Coordination with the Los Angeles Department of Health Service Emergency Operations Center

By 5:00 AM, April 30, LAEMSA had placed six hospitals on disaster alert status (OES, 1992). This included the three hospitals that had already activated. Prior to this time the agency had already begun collecting injury data, and responding to hospital requests for assistance. Administrators at the hospitals interviewed appeared to be uncertain about how to obtain supplies, personnel or other assistance from LAEMSA. In nearly every case they attempted to get assistance from sister agencies, other hospitals, or by calling providers directly. Additional creative efforts were made if these avenues failed. Few calls for assistance went directly to LAEMSA. In some cases, OES or the EMS Authority heard about the shortfall and communicated the need to LAEMSA for approval and routing. Several factors may account for these efforts. One may be that, as noted above, no one expected the event to go on so long. Shortfalls were not expected. A second possibility may be that the hospital administrators who managed the event had not received emergency response training and did not know how to access the county's disaster response system. Third, the emergency department may not be closely linked to the disaster decision making system that is dealing with all the hospital's problems. This is even true of a Multi-casualty event where the ER is handling many seriously injured patients and, if a base hospital, directing their distribution. That emergency radio communications, such as HEAR and ReddiNet, are often located in the emergency department compounds this problem. In some cases, hospital administrators do not routinely monitor radios while in others the monitoring is performed by administrative staff utilizing the Command Post HEAR radio as in the case of Martin Luther King/Drew Medical Center (Renford, 1993). Thus, communications with the emergency department may not be sufficient to inform hospital wide decision makers about what is occurring or to gain information about the status of the hospital. For example, in one case ER staff felt that they needed additional staff while, at the same time, administrators were stating that there was no problem. Finally, emergency department nurses are the ones who typically get the disaster training, not the administrators. From a practical standpoint of course, communication equipment needs to be in the Emergency Department because it is routinely used on a daily basis. Better lines of communication between the hospital staff involved in the event needs to be emphasized. In at least one case this lack of knowledge about LAEMSA's resource support system led to difficulties with obtaining additional staff. On Wednesday night the coordinator of the 20 DBs Orange County Search and Rescue Team contacted Daniel Freeman to see if they needed assistance. After determining that they did, the coordinator attempted to arrange for transportation by contacting the California National Guard at Los Alamitos for a helicopter to take them to their destination. When the medical volunteers arrived at Los Alamitos airfield gate they were not allowed to enter. The proper County/OES channels for making and approving a request had not been followed. Later the same evening, with the assistance of the EMS Authority, Daniel Freeman was able to contact LAEMSA and make the request for medical volunteers. This time, the Medical Branch Coordinator properly requested the volunteer personnel and arranged for their transportation. Unfortunately, another bureaucratic problem emerged. The volunteers had to be sworn in as Los Angeles County Disaster Service Workers before they could be deployed. The main holdup was administration of the oath. Besides this problem, an appropriately licensed driver had to be found t drive the van that would transport them. Both problems were eventually resolved with the volunteer arriving at the hospital early the next morning. Along with the above, hospital administrators felt isolated and lacked critical information about county or city activities to deal with the civil disturbance. The hospitals needed this information to plan the response.

Medical Care for the Injured

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