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��DRC Program Overview: EMS Integration in Disaster Response

Essence Wilson, BSN, PHN, MICN

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�Today We’ll Discuss…�

Objectives

Describe the purpose of the Los Angeles County Disaster Resource Center (DRC) Program.
Explain how EMS providers support the DRC Program during disasters.
Identify the roles of EMS providers within the DRC system.
Recognize the disaster resources available through the DRC Program.
Demonstrate how EMS providers coordinate with DRCs during a disaster response.

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History

Disaster Advisory Committee

2001

HPP Program

2003

HealthCare Coalition

DCAC (Disaster Coalition Advisory Committee) 2013

The disaster section and the Disaster Advisory Committee were created in 2001, after the 9/11 World Trade Center attacks. At the time, the disaster section was just a handful of staff.

In 2002, as a result of the Anthrax attacks, the EMS Agency received funding– that was used to purchased decontamination equipment for our hospitals.

In 2003 Los Angeles County became a direct recipient of Hospital Preparedness Program (HPP) Grant funding. The EMS Agency’s Disaster section became the keeper of the HPP grant as well as other Homeland security grants. UASI, SH5N1,

As part of the guidelines, Los Angeles County became responsible for dispensing these funds through our diverse county and as well as co-leading a Healthcare coalition.

Disaster Services section assists and facilitates our healthcare coalition in Disaster Preparedness, Response, Mitigation and Recovery.

Through funding, we support redundant communication capabilities to ensure we have a way to communicate with our facilities during a disaster

All our hospitals are on Reddinet
Our disaster resource centers, and trauma centers all have satellite phones imbedded into their landline system, our other hospitals have regular satellite phones
We provide Everbridge (Mass communication platform)

Funding also includes other side projects to support the coalition and enhance our preparedness efforts like Power for Patients, trauma throw bags for our EOA providers, or special pathogen preparedness for our state special pathogen treatment centers

The EMS Agency Disaster section monitors the HPP grant and conducts contract compliance monitoring to ensure deliverables are met

Medical Response & Surge Exercise (MRSE) held annually
Training and education – Hospital Disaster Management Training every quarter
Workshops and seminars – BCP workshops, disaster mental health resiliency programs
TTX exercises for our smaller facilities like surgery centers, dialysis centers, home health and hospice

The Disaster Coalition Advisory Committee (DCAC) is a network of healthcare organizations, government agencies, and providers working together to strengthen emergency preparedness, response, and recovery. The Coalition works to train all healthcare sectors in the disaster response system procedures to ensure:

Appropriate assistance for all healthcare and long-term care agencies and facilities to develop and improve disaster plans
Integration and coordination of response across the healthcare system during a disaster
Collaborative medical surge operations to care for victims are available during a mass casualty and/or large-scale event
Ability to determine the status of the healthcare system and the safety and location of patients and clients
Disaster response operations are coordinated between facilities and agencies to meet the needs of the public

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Hospitals
Ambulatory Surgery Centers
Dialysis Centers
Home Health and Hospice
Urgent Cares
Mental/Behavioral Health
Emerging Infectious Diseases (EID) Program
EMS Providers
Skilled Nursing Facilities
Community Clinics

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LAC Healthcare Coalition Membership

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LAC Healthcare Coalition Membership

Government

Public Health departments (LAC, LB, Pasadena), LAC EMS Agency, Office of Emergency Management, CDPH, ASPR

Trade Group organizations

HASC (hospitals), CCALAC (clinics), CAHF (LTC), ESRD Network 18 (dialysis), CAHSAH and LAHHC (home health/hospice)

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LA County Healthcare Coalition (HCC) – DCAC Committee

LAC EMS Agency and DPH EPRD co-chair DCAC to ensure that medical and health activities are carried out

Preparedness
Mitigation
Response
Recovery

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Disaster Resource Center (DRC) Program

DRC program developed in 2004 to support the healthcare system in working together on emergency preparedness and response
DRC Coordinator’s Committee

EMS Agency
DRC managers
Trauma Centers
HASC, CAHF, Public Health, Fire

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DRC Program

DRCs host six meetings annually with umbrella hospitals & other healthcare partners:

5 Umbrella meetings
1 Regional decontamination drill

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DRC Program

Thirteen large caches

Tents, ventilators, Pharmaceutical caches, Medical/Surgical supplies, mass fatality equipment, Chempack resources, etc.

Strategically located throughout the County to cover various geographic areas called Regions
Ready for deployment in mobile trailers

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How DRCs Prepare EMS and Healthcare Partners

Support coordinated disaster planning across hospitals, EMS, public health, and healthcare partners.
Maintain regional disaster resources that can support medical surge operations.
Conduct regular planning meetings and regional exercises to strengthen coordination.
Build relationships before disasters so agencies can respond more effectively together.

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Disaster Resource Centers

California Hospital
Kaiser LA
Cedars-Sinai
Ronald Reagan UCLA
Children’s Hospital LA
LAC Harbor/UCLA
Henry Mayo Newhall

LA General Medical Center
Dignity Health-Saint Mary
MemorialCare Long Beach
PIH Health Whittier
Pomona Valley
Providence St. Joseph

Community Clinic Association of Los Angeles (CCALAC)

TDRC

Trauma Centers

TDRC

PDRC

SPTC

Special Pathogen Treatment Center

SPTC

The DRC program is comprised of thirteen hospitals (split into 10 regions, 9 technically) and one community clinic association, geographically located) throughout LA County. Decisions were made with a few things in mind, including requiring that each region have a trauma center. Some DRCs that share regions have hospitals that joined after grant funds were already used so they purchased equipment on their own to be allowed to qualify as a DRC so in those cases there are shared regions.

