California Community Clinics and Health Centers and Southern California Fire Response

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1 California Community Clinics and Health Centers and Southern California Fire Response Nora O Brien, California Primary Care Association AAPCHO 20 th Anniversary Conference & Gala March 11, 2008

2 Presentation Overview o CA CCHC Overview o Roles of CCHCs, regional clinic associations and Primary care associations (PCAs) in emergency response o CCHC fire response lessons learned and recommendations March 11, 2008 AAPCHO 20th Anniversary Conference 2

3 CA CCHCs at a Glance o Non-profit Community Clinics and Health Centers (CCHCs) provide primary health services to everyone regardless of their ability to pay, immigration or insurance o There are over 4,100 CCHC medical staff providers (doctors, mental health, nurses) o 790 CCHC practice sites which provided 11.2 million patient visits* March 11, 2008 * 2005 AAPCHO OSHPD 20th Annual Anniversary Utilization Conference Report3

4 CA CCHCs at a Glance o Of the 3.7 million CCHCs patients: o 52% are Latino, 32% Caucasian, 7% are Asian Pacific Islander, 7% African American, and 2% Native American o 50% of the patients are Limited English Proficient* o 1 million uninsured patients o 82% are below 200% Federal Poverty Level *2005 OSHPD Annual Utilization Report March 11, 2008 AAPCHO 20th Anniversary Conference 4

5 CCHC Emergency Response Roles Provide medical surge capacity for hospitals and public health Offer medical staff Offer CCHC facilities and mobile vans Triage Disease surveillance Mental health services Outreach to ethnic community leaders and population March 11, 2008 AAPCHO 20th Anniversary Conference 5

6 CA CCHC 2007 Southern California Fire Response March 11, 2008 AAPCHO 20th Anniversary Conference 6

7 2007 Southern California Fires o 1,500 homes were destroyed and more than 500,000 acres of land burned from Santa Barbara County to the U.S. Mexico border. o Nine people died as a direct result of the fire, 85 others were injured o Fires caused the largest evacuation in California history- 515,000 people March 11, 2008 AAPCHO 20th Anniversary Conference 7

8 2007 Southern California Fire Medical Response o Over 2,200 medical patients evacuated othree acute care hospitals (285+) omultiple nursing facilities (1,900+) omany facilities closed or pre-staged for evacuation o (4 hospitals 26 clinics multiple medical groups)* *information provided by California Hospital Association March 11, 2008 AAPCHO 20th Anniversary Conference 8

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10 CCHC Fire Response Antidotes o CCHC staff sent to Qualcomm Stadium o Mental Health services were provided at evacuation sites o Rural SD CCHC site sheltered residents for 3 weeks o CCHC staff affected by evacuation orders o 26 CCHC sites closed o $1.5 million fiscal impact reported in San Diego County March 11, 2008 AAPCHO 20th Anniversary Conference 10

11 CCHC Fire Response Antidotes o Fire didn t require mass medical response o Medical issues were primary care orespiratory issues from smoke and ash olack of pharmaceuticals for chronic condition o CCHCs used practice management systems to identify patients at risk ohomebound seniors with limited mobility ocopd, asthma, emphysema ooffered transportation to patients at risk March 11, 2008 AAPCHO 20th Anniversary Conference 11

12 CPCA Fire Response Lessons Learned o CCHCs were integral to disaster response in each county staff and facilities o CCHC Mobile Vans were heavily used o Regional consortia disaster response coordination worked o Riverside County gave open invoice to IBHS o Best practice: San Diego County Medical Operations Center infrastructure March 11, 2008 AAPCHO 20th Anniversary Conference 12

13 San Diego County MOC Org Chart March 11, 2008 AAPCHO 20th Anniversary Conference 13

14 Fire Response Lessons Learned o Training of CCHC staff- IBHS mental health just-in-time training o Key partners such as Direct Relief were invaluable for supplies and funding o$600, 000 given for clinic recovery o Statewide exercise during the fire confused CCHCs o PCA served as information flow from multiple federal, state, and local partners March 11, 2008 AAPCHO 20th Anniversary Conference 14

15 Fire Response Lessons Learned and Recommendations o Dissemination of information- needed pre-determined PCA communication structure o Respiration guidance needed earlier- fire specific guidelines- pre-event orders o Inclusion of state provider orgs in county EMS/LHD/OES calls o Timely hotwash- debriefing March 11, 2008 AAPCHO 20th Anniversary Conference 15

16 Fire Response Lessons Learned and Recommendations o No patient tracking system in place for reimbursement o CPCA Disaster Relief Fund needed odirect Relief, TCE, and funders donated $$$ o Inclusion of CPCA, consortia, and CCHCs in WEB EOC applications March 11, 2008 AAPCHO 20th Anniversary Conference 16

17 What s s Next for CCHC Emergency Management? o Bureau of Primary Health Care (BPHC) Emergency Management Expectations FQHCs and Look-Alikes will need to: Have a Emergency Management Plan Communications systems Collaborations and Partnerships with LHDs and hospitals Develop business continuity plans March 11, 2008 AAPCHO 20th Anniversary Conference 17

18 Questions? Nora O Brien Associate Director of Program Planning and Development California Primary Care Association 1215 K Street, Suite 700 Sacramento, CA ext 232 nobrien@cpca.org March 11, 2008 AAPCHO 20th Anniversary Conference 18