San Diego Firestorm 2007 Medical-Health Response Overview Jan C. Spencley Hospital Preparedness Coordinator Hospital Association of San Diego & Imperial Counties California Hospital Association December 4, 2007 California Primary Care Association

12 Distinct Fires – 400,000 Acres

Firestorm 2007 Overview Major Fires (12 total) Fire Name Date Started Location Acres Homes Destroyed Other Structures Destroyed Injuries Deaths Harris 10/21/2007 South East County 85,000 111 88 37 6 Witch Creek North East County and City of San Diego 197,990 911 205 28 2 Rice Canyon 10/22/2007 Fallbrook 9,000 206 42 3 Poomacha 10/23/2007 North East County Merged with Witch on 10/26/2007 42,000 78 19 18 Horno Camp Pendleton 21,084 1 TOTAL 355,074 1,306 354 87 8 Over 400,000 Acres burned – 15% of San Diego County December 4, 2007 California Primary Care Association Source: County of San Diego: WebEOC, PreHospital MICN data, Medical Examiner Data

Largest Evacuation in California History Approximately 515, 000 people evacuated December 4, 2007 California Primary Care Association

California Primary Care Association Disaster Medical-Health Component Coordinated through Medical Operations Center (MOC) December 4, 2007 California Primary Care Association

Over 2,200 medical patients evacuated Three acute care hospitals (285+) Multiple nursing facilities (1,900+) Many facilities closed or pre-staged for evacuation (4 hospitals – 26 clinics – multiple medical groups)

California Primary Care Association Mass Care & Shelter All requiring medical screening and care 52 Shelters Did anyone worked or volunteered in a shelter during the 2003 wildfires? In 2003 during the wildfires… we had at least 13 shelters that were opened, and we have many of our PHNs worked in the shelters along side Red cross volunteers and covered more than 100 nursing staff positions in one week period when the shelters were opened… that was plenty and certainly a difficult period for many of us but just to compare, in 2004 during the 4 hurricanes that devastated Florida, they had at one point more than 400 shelters open and >100,000 evacuees… here in SD we have total about 200 PHNs so as you can imagine if we have a situation at all like that where there's a need for more shelters or they had to stay open in longer duration, we would definitely be needing assistance from all of you in this room and many more. December 4, 2007 California Primary Care Association

Medical Screening and Care at Shelters Many shelters were initiated by American Red Cross (ARC), but many were also initiated by churches and local organizations/jurisdictions County provided central coordination for deploying medical care resources to shelters Hospitals and Clinics provided mobile medical assets and clinical teams to augment County staff at shelters and Local Assistance Centers (LAC) Medical Reserve Corps provided staff to provide medical screening and care at shelters (48RN/15MD/1FNP/1RT) Those arriving at shelters were screened and triaged to appropriate care facilities if necessary SNF patients Other nursing home patients (self-evacuations) Evacuees December 4, 2007 California Primary Care Association

California Primary Care Association Key Lessons Learned Integrate LTC into planning and response SNF/ICF Convalescent/Assisted Living Board & Care/Group Homes Hospice – Special Needs Populations Evacuation steps and issues (laundry list) Continue to improve information systems Expand information system use (EMAN, WebEOC) Integrate systems (one portal) Establish donation coordination - center(s) Training on MOC roles - systems Expanded training on Disaster System (ICS) December 4, 2007 California Primary Care Association

Success Factors Medical-Health Collaboration Integrated Planning Military participation Vertical and horizontal Incident Command Structure Unified for region (18 cities plus County) Medical Operations Center (MOC) Response partner ICS activation/use Communication Communication across jurisdictions WebEOC Provider representatives at MOC Broad (Field to ICS to providers) December 4, 2007 California Primary Care Association

2007 Santiago Canyon Wildfire Mary Massey, Hospital Preparedness Coordinator December 4, 2007 California Primary Care Association

California Primary Care Association STATISTICS 28,400 Acres 15 Structures 1900 Firefighters at peak December 4, 2007 California Primary Care Association

California Primary Care Association AREA COMMAND Deployed 5 Fire Strike Teams to Malibu Deployed 8 Ambulance Strike Teams to SD Received patients and evacuated residents from San Diego (Including over 90 LTF patients) December 4, 2007 California Primary Care Association

COMMUNICATION - Public Hotline-Maps OCFA Website 211 on CMS/Amber Signs OA Press Releases Use media to your advantage WiFi at shelters December 4, 2007 California Primary Care Association

COMMUNICATION - Interagency WebEOC ReddiNet RACES and HDSCS 24 Hour staffing 800 mhz system Interoperability December 4, 2007 California Primary Care Association

California Primary Care Association EVACUATION 1900 mandatory 700 voluntary Jail and Boys Camp Schools (Received from San Diego hospitals and Long Term Care Facilities) December 4, 2007 California Primary Care Association

California Primary Care Association CARE AND SHELTER Red Cross Shelters State Beaches Parking Lots Supplies/Food Services (Social Services, Behavioral Health, Fire, Community, Public Health, Animal Services) Staffing (ARC, MRC) December 4, 2007 California Primary Care Association

California Primary Care Association TRANSPORTATION Ambulance Buses Road Closures Toll Road Interstate 5 December 4, 2007 California Primary Care Association

California Primary Care Association ANIMALS Sheltering Fair Grounds LA County Race Track OC Animal Shelter Plan Ahead December 4, 2007 California Primary Care Association

California Primary Care Association HOSPITALS Maintained an average of 700 available beds Received requests from hospitals and long term care in San Diego December 4, 2007 California Primary Care Association

California Primary Care Association LESSONS LEARNED Real-time satellite pictures Updated Maps State OES Representation Long-term Support Staffing Donation Management Volunteer Management Obtain SD EOC website December 4, 2007 California Primary Care Association

California Primary Care Association QUESTIONS December 4, 2007 California Primary Care Association