulance companies, and other elements of the private sector necessary for a medical response. LADHS management of the provision of emergency medical care in the field is limited to that given at hospitals, health centers, freestanding emergency clinics, first aid stations, casualty collection points and/or field hospitals (LADHS, 1984). It does not include coordination and direction of Los Angeles City, County Fire, or other city fire department EMTS. Specifically: The EMT-Ps will be activated and dispatched by controlling agencies. The incident commander at the site will coordinate the activities of all EMT-1 and EMT-P provider agencies during a disaster situation (LADHS, 1984). The plan calls for coordination of the emergency medical response with all public safety agencies through the County Sheriff's EOC. LADHS is also responsible for transporting emergency medical and paramedical personnel to the disaster site, casualty collection points, field hospitals, and other facilities established or under the responsibility of the department. This includes deployment of private ambulances, working closely with the Los Angeles County ambulance associations. Finally, the Department "determines if and when mutual aid resources will be needed; initiates the request; and responds to requests for mutual aid from other jurisdictions" (LADHS, 1984).

Medical Care for the Injured

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