# Presentation: 411388

## San Diego County MRC and the Red Cross: An Integrated Response to Disasters

- John Hill
- Director of Disaster Preparedness – San Diego County Medical Society
- Volunteer Coordinator - San Diego County MRC

## San Diego County MRC

- “Sponsored” by SD County Public Health Services (PHS)
- Development and organization contracted to SDCMS
- MRC Coordinators include PHS and EMS staff
- Volunteers registered with County Office of Emergency Services (OES) as Disaster Service Workers (DSW)

## Disaster Shelters in San Diego County 

- Operational Area Emergency Plan
- Annex “G” – Care And Shelter Operations
- Red Cross provide bulk of Mass Care Services
- HHSA and PHS will assist Red Cross
- Provide trained personnel to Mass Care Shelters (PHNs)

## Disaster Shelters in San Diego County 

- Public Health Nursing provides PHNs
- Administer first aid following Red Cross protocols
- Perform health assessments to identify health problems
- Perform a variety of other health related tasks:
- Chronic disease monitoring
- Protect residences from communicable disease
- Monitor food preps
- Health education

## Background 

- Viejas and Julian Fires (2001/2002) - need to open more than 2 Disaster Shelters simultaneously
- Public Health Nursing agreed to provide some PHNs to be trained on Red Cross Shelter Operations and Protocols
- Training Program initiated by PHS and Red Cross for the PHNs

## Background 

- Fall 2003 - Cedar Fires
- Largest wildfire in California history
- Within 48 hours Red Cross established 12 Disaster Shelters
- 85 PHNs worked more than 100 12-hour shifts

## MRC Status in 2003 

- SDCMS establishing physician volunteer network to assist PHS
- Working with PHS to submit application for MRC grant
- Hospital ERs not overwhelmed with victims (except for Burn Unit)
- Did not realize health situations at shelters
- Decision made with PHS to not activate volunteers

## Cedar Fires Debrief 

- RC and PH Nurses encountered large number of medical issues
- Most didn’t require transport to ER, but did not fall within protocols for treatment at shelter either
- Huge number of maintenance med prescriptions
- Medical supply needs such as oxygen/insulin
- Not out of the norm, but volume was overwhelming
- NEED TO HAVE A SYSTEM TO MEET MEDICAL NEEDS OF VICTIMS IN SHELTERS!!

## Developing the Partnership

- Brainstorming session
- County
- EMS Disaster Coordinator
- Lead PHN
- MRC Coordinators
- Red Cross
- Disaster Health Services Directors
- Lead Physician
- Lead Nurse

## Developing the Partnership

- Brainstorming session
- Educated each other!
- Discussed what had been needed in fires
- Discussed what could possibly have been done
- Discussed liability (RC vs. DSW) to ensure RC immune
- Discussed RC notification that MRC is needed
- Next steps

## Developing the Partnership

- Public Health Nurses
- PHS and Red Cross developed training curriculum
- Red Cross Shelter Operations
- Red Cross Disaster Health Services Protocols
- MRC capabilities and interaction
- Over 180 PHNs trained

## Developing the Partnership

- MRC Advisory Board
- Red Cross represented by:
- RC Physician
- RC Lead Nurse
- Disaster Health Services Staff
- MRC adopted Disaster Shelters as a core mission

## Developing the Partnership

- Developed notification procedure
- Developed shelter layout structure
- Developed client flow to include medical
- Determined the scope of practice for MRC would be defined during activation by Public Health Officer
- No need for MOU since already in Annex G

## Hurricane Katrina

- 1st MRC Activation
- Notified by EMS of possible evacuees arriving in SD
- Sept 2nd: conference call w/Red Cross, County, DHS..
- Sept 3rd: conference call at 1800 hrs
- Shelter being established for up to 170 evacuees arriving via plane on Sept 4th
- Called 9 volunteers, reached or left message with 8

## Hurricane Katrina

- 3 MDs and 5 RNs mustered at shelter
- MRC/RC established medical location and client flow
- MRC brought basic medical items
- RC provided first aid materials, purchased additional supplies and made arrangements to fill prescriptions
- Deputy PHO assigned to establish scope of practice

## Hurricane Katrina

- 80 evacuees arrived approx 1900 hrs
- All seen by PHNs under RC protocols
- 35 referred to MRC RNs and MDs
- Performed medical assessments/exams
- Wrote prescriptions
- Referred for follow up
- 1 transport to ER
- MRC deactivated at 2230 hrs

## Hurricane Katrina

- Throughout week of Sept 5th prepared for arrival of FEMA flights
- Red Cross was lead agency
- MRC/Disaster Health Services developed shelter layout at local university for 600
- MRC communication system to solicit volunteers
- Activated 2 MRC MDs to see clients at RC offices
- MRC pharmacist system to assist filling prescriptions
- RC established Family Assistance Center (FAC)

## Hurricane Katrina

- Sept 10th to Oct 14th at FAC
- 17 physicians volunteered for 79 4-hour shifts
- 12 nurses volunteered for 21 4-hour shifts
- 3 pharm techs volunteered for 7 4-hour shifts
- More than 2300 clients registered at FAC
- Nurses from RC, PH, and MRC saw 547 under RC protocols
- 339 needed to be seen by MRC physicians

## Hurricane Katrina

- Sept 10th to Oct 14th at FAC
- What did they do?
- Performed medical assessments/exams
- Wrote prescriptions
- Worked with community clinics on referrals/follow up
- Provided emotional comfort and support
- Arranged transport to ER or Urgent care if needed

## Hurricane Katrina

- Identified a need to better fill prescriptions
- Some MRC physicians brought sample meds
- Solicited other MRC and SDCMS physicians
- MRC pharmacists and pharm techs inventoried
- Allowed for onsite filling of the common prescriptions
- Saved the local RC chapter thousands $$

## Lessons Learned

- MRC needs more medical supplies than RC or PHN carry
- Medical location in shelter set up
- MRC protocols “tailored” for each event
- Scope of practice set by PHO each time
- Collaborate with RC on training programs/drills
- Train MRC nurses and physicians on RC forms

## Lessons Learned

- Develop J-I-T training on Shelter Ops
- Train the PHNs on MRC volunteer management
- Develop MRC patient forms
- For long term shelters, establish watch bill system
- Identify common issues and establish prescription plan

## QUESTIONS?

## John Hilljhill@sdcms.org619-285-6452