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Disaster Volunteer Utilization Plan: Guidance DocumentVersion 1: February 2013

AcknowledgementsThe Community Clinic Association of Los Angeles County would like to thank the following Disaster Volunteer Toolkit planning group members for their efforts in compiling this draft Disaster Volunteer Utilization Plan:

Sandra Shields, LMFT, CTSSenior Disaster Services Analyst, EMS Agency

Jacqueline Rifenburg, RN, MICNDisaster Resource Center Program Manager, EMS Agency

Brian Budds, RN, MS, JDCiraolo Consulting, LLC

Michael Ciraolo, RN, MSCiraolo Consulting, LLC

Jee Kim, MPHEmergency Preparedness and Response ProgramCounty of Los Angeles Department of Public Health

Terry Stone, Safety/Emergency Management Manager EMSHenry Mayo Newhall Memorial Hospital

Christopher RiccardiEmergency Management, Security and Environmental SafetyProvidence Little Company of Mary Medical Center San Pedro

Carole SnyderEmergency Preparedness Coordinator, Presbyterian Intercommunity Hospital

Trevor Rhodes, MEMEmergency Preparedness Coordinator, CCALAC

Madeline KieferCommunity HealthCorps Navigator, CCALAC

NOTE: This is a draft document. Comments and suggestions can be directed to Trevor Rhodes at (213) 201-6507 or [email protected].

mailto:[email protected]


Table of ContentsAcknowledgements.................................................................................................................................1

INTRODUCTION...........................................................................................................................................4

I. Executive Summary..............................................................................................................................4

II. Purpose................................................................................................................................................5

III. Definitions and Acronyms...................................................................................................................5

BACKGROUND.............................................................................................................................................6

IV. Healthcare Sector: Clinics...................................................................................................................6

V. Triggers and Surge Strategies..............................................................................................................7

Indicators and Triggers........................................................................................................................7

Clinic Tiers............................................................................................................................................7

Clinic Facility Sizes:..............................................................................................................................7

Clinic Incident Command Team...........................................................................................................8

VI. Surge Strategies................................................................................................................................10

Core Medical Surge Clinic Services....................................................................................................10

Surge Strategies to Increase Patient Care..........................................................................................11

Clinic Surge Staff Strategies Based on Facility Impact........................................................................12

CONCEPT OF OPERATIONS........................................................................................................................14

VII. Volunteer Use..................................................................................................................................14

Volunteer Use During Non-Emergency Events..................................................................................14

Role of Volunteers in an Emergency..................................................................................................14

VIII. General Volunteer Management....................................................................................................14

Initial Issues to Consider....................................................................................................................14

Requesting of Volunteers..................................................................................................................14

Supervision of Volunteers..................................................................................................................16

Tracking of Volunteers.......................................................................................................................16

Orientation and Training of Volunteers.............................................................................................16

Utilization Strategies..........................................................................................................................16

Demobilization of Volunteers............................................................................................................17

IX. Credentialed (DHV) Volunteers........................................................................................................18

Requesting of Credentialed Volunteers.............................................................................................18

Qualifications and Credentialing........................................................................................................18

Legal Responsibilities and Liabilities..................................................................................................19


Orientation and Training...................................................................................................................19


Demobilization...................................................................................................................................19

X. Affiliated Volunteers..........................................................................................................................19

Requesting of Affiliated Volunteers...................................................................................................19




Demobilization...................................................................................................................................20

XI. Spontaneous Volunteer Management..............................................................................................20




XII. References.......................................................................................................................................22


INTRODUCTION

I. Executive SummaryAs surely as disasters will happen, volunteers will show up asking to help. The use of volunteers in the medical community often raises concern because there are so many unknowns. How many volunteers will come, and when? Will any of the volunteers have the skills we really need? What happens if somebody gets hurt? Where will the volunteers stay? Who will feed them, and how? How will they know where to go and what to do? Who will manage them? Who will provide liability insurance? The list goes on.

