Ambulance Strike Teams

The systems we create before a disaster occurs will have a significant impact on our ability to respond to the disaster. Even small things left unprepared can develop into complex problems, which can unnecessarily consume a large amount of time during disasters. Careful planning and system construction will help prevent the emergence of these complex problems.

History
California's Emergency Medical Services Authority (EMSA) began efforts to create the framework for a structured ambulance response to disasters soon after its formation more than 20 years ago. Through the years, this need was reinforced on a number of occasions where management and support proved difficult due to the lack of an organized response within the framework of a unified system. When California suffered major flooding during the winter of 1997, the response by private ambulances was poorly organized and left some counties without enough resources to meet their day-to-day needs.1

After September 11, 2001, officials from Los Angeles County and American Medical Response (AMR) met to formulate a plan for an effective joint disaster response within Los Angeles County. They developed a strike team model similar to the one adopted by the state.2 AMR was able to test this model during the firestorms of 2003 in San Bernardino, Los Angeles and San Diego counties with a great deal of success. This success demonstrated that a coordinated response by private nonfire-based providers, within the framework of the Incident Command System (ICS), was possible. The strike teams were successful in evacuating hospitals and other medical facilities, backfilling cities where fire resources were all committed to the fires, and handling the surge of emergency calls surrounding the communities directly affected by the fires.

In 2002, EMSA confirmed that development of ambulance strike teams (ASTs) and medical task forces (MTFs) were a critical component of the state's ability to respond to disasters and homeland defense efforts. EMSA, the governor's Office of Emergency Services (OES), the California Fire Chiefs Association, the California Ambulance Association (CAA) and others worked together to develop guidelines for the use of ASTs and MTFs during disasters.

A committee of multidisciplinary industry professionals was formed under the guidance of EMSA. This Ambulance Strike Team/Medical Task Force Committee met frequently in Sacramento to produce a foundation of documents and create a framework of cooperation necessary to bring together the public and private sector emergency management teams in an unprecedented cohesive effort.

Concept of Operations
An AST is made up of self-supporting units of the same type and kind of resource, with common communication and a leader. These units are able to receive, triage and transport victims from the scene of a disaster. There are two possible complements of ambulance strike teams according to the EMSA plan. Type I-ALS strike teams consist of five ALS ambulances and one team leader with a vehicle. Type II-BLS strike teams consist of five BLS ambulances and one team leader with a vehicle.

A medical task force (MTF) is defined as a group of resources with common communications and a leader. An MTF may be sent to an incident or formed at an incident and can consist of a combination of resources. MTFs consisting of combined Type I-ALS and Type II-BLS strike teams and individual resources were utilized for hospital evacuations during the 2003 firestorms.

The use of strike teams makes resource management more effective by maximizing use of the resources, limiting the supervisors' span of control and simplifying communications. AST/MTF are utilized within the framework of the Standardized Emergency Management System (SEMS), using the Incident Command System (ICS) to provide the best response during a disaster.