Overview of LAEMSA Response

The first chapter of this report identifies LAEMSA's role and responsibilities for responding to a disaster. It would be helpful to the reader to quickly review it. On Wednesday at 8:45 PM, the County EOC notified LAEMSA staff that a representative was needed there and to activate the LADHS EOC (Chaffin, 1992). The County EOC position was staffed and the LADHS EOC operational by 1 1:00 PM that night. Both would be continuously staffed until Sunday afternoon. The function was then passed to Medical Alert Center which coordinates field dispatching to hospitals. LAEMSA disaster staff remained on call until Monday. Generally, it took a very brief period of time to start up LAEMSA's EOC and make it functional. Along with a number of LAEMSA staff, an Los Angeles City Senior Paramedic Supervisor reported to the LA DHS EOC. The "Medical Annex" does not specifically identify which aspects of the EMS system, other than those failing under the jurisdiction of LADHS will be coordinated with whom, how priorities will be set or resources allocated between cities or across the county. The plan details only how LADHS will allocate and coordinate its resources. LAEMSA's first task, according to existing disaster plans and procedures, was to determine the number of casualties and critical and non-critical hospital beds available for patients close to the civil disturbance. A hospital survey was initiated at 1:00 AM Wednesday morning using the ReddiNet and HEAR systems. On several occasions hospitals did not respond, requiring a follow-up telephone call. This delayed hospital casualty and bed data gathering. LAEMSA also gathered data on the number of civil disturbance related injured coming into hospital emergency departments. It turned out that it was impossible to separate civil disturbance related injured from others. There was also a problem with the definitions of a "critical" and a "non-critical" injury. The decision was quickly made to define the earlier as a hospital admission and the latter as someone treated in the emergency department and released. A few hours later LAEMSA extended hospital bed polls to all basic receiving hospitals. p They were polled throughout the event (see the injury data section of this report for report interval problems). There was some confusion about the number of injured because hospitals tended to give the total to that time rather than additional injured since the last report. LAEMSA quickly resolved it. Efforts were also made to determine hospital status but existing earthquake oriented reporting formats did not work well for this purpose. The data quickly indicated that Martin Luther King/Drew Medical Center and Daniel Freeman Medical Center were getting stressed or inundated by casualties. LAEMSA requested Los Angeles City Fire Department to divert ambulances to other hospitals. The result was to take some of the pressure off these hospitals by moving a significant number of casualties to Saint Francis Hospital. (The results of this decision are discussed in the hospital response section of this report.) LAEMSA did not contact health centers, freestanding emergency clinics, and other community health care providers on Wednesday to determine their availability to give emergency care or condition per the Medical Annex of the county emergency plan. As far as can be determined they were not integrated into the EMS response. (It should be noted that clinics are not formally part of the EMS disaster response in nearly all counties). As it turns out, most were probably closed as indicated by difficulties that clients had with obtaining Women and Infant Care vouchers the following week. The "Medical Annex" of the disaster plan allows LADHS to establish first aid stations, casualty collection points and other field medical care stations if needed. Given the conditions during the civil disturbance, it would have been very difficult to establish and protect such operations. Also, existing information indicated that available EMS field and hospital resources were being used as effectively as they could given the law enforcement protection delays. At 9:30 Thursday morning, LAEMSA's Medical Director temporarily suspended the requirement for paramedics to make base station contact for each advanced life support patient. He also allowed paramedics to use approved Communication Failure Protocols. This facilitated the rapid stabilization and transport of patients. Los Angeles City and County Fire Departments were aware of the decision but other providers apparently weren't. EMT survey data indicates that a significant minority was not aware of the new orders. At the same time the LAEMSA Medical Director suspended base station contact, the LAEMSA lifted all catchment and service areas for trauma centers and paramedic receiving hospitals. This allowed EMTs to transport their patients to the closest available emergency department or trauma center. LAEMSA found it difficult to define the area affected by the civil disturbance. Los Angeles City and County, Long Beach and other cities adopted curfews but it was very difficult to determine the exact curfew lines that resulted from these individual decisions at least, in part, because these boundaries were constantly changing. Each local fire service or private ambulance company tracked the need for ambulances and activation of backup units in their jurisdiction. At the request of Los Angeles City Fire Department to LAEMSA, five staffed DHS ambulances were made available to them. They were used as first aid stations for fire and police personnel sustaining minor injuries. Private ambulance companies informed LAEMSA that no additional resources were available. Region 6 Regional Disaster Medical Health Coordinator made 43 ALS/BLS units available through EMSA's state mutual aid system if needed, on Thursday at 6:00 PM (Batch, 1992). LAEMSA determined that there were sufficient assets still available in the County to take care of anticipated needs. (Field response assets and their coordination are discussed more fully in the field response section of this report.) Los Angeles City and County Fire Departments had problems with resupplying their ambulances at hospitals. A request for assistance was made through the County EOC. Hospitals also had supply problems. Our analysis of the field and hospital response indicates that these problems never reached the point where they compromised care. LAEMSA responded to a number of critical response problems. Daniel Freeman Hospital requested additional staff. This was coordinated through the Medical Branch of the Office of Emergency Services' Regional Operations Center at Los Alamitos Air National Guard Base. At Martin Luther King/Drew Medical Center's request, LAEMSA obtained twenty units of blood and transported them via DHS ambulance to the hospital. Arrangements were made through the LAC-USC Medical Center to provide prescription medications to Red Cross Shelters. A second request to develop a method for people to obtain prescription drugs in the disaster area was handled by Public Health Programs. According to the Hospital Council of Southern California, numerous requests for escort services were made to LAEMSA (HCSC, 1992). LAEMSA responded to this staffing problem by working with the Los Angeles County Sheriff to set up an escort service at Carson City Hall about thirty-six hours after the requests came in (HCSC, 1992). In some cases, the service was too far away from the hospital to be effective. More sites all around the disaster area could have accommodated people coming from any part of the county. Many nurses would have to drive through the disaster area to get to the escort service. In the end the system was not practical and wasn't used.

Medical Care for the Injured

Continue to Management of the LAEMSA Emergency Operations Center

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