While these concerns are all important, the value that volunteers can provide in the critical recovery phase of a disaster cannot be denied. Volunteers offer skills necessary to help meet a clinic’s commitments to the community. However, without an effective screening and referral process in place, the convergence of volunteers without needed skills, organization, or training will hamper the clinic’s response. Specialized planning, information sharing, and management structures are necessary to coordinate efforts and maximize the benefits of volunteers during any disaster, therefore volunteers must be anticipated, planned for, and managed through public, private, and non-profit coordinated efforts.

Volunteers are successful participants in emergency management systems when they are flexible, self-sufficient, aware of risks, and willing to be coordinated. Volunteers want their time to be valued, and they want to feel like they are making a difference in support of the disaster. The ultimate goal of volunteers is to provide assistance to others. An effective volunteer management system positively affects the volunteers themselves and thus contributes to the healing process of both individuals and the larger community. To ensure that community clinic facilities are equally benefited by the efforts of volunteers, policies, processes, documentation, training, and reporting structures must be in place prior to the arrival of any volunteers at the clinic site.

This Disaster Volunteer Utilization Toolkit establishes recommended guidelines, procedures, and policies for the effective utilization of volunteers across the whole disaster lifecycle at community clinics. Due to the unique nature of various types of volunteers, the requesting, receiving, utilization, and demobilization process is categorized into specific sections for credentialed, affiliated, and spontaneous volunteers.

The toolkit does not address day to day use of volunteers in the clinic setting. Instead, the operational concepts reflected in the plan focus on potential large-scale disasters that can generate unique situations requiring novel responses when day-to-day resources are overwhelmed. The surge strategies and volunteer utilization examples are designed to facilitate response to extraordinary emergencies or disaster situations associated with natural disasters, human caused events, and technological incidents. However, these concepts may be employed and practiced with preplanned special events conducted by the clinic on a seasonal or annual basis. Normal clinic use of volunteers should be considered and incorporated into the Disaster Volunteer Utilization Plan as deemed appropriate for your facility.

The toolkit is meant to function as just that: a toolkit. Take out the ‘tools,’ or pieces of information that are relevant to your clinic, to fill existing gaps and provide a comprehensive approach to credentialed, affiliated, and spontaneous volunteer management.


II. PurposeThe purpose of the Los Angeles County Community Clinic Disaster Volunteer Utilization Plan is to provide a framework that strengthens the ability of Los Angeles County community clinics to rapidly and effectively respond to emergencies through the coordination and utilization of credentialed, affiliated, and spontaneous volunteers.

Recent natural and man-made catastrophic events have demonstrated the need for volunteer healthcare professionals and lay volunteers to supplement and enhance response and recovery capabilities during and after such events. Public health preparedness initiatives that include pre-credentialed volunteers have been developed to address local, regional, multi-state and federal collaboration.

This Plan aims to provide community clinics with resources regarding the use of volunteers, including information outlining the process of requesting, receiving, training, credentialing, utilizing, and demobilizing volunteers.

III. Definitions and AcronymsVolunteer Someone who willingly provides his/her services without receiving financial

compensation.Credentialed Volunteer An individual with some sort of medical or clinical qualification that is

registered within the Disaster Healthcare Volunteer (DHV) system. These volunteers have had their credentials verified. They are requested through the Medical Alert Center and are then deployed to hospitals and clinics that need their services during an emergency. DHVs are not first responders; these resources are not to be considered a rapid-reaction force. Credentialed Volunteers might be physicians, medical assistants, registered nurses, mental health professionals, emergency medical technicians, etc.

Affiliated Volunteer An individual that is attached to a recognized voluntary or nonprofit organization and is trained for specific disaster response activities. Their relationship with the organization precedes the immediate disaster. Examples of affiliated volunteer groups include CERT, Search and Rescue teams, the Disaster Medical Reserve Corps, and American Red Cross Disaster Action Teams (DAT).

Spontaneous Volunteer An individual who comes forward following a disaster to assist in response efforts, without pay or other consideration. Spontaneous volunteers, also called unaffiliated volunteers, are not initially affiliated with a response or relief agency or pre-registered with an accredited disaster council. However, they may possess training, skills and experience that can be useful in the relief effort.

