medical (dmat) response to s. ca wildfires 2003 david lipin unit commander dmat ca-6

Medical (DMAT) Medical (DMAT) Response to S. CA Response to S. CA

Wildfires 2003Wildfires 2003David LipinDavid Lipin

Unit CommanderUnit Commander

DMAT CA-6DMAT CA-6

Overview: Medical Care at Overview: Medical Care at WildfiresWildfires

• 6 Distinct Areas of Medical Care:6 Distinct Areas of Medical Care:– Fire-line medical careFire-line medical care– Ground evacuation & transportGround evacuation & transport– Air evacuation & Air evacuation &

transporttransport– Base camp medical Base camp medical

carecare– Base camp medical Base camp medical

dispensarydispensary– Civilian sheltersCivilian shelters

DMAT Mutual Aid DMAT Mutual Aid Agreement Agreement (1/2)(1/2)

• There is no federal or state mutual medical aid There is no federal or state mutual medical aid structurestructure

• CA DMATs work together under 1 team’s 501c3CA DMATs work together under 1 team’s 501c3• Agreement is with a private, 501c3 medical Agreement is with a private, 501c3 medical

providerprovider• 501c3 provides pay, insurance to participating 501c3 provides pay, insurance to participating

DMAT members as employeesDMAT members as employees• 501c3 has contract with CDF, USFS as a private 501c3 has contract with CDF, USFS as a private

service provider (e.g., ambulance service)service provider (e.g., ambulance service)– Incident must meet certain minimum criteriaIncident must meet certain minimum criteria– Can Can optionallyoptionally respond if requested respond if requested– Requesting agency pays for costs + overhead (no Requesting agency pays for costs + overhead (no

profit)profit)

DMAT Mutual Aid DMAT Mutual Aid Agreement Agreement (2/2)(2/2)

• Agreement has specific resource Agreement has specific resource requirements:requirements:– 1 MD/PA/NP, 1-2 RN, 1-2 EMT-P, 1 EMT1 MD/PA/NP, 1-2 RN, 1-2 EMT-P, 1 EMT– Expandable upon mutual agreementExpandable upon mutual agreement– Self-sufficient for 72 hoursSelf-sufficient for 72 hours– Dependent upon requesting agency for Dependent upon requesting agency for

logisticslogistics– Handle own specialty (medical, Handle own specialty (medical,

pharmaceutical) resupplypharmaceutical) resupply– Handle own staff rotations, transportation, Handle own staff rotations, transportation,

etc.etc.

Integrating the DMAT Integrating the DMAT (1/3)(1/3)

• Local Command Structure (ICS):Local Command Structure (ICS):– DMAT members report to DMAT Team LeaderDMAT members report to DMAT Team Leader– DMAT Team Leader reports to Medical Unit DMAT Team Leader reports to Medical Unit

LeaderLeader• Local operations (within approved DMAT scope)Local operations (within approved DMAT scope)• Logistical support (except medical supplies)Logistical support (except medical supplies)

– Medical Unit Medical Unit Leader reports to Leader reports to agency Logistics agency Logistics Section ChiefSection Chief


• DMAT Command Structure:DMAT Command Structure:– DMAT Team Leader reports to DMAT DMAT Team Leader reports to DMAT

Wildfire Program CoordinatorWildfire Program Coordinator• Staffing rotation & issuesStaffing rotation & issues• Medical suppliesMedical supplies• Time & attendance, travel, etc.Time & attendance, travel, etc.

– DMAT Wildfire Program DMAT Wildfire Program Coordinator reports to CDF Coordinator reports to CDF Sacramento CommandSacramento Command• Program availabilityProgram availability• Response coordinationResponse coordination


• Medical Authority:Medical Authority:– DMAT members report to DMAT Medical DMAT members report to DMAT Medical

OfficerOfficer• Highest on-site medical credentialHighest on-site medical credential• Can also be DMAT Team LeaderCan also be DMAT Team Leader

– DMAT Medical Officer reports to Wildfire DMAT Medical Officer reports to Wildfire Program Consult PhysicianProgram Consult Physician• Off-site, available by phoneOff-site, available by phone• Only if DMAT Medical Officer is not a physicianOnly if DMAT Medical Officer is not a physician

– Oversight by Wildfire Program Medical Oversight by Wildfire Program Medical DirectorDirector

– Review by 501c3 DMAT’s Medical DirectorReview by 501c3 DMAT’s Medical Director

S. CA Wildfires Medical S. CA Wildfires Medical Response Response (1/2)(1/2)

• DMATs responded to 5 firesDMATs responded to 5 fires• Limited other private medical Limited other private medical

providers used (ambulances)providers used (ambulances)• Limited private-sector Limited private-sector

medical mutual aidmedical mutual aid– Equipment sharing organized Equipment sharing organized

through regional EOCsthrough regional EOCs• Fire/EMS systems reverted to Fire/EMS systems reverted to

