EMSA Response Issues

The earlier section discussing the overall management of the local EMS response clearly shows that key components of the response do not fall under the jurisdiction of LAEMSA. In particular, they don't set the EMT field response priorities. This raises the question of how requests for field response related medical mutual aid would have come to EMSA if it were needed. How does EMSA obtain an overall view of the response when there is no central control point, local public and private organizations are putting their own response together and the system is self organizing without overall direction? How are requests for medical mutual aid that come through the OES fire service system to be handled and coordinated? Should the local EMS Agency be involved in managing these resources or should they simple be assigned to the fire service since they manage them on a day to day basis? Recent EMSA staff trips to examine the EMS response during two major hurricanes shows that this response is not unusual. Local EMS providers will in fact organize at the community level along existing lines to provide services (Koehler, 1991). These structures will vary from community to community, from disaster to disaster. A civil disturbance disaster is very different from a natural or technological disaster in some important respects. Some of these differences may account for a higher level of stress experienced by staff. For example: Television pictures of violent acts being carried out by individuals and groups against property, other citizens and government workers vs Pictures of people needing help and working together to help each other. A natural event, such as an earthquakes usually has a single well defined center of destruction and damage vs. a civil disturbance that appears to be growing and may ignite close to home. A natural event is an "act of God" producing a geographically well defined set of injuries vs. brutal injuries inflicted by one person upon the property or body of another. Following a natural disaster there is no one to blame for causing the event vs. media interviews with the public in the disaster area who blame various ethnic groups and "government" generally. A natural event does not usually immediately connect with One's own ethnic identity or value judgment about how "just" the event is vs. feelings about the Rodney King verdict and guilt or outrage about what is occurring associated with one's own ethnic identity or that of other workers. Generally, EMS Authority staff were caught in a role conflict between responding as a disaster worker on the one hand and being a "victim" of the other. By "victim," I mean being a possible target of random violence or the self identification that goes with one's own ethnic identity and how it relates to the actions observed during the civil disturbance or to the causes leading up to the event. Critical stress debriefing was an important method for dealing with these problems. Also, prior office training in cultural tolerance was helpful. EMSA's rapid and successful response resulted from careful planning, training, and exercises. Over the past two years, Authority staff have: Conducted two county level medical disaster training conferences, and six hospital training sessions with multiple participants from different hospitals; Participated or held ten state level disaster exercises; and, Responded to four earthquakes and a major hazardous materials spill that required the Authority to establish the EMSOC, mobilize the system, and coordinate means to deliver medical and personnel resources if needed. EMSA's planning efforts, and participation in training and exercises, has prepared the agency to respond to various types of disasters. This experience shows that it is the opportunity to set up and practice using disaster related response systems that makes it possible to quickly organize the response. The lessons learned from this event should be included in the EMSA disaster response plan annex.

Medical Care for the Injured

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