DSW (Disaster Service Worker)

Any person registered with a disaster council or the Governor’s Office of Emergency Services for the purpose of engaging in disaster service pursuant to the California Emergency Services Act without pay or other consideration.

DHV (Disaster Healthcare Volunteer)

Any individual with medical, health, mental health, and other specialties that has been pre-registered in the DHV system. They have had their qualifications verified and are registered as DSWs. During emergencies, they are requested by and deployed to clinics and hospitals that need additional medical staff.


MHOAC (Medical and Health Operational Area Coordinator)

Each Operational Area has a MHOAC who serves as a 24-hour, seven days a week, single point of contact for disaster medical and health operations. They assist the Operational Area Coordinator with the coordination of medical and health resources within the Operational Area. This includes evaluating the availability of resources within the Operational Area, identifying medical health resource requirements as the status of an incident changes, and assisting with the requesting, prioritization and assignment of incoming resources.

SEMS (Standard Emergency Management System)

The fundamental structure for the response phase of emergency management in California. SEMS is required by the California Emergency Services Act (ESA) for managing multiagency and multijurisdictional responses to emergencies in California. The system unifies all elements of California’s emergency management community into a single integrated system and standardizes key elements.

NIMS (National Incident Management System)

A structured framework, similar in concept to SEMS, used nationwide to coordinate emergency preparedness and incident management among various federal, state, and local agencies.

CERT: Community Emergency Response TeamsEOC: Emergency Operations CenterFEMA: Federal Emergency Management AgencyICS: Incident Command SystemNVOAD: National Voluntary Organizations Active in DisasterVOAD: Voluntary Organizations Active in DisasterVRC: Volunteer Reception Center

BACKGROUND

IV. Healthcare Sector: ClinicsThe clinic sector is composed of health centers, including Federally Qualified Health Centers, Department of Public Health clinics, and Los Angeles County clinics. These clinics represent a mix of public and private entities that provide a number of services and face specific challenges in a surge event. Due to regulations, clinics are unable to provide 24 hour patient care and satellite clinic sites are limited to 20 hours of operations per week. They serve the uninsured and medically underserved populations, and address cultural differences and economic disparities that can impact the health of their patients.

Community Health Centers and Free Clinics are referred to collectively as “Community Clinics.” These include federally funded and federally designated clinics, large and small clinic corporations. Community clinics provide an assortment of primary non-acute medical and dental care services, and some have lab and radiology. Most have a pharmacy or dispensary. Many also offer mental health and social services.


V. Triggers and Surge StrategiesIndicators and TriggersWhen any of the triggers listed below are reached the clinic, the Incident Management Team should be activated and the surge strategies outlined in the following section should be utilized, based on the severity of the emergency.

□ 20% above average daily census□ Staff loss/unavailability of 15-30%□ Inability to transfer patients to hospitals□ EMS/MAC notification of a system wide surge□ Mayoral declaration of an emergency, or a federally declared disaster

Additional Triggers to Consider:□ The incident significantly impacts or is anticipated to impact public health or safety□ The incident disrupts or is anticipated to disrupt the Public Health and Medical System□ Resources are needed or anticipated to be needed beyond the capabilities of the

Operational Area, including those resources available through existing agreements (day-to-day agreements, memoranda of understanding, or other emergency assistance agreements)

□ The incident produces media attention or is politically sensitive

Clinic TiersClinic tier and size information can assist in the planning process of requesting volunteers and recognizing various surge levels. This information should be used to determine how many volunteers are needed, and how to reassign existing staff.Tier III: About 30% of clinics fall in this category

Facilities with annual census < 10,000Tier II: About 65% of clinics fall in this category

Facilities with annual census 10,000 – 100,000Tier I: About 5% of clinics fall in this category

Extremely high annual census Facilities that have the following:

o Urgent care and/or ambulatory surgeryo Pharmacy, Radiology and Laboratory

On a daily basis, they provide a “higher level of care” They employ a high concentration of providers, MDs & RNs, with

Emergency Medicine experience and background

Clinic Facility Sizes:Small: Facility offering patient services with 1-3 exam rooms and/or 1-20 total staff

membersMedium: Facility with 3-10 exam rooms and 20-50 total staffLarge: 10+ exam rooms and 50+ total staff on siteCorp. Office: Facility supports clinical activities in an administrative capacity.

(May or may not be co-located with a patient services site)


Clinic Incident Command TeamThe Incident Command System (ICS) is designed to enable effective and efficient incident management by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure. Clinics should use the ICS to plan, organize, staff, direct, and control emergency situations. The specific ICS organizational structure used will depend on the scope and type of the emergency.

In most emergencies, core objectives should be prioritized as follows: Ensure life safety – protect life and provide care for injured patients, staff, and visitors Contain hazards to facilitate the protection of life Protect critical infrastructure, facilities, vital records, and other data Resume the delivery of services Support the overall community response Restore essential services/utilities Provide crisis public information

ICS staffing starts with the Incident Commander, and expands based on the positions needed to manage the size and complexity of the incident. ICS employs four functional sections (Operations, Planning, Logistics, and Finance and Administration) in its organizational structure. The Incident Management Team is responsible for external notifications and ongoing communications with other responding agencies, including DHV resource requests.

Sample Small Clinic Team Structure: Sample Medium Clinic Team Structure:


Sample Large Clinic Team Structure:

Sample Corporate Office Clinic Team Structure:


VI. Surge StrategiesCore Medical Surge Clinic Services The clinic services mentioned below are services likely to be required in the case of a medical emergency. Included is a description of the service, and the tasks associated with it.

Mass Casualty CareDescription: Clinics should be prepared to respond to a mass casualty event.

Tasks: Sufficient staff to manage patient surge Triage capability ALS Capability Holding Agreements with receiving hospitals Integration of clinic into operational area

medical response system

Reception and TriageDescription: During disasters, clinics may become points of convergence for injured, infected, worried, or dislocated community members. Depending on the emergency and availability of other medical resources, clinics may not be able to handle all of the presenting conditions. Minimum clinic role will likely be triage, reporting, stabilization, and holding until transport can be arranged.

Tasks: Reception area Response plan Staff recall procedure Crowd Management Location of Shelters Triage tags Triage training Medical supplies

Reception of Hospital OverflowDescription: In disasters, hospitals may be overwhelmed with ill and injured patients requiring high levels of care, while at the same time facing convergence from patients with minor injuries or the worried well. Clinics may be requested to handle people with minor injuries of patients to relieve the pressure on the hospital.

Tasks: Requirements above for mass casualty care Prior agreement that defines: circumstances

for implementation, types of patients that will be accepted, resource/staff support provided by hospital, patient information/medical records, liability releases

Mental Health ServicesDescription: Clinics can expect the convergence of the “worried well” following a disaster.

Tasks: Disaster mental health training for

clinicians/licensed mental health staff Internal or external mental health team External source of trained personnel to

augment response

Mass ProphylaxisDescription: Clinics may be requested to participate in mass prophylaxis managed by the local health department.

Tasks: Availability of staff who can volunteer Procedures for determining when clinic staff

can volunteer


Surge Strategies to Increase Patient CareThe diagram below illustrates possible surge strategies that can be implemented in clinic surge situations. When there is an increase in the number of patients at the clinic and a loss in normal staff availability, consider the suggestions below to increase the clinic’s patient care capabilities. Begin with the box on the left, and move to the middle and right boxes as more patients come to the clinic.

Increase staff via requesting and assigning credentialed volunteers (DHV, DMAT, Disaster Service Workers), affiliated volunteers, and spontaneous volunteers

Establish unlicensed treatment areas (ex. Outpatient surgery rooms, parking lots, waiting rooms)

Establish temporary treatment areas (ex. Tents)

Reassign staff Recall staff Utilize staff from other clinic

sites Standing orders for licensed

nursing staff Standing orders for medical

assistants

Cancel elective appointments

Process to extend normal outpatient clinic hours

Rapid patient discharge

Percent of Patients above Average Census

Clinic Staff Reporting to Work


Clinic Surge Staff Strategies Based on Facility Impact On the following page, you will see a table that outlines the five different levels of facility surge. Depending on the current level of surge at the clinic, different services can be prioritized and staff can be reassigned to meet the needs of certain services. If the clinic facility continues to experience surge and moves to more extreme surge levels (ie. Red or Black), volunteers from affiliate agencies and the DHV system should be requested.

A blank Clinic Surge Staff Planning Matrix is provided in Appendix 7, and should be filled out by the clinic prior to an emergency. In this matrix, every row should represent a different clinic service (ie. General Medicine, Pediatrics, Laboratory, Radiology, Mental Health, OB/GYN, Triage). The columns should be filled out, outlining the staff used for a given service depending on surge level. As surge increases, staff should be reassigned, assigned, or have volunteers requested, depending on whether that service is necessary in an emergency. (For example, triage will most likely need more staff assigned to its service, or have volunteers requested, while OB/GYN and radiology can most likely reassign their staff to other services). Clinics should fill out two versions of this matrix: one for sudden onset events, such as earthquakes, and one version for slow onset events, like a pandemic.

Use the following Service Surge Strategies Staff Category Legend, and list of possible services offered at the clinic site to fill out your blank Matrix.

Service Surge Strategies

NO Normal OperationsEH Extend HoursIS Increase StaffRS Reassign StaffRV Request VolunteersCS Close Service

Staff CategoriesMH Mental Health Worker IN IntensivistsNP Nurse Practitioner NIN Non-IntensivistsOB/GYN Obstetrician CCN Critical Care NursesPA Physician’s Assistant NCN Non-Critical Care NursesPED Pediatrician PHM PharmacistsRN Registered Nurse RTH Respiratory TherapistsREG Intake Worker (Billing Office, Receptionist,

and Registration)MD Physician

WIC Women, Infants, and Children MA Medical AssistantDDS Dentist DN Dental HygienistDA Dental Assistant HE Health Educator

Possible services offered at clinic site: General Medicine Pediatrics OB/GYN Urgent Care Mental Health Dental Laboratory Radiology


Service Surge Strategies Based on Facility ImpactSurge Monitoring Diagram Color DescriptionsThe designations of the surge monitoring colors will be made by the authorized designee from the clinic operations/command center to the local jurisdiction. Below is a description of each of the five facility levels of surge. Green (Normal Operations): Facility is operational and in usual day-today status. No assistance from the jurisdiction required Yellow (Under Control): Facility is experiencing a surge and is able to manage the situation within their organization. No assistance from

the jurisdiction required. Orange (Modified Services): Facility is experiencing a surge and has begun to modify their services. Some assistance from the jurisdiction

required. Red (Limited Services): Facility is not capable of meeting the demand for care, are able to offer limited services and requires assistance from

the jurisdiction. Black (Essential Services): Facility is not capable of meeting the demand for care.*Surge Diagram colors and descriptions were adapted from the CDPH Standards and Guidelines…Foundational Knowledge

CLINICSNormal Operations Under Control Modified Services Limited Services Essential Services

STAF

F

- Reassign staff with a clinical background according to their skillset

- Standing orders for licensed nursing staff- Standing orders for medical assistants

- Standing orders for licensed nursing staff- Standing orders for medical assistants- Increase staffing via accepting and assigning healthcare volunteers (DHV, DMAT, etc.)

- Increase staffing via accepting and assigning healthcare volunteers and displaced county workers (DHV, DMAT, Disaster Service Workers, etc.)

MO

DE O

F O

PERA

TIO

NS

- Continue Operations, i.e. Do not close doors; all regular clinic patients self-refer to the hospital & emergency dept for regular, ongoing, chronic care needs- Triage by phone

- Cancel non-urgent appointments- Provide medication by phone, or fast-track, e.g. medication refill, ‘known’ clinic patients, etc.- Extend operating hours

- Accept Minor, Stable, ambulatory patients from the hospital via referral- Tier 1 Urgent Care and MACCs to accept minor, stable patients via BLS transport- Implement Continuity of Operations Plan

- Tier 1 Urgent Care and MACCs to accept minor, stable patients via BLS Ambulance transport- Continue to provide care to clinic patients (stable and non-critical) beyond the 23 hour limit.- Implement Continuity of Operations Plan

- Implement Continuity of Operations Plan


CONCEPT OF OPERATIONSThe concept of operations describes a strategy behind organizing the multiple volunteer management functions into a system.

VII. Volunteer UseVolunteer Use During Non-Emergency EventsVolunteers may be used to support disaster and community events, public health events such as health fairs, exercises, and immunization clinics. Clinics should consider training volunteers that are already registered as volunteers at their clinic in emergency response, and contact them if an emergency should occur and their assistance is needed.

Role of Volunteers in an EmergencyVolunteers can be a significant resource of timely manpower, skills, and abilities, while providing valuable insight on a community’s needs. Often, volunteer assistance is important because it can be quickly provided by people living or working close to damaged areas. Volunteers can also augment emergency staff with basic skills and support activities, allowing responders to focus their efforts on specialized work. In addition to helping others, some believe that participating in volunteer service is helpful to disaster victims. Volunteerism has been suggested as an avenue to reduce stress, as an outlet for rage, as part of the healing process, and as a means of empowering victims.

VIII.General Volunteer ManagementInitial Issues to ConsiderBefore requesting volunteers, clinics need to consider whether or not they can provide certain services for their volunteers. If you cannot provide your volunteers with food, transportation, and lodging, you need to make sure that the volunteers that you request are able to bring their own food, have somewhere to stay, and have transportation to the clinic.

If the clinic is experiencing an austere condition (ie. Exposure to hazardous materials or contagious pathogens), volunteers must be informed so they can bring the required personal protective equipment. Similarly, volunteers should be informed of any other special conditions that might influence their ability to volunteer, or might influence what they bring to the clinic. For example, volunteers with asthma would need to know if there were large amounts of debris and dust so they know to bring their inhaler.

Requesting of VolunteersThe requesting process varies depending on what type of volunteer is being requested (credentialed or affiliated). Below is a flowchart that outlines the process.

This flowchart can also be found in Appendix 2a. See the “Requesting of Volunteers” section under both “Credentialed Volunteers” and

“Affiliated Volunteers” for more specifics.


Supervision of VolunteersAn appropriate level of supervision must be provided to volunteers at all times. The supervisor’s job is to ensure that volunteers understand their responsibilities, know how to carry out their work, and are meeting performance standards, especially in regard to safety. Supervision ensures volunteers are correctly utilizing necessary supplies and equipment and not creating a situation which may cause harm to others. Additionally, Volunteer Coordinators and other clinic employees working with volunteers should be trained to recognize signs of critical incident stress among volunteers.

Tracking of VolunteersVolunteers who are deployed must be accounted for from the initiation of assignments through demobilization. This involves:

□ Signing volunteers in and out□ Noting the role they were assigned to and the tasks they completed□ Rating their performance Use the Disaster Volunteer Registration Form (Appendix 3f) and HICS 253 and 252 forms

(Appendix 4a and 4b) to properly and efficiently register and track your volunteers.

Orientation and Training of VolunteersDeveloping a plan for orienting, training, and supervising volunteers is essential to the successful involvement of volunteers in disaster response and recovery efforts. Training helps ensure safe volunteer operations, tells volunteers they are being taken seriously, helps maintain consistency and quality of services to clients, and helps protect the interest and assets of the organization.

The amount and type of training that volunteers receive should be based on: The level of the volunteers’ experience The risk of the activity they will be engaging in The complexity of the task The equipment required Any policies or regulations related to the task

Volunteers should be oriented to the organization and the disaster situation. Orientation should cover:□ The agency’s disaster mission, key policies and procedures□ Safety instructions, what to do in case of accident or injury, and relevant environmental factors□ A tour of necessary facility sites□ A written description of their role, to include known skills, knowledge, or abilities to support

each role Read Appendix 3g: Disaster Volunteer Orientation Checklist for more instructions on how to

orient volunteers. See the “Orientation and Training” section under “Credentialed Volunteers” for more

information on training DHVs.