Not all DRCs are Trauma Center but for those that are they have a designation as TDRC, T for Trauma. The pediatric Trauma center is PDRC

Additional programs funded by HPP are Special Pathogen Treatment Centers run by my colleague who oversees the Emerging Infectious Disease (EID) program. Only DRCs were asked to participate in this program due to the experience managing large caches and HPP activities

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DRC Regions

Region	Disaster Resource Centers
1	California Hospital & Kaiser LA
2	Cedars-Sinai & Ronald Reagan UCLA
4	LAC Harbor-UCLA
5	Henry Mayo Newhall
6	LA General Medical Center
7	Dignity Health - Saint Mary & MemorialCare Long Beach
8	PIH Whittier
9	Pomona Valley
10	Providence St. Joseph

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Planning

Burn Surge Plan 2010, updated 2024
Pediatric Surge Plan 2013 and Pediatric Acute Surge Plan 2024
Trauma Surge
Emerging Infectious Disease related plans

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EMS Provider Response Role

Initial Patient Treatment & Destination

MCI Trauma Surge
Burn Surge Plan
Peds Surge Plan

Transportation
Evacuation

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Burn Surge Plan

Burn Surge Plan Activation- An incident resulting in 20 or more burn patients or any event that exceeds burn care resources available in LAC
Burn Resource Center (BRC)-A BRC is a designated trauma center in LAC that has agreed to provide medical care for up to 20 critically burned patients for a minimum of 72 hours.
Creates acute 300 burn beds

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Burn Surge Plan

Major/Critical Burns:

Adults (15+): Burns ≥ 20% Total Body Surface Area (TBSA)
Pediatrics (14 and under): Burns ≥ 10% TBSA

Minor Burns:

Adults: Burns < 20% TBSA
Pediatrics: Burns < 10% TBSA

BRC (Trauma Center)

Most Assesible 911 Receiving ED

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Pediatric Acute Surge Plan

Plan doubles LA County pediatric inpatient capacity
Tiered system (pt acuity & age, and hospital capacity & capability)
Get most critically ill or injured children to the top tier facilities
Plan is dependent on complete system participation
Pediatric Surge plan was modified August 2024 to reflect Lessons learned from Pediatric Trauma Surge exercise

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Patient Distribution by Tier

HOSPITAL TIER	TIER DESCRIPTION
Tier 1	Pediatric Centers (PTC/PMC)
Tier 2*	Pediatric Medical Centers (PMC)
Tier 3	Adult Trauma Centers
Tier 4	Pediatric Acute Inpatient Bed
Tier 5	Emergency Department Approved for Pediatrics (EDAP) do not provide inpatient pediatric services
Tier 6	No Pediatric Services
Tier 7	No Emergency Services/ Specialty Centers

Over 8 years old

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Pediatric Acute Surge Plan

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Exercises

Active Shooter
Evacuation
Special Pathogens exercises & Drills
Chempack exercise

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When Disaster Strikes

The first to arrive at the scene of an incident assumes control until relieved by someone with greater experience.
In cases involving multiple agencies such as police and fire a "Unified Command" approach is adopted to ensure both agencies can effectively pursue their objectives.

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Medical Coordination Center (MCC) Activation

Los Angeles County will monitor the situation and activate the MCC if the situation demands it.
The MAC team will conduct necessary polling of all hospitals for:

Facility damage assessment
MCI (ER bed availability)
pertinent resources
HAvBED data (In-patient bed availability)

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Resource Requests

Resource Requests should be submitted through ReddiNet. In cases where that is not feasible, submit the Resource Request form via fax* to the MAC.

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Resource Management -DRC Caches

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Disaster Staging Facility

Designated pick-up location for some requested resources
(2) Decontamination trailers:

The 28-foot trailers are equipped to handle ambulatory and non-ambulatory patients.

Chempacks – for nerve agent attacks and is a part of the SNS. Contains auto-injector antidote kits, atropine, sterile water, diazepam and versed. Total of approx. 158 in 86 locations throughout the state. Hospital chempacks can treat approx. 1000 patients and the EMS chempacks about 450.

-DLX tents

- approx. 20 These are for rapid deployment to provide quick shelters

-Pharmaceutical cache

-CHEMPACK (Nerve agent antidotes) (65 total) Distributed amongst the DRCs, some hospitals and Fire agencies (allows for rapid response to a chemical incident

-Local pharmaceutical cache (13 total) Distributed amongst the DRCs

-LTV Ventilators

-394 distributed to hospitals throughout LA County. 260 of which were given to DRCs (received 20 each)

-Other Medical and Health supplies and equipment (PPE, generators, HVAC systems, oxygen concentrator, de-corporation agents, etc.)

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Resource Coordination - SNS Distribution

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Resource Coordination

Expanded Scope of Practice

EMTs and Paramedics were deployed to work as additional staff in Emergency Departments

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Takeaways

Healthcare preparedness is regional
DRCs support operational coordination
Relationships strengthen disaster response

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Questions