Fire-only systemsFire-only systems– Private ambulance backfill, but Private ambulance backfill, but

caused difficultiescaused difficulties

S. CA Wildfires Medical S. CA Wildfires Medical Response Response (2/2)(2/2)

• Stats:Stats:– 5 missions at 8 sites5 missions at 8 sites– Response team:Response team:

• 12 elapsed/37 response days12 elapsed/37 response days• 63 responders spent 261 days in 63 responders spent 261 days in

fieldfield

– 482 patients treated482 patients treated– 22 transported or removed from 22 transported or removed from

dutyduty– 82 “prevented” transports/ER 82 “prevented” transports/ER

visitsvisits– Value:Value:

• Total cost ~ $130KTotal cost ~ $130K• ER visits prevented @ $4K/visit ER visits prevented @ $4K/visit

(incl. transport) = $328K(incl. transport) = $328K

Lessons Learned Lessons Learned (1/2)(1/2)

• Disaster response; not a Disaster response; not a regular responseregular response– Didn’t figure this out soon Didn’t figure this out soon

enoughenough– No inherent concept of No inherent concept of

“wildfire disaster”“wildfire disaster”

• Don’t depend on local Don’t depend on local logistics for specialty logistics for specialty resupplyresupply

• Staffing flexibility worked Staffing flexibility worked wellwell– Can’t do open-ended, multi-Can’t do open-ended, multi-

week deploymentsweek deployments

• Assignment flexibilityAssignment flexibility– Moving from one fire to Moving from one fire to

another; one site to anotheranother; one site to another

Lessons Learned Lessons Learned (2/2)(2/2)• Traditional mutual aid Traditional mutual aid

arrangements break down in a arrangements break down in a larger-scale disasterlarger-scale disaster– Insufficient resourcesInsufficient resources– Resource overlapResource overlap– Resources held in reserveResources held in reserve

• Operational prioritization ≠ Operational prioritization ≠ medical prioritizationmedical prioritization– Proximity to hospitalProximity to hospital– Number of staffNumber of staff– Type of staff (engines vs. hand Type of staff (engines vs. hand

crews)crews)

• Need hospital/clinical mutual Need hospital/clinical mutual aid mechanismaid mechanism

Questions?Questions?David LipinDavid LipinDMAT CA-6DMAT CA-6

[email protected]@pacbell.netwww.emsa.ca.gov/dmatcdf.htmwww.emsa.ca.gov/dmatcdf.htm

Program HistoryProgram History

• Initial contract in mid-summer Initial contract in mid-summer 20012001

• Available for response in late Available for response in late summer 2001summer 2001– Program postponed due to 9/11Program postponed due to 9/11

• First response in 2002 fire seasonFirst response in 2002 fire season– 1 cache1 cache– 4 missions4 missions

• Grew in 2003Grew in 2003– 2 caches2 caches– Simultaneous deployment to 2 missionsSimultaneous deployment to 2 missions– Longest/largest mission to date (80+ patients in Longest/largest mission to date (80+ patients in

single day)single day)– 5 missions prior to S. CA Wildfires5 missions prior to S. CA Wildfires

S. CA Wildfires Response S. CA Wildfires Response (2/5)(2/5)

• 10/27:10/27:– CDF requests simultaneous response to CDF requests simultaneous response to

5 fires5 fires– DMAT Program Coordinator meets w/ DMAT Program Coordinator meets w/

CDF Sacramento CommandCDF Sacramento Command• Determine fire prioritiesDetermine fire priorities

– On-hold teams:On-hold teams:• Re-deploy to 2 firesRe-deploy to 2 fires• Split 2 caches into 4Split 2 caches into 4


• 10/28:10/28:– 2 additional teams deployed to 2 fires2 additional teams deployed to 2 fires– 1 fire designated as primary “resupply” 1 fire designated as primary “resupply”

locationlocation– Remote admin team begins staffing Remote admin team begins staffing

availability collection & rotationavailability collection & rotation– 2 logistics teams launched to shuttle supplies2 logistics teams launched to shuttle supplies


• 10/29:10/29:– One mission increases One mission increases

DMAT staffing to 8DMAT staffing to 8

• 10/30:10/30:– 2nd mission increases 2nd mission increases

DMAT staffing to 10DMAT staffing to 10

• 11/08:11/08:– Final medical team Final medical team

demobilizesdemobilizes– Caches and Logistics Caches and Logistics

Teams returnTeams return

medical (dmat) response to s. ca wildfires 2003 david lipin unit commander dmat ca-6

Documents

medical dmat response

specialty medical

medical authority

dmat members

private medical providers

ca wildfires medical

dmat mutual aid agreement

501c3 medical provider