Utilization StrategiesFill out the Clinic Surge Staff Matrix in Appendix 7 to determine how you will utilize volunteers during an emergency.


Demobilization of VolunteersAll volunteer activities will, at some point, come to an end. This may occur as a whole for all volunteers involved in a mission or for individual volunteers as they reach the limits of their ability to volunteer or at the end of their assignment. In all cases, there are steps that need to be taken to ensure that assigned duties are addressed, volunteers’ concerns are taken into consideration, logistical concerns are attended to, and the volunteer’s experience is appreciated and documented. The following should be addressed:

Release from Duty Before a disaster volunteer can be demobilized, they must be released from duty by their immediate supervisor. The Volunteer Coordinator should confirm their release from duty through pre-identified documentation protocols.

Volunteer Brief of Replacement Volunteers should brief any replacement staff, be they volunteer or otherwise, if appropriate, on all pertinent information needed to perform the job and ensure smooth operations.

Out-processing and Exit Interview An exit interview should be conducted to educate the volunteer about the typical physical and mental health reactions to disasters, and to inform them of the follow up resources available if the typical mental health reactions last longer than the volunteer is comfortable with and/or it interferes with their functioning. At small facilities, the Volunteer Coordinator may assume this role. Ideal candidates for this role may come from Human Resources staff or Mental/Behavioral Health staff.

Use the “PsyStart Staff Self Triage System” form (Appendix 3e) to assess the physical and mental health of each volunteer

Notification of Home/Sponsoring OrganizationThe receiving clinic is responsible for ensuring that the sending organization is informed of the demobilization of the disaster volunteer.

Completion of Tracking Data Confirm that Appendix 3f: Disaster Volunteer Registration Form is completed for each volunteer (this form should be filled out for each volunteer when they are received). In addition, the number of hours worked should be noted using Appendix 4a: HICS 253 or Appendix 4b: HICS 252. All post-deployment records must be properly collected and stored according to local guidance.

Debriefing and AssessmentIt is important to understand what the volunteer experience was like and what lessons can be learned for future volunteer use. The receiving clinic may ask volunteers to participate in debriefing and may use their own volunteer feedback form if they have one.

Use Appendix 4c: ICS 226 Individual Performance Rating form to assess the performance of each volunteer

Transportation Back to Point of Departure/Embarkation Depending on arrangements made at the time of the deployment, the receiving clinic is responsible for arranging disaster volunteer transportation back to the point of departure/embarkation or initiating the process to request transportation from the sending organization.


IX. Credentialed (DHV) VolunteersDisaster Healthcare Volunteers (DHV) is a statewide “database” of volunteers that have some type of medical expertise, such as physicians, nurses, EMTs, and medical assistants. All of the volunteers in the database have signed up to help in the case of a disaster. Clinics utilizing this resource will need to establish a just-in-time on-boarding process to ensure volunteers have all the information and resources they need to adequately respond to an emergency and maintain existing clinic controls and standards of care.

Requesting of Credentialed VolunteersFill out the “Resource Request Medical and Health” form (Appendix 2b) and the supplementary “Disaster Healthcare Volunteer Personnel Request Form” (Appendix 2c) to request DHVs. These forms should be submitted to one of the following contacts (listed in order of preference):

1. ReddiNet (for clinics with access)2. Los Angeles Emergency Medical Services Agency:

a. Email: [email protected] b. Fax: Medical Alert Center (562) 906-4300; DOC (562) 944-5248c. Phone: Medical Alert Center (866)-940-4401

3. The Community Clinic Association of Los Angeles County (CCALAC)a. Email: [email protected] b. Fax: (213) 250-2525c. Phone: (213) 201-6500

4. Everbridge5. CWIRS Radio: for County Comprehensive Centers6. HAM Radio (Frequency List available by request)

The Disaster Healthcare Volunteer Request Form requires clinics to denote the desired Emergency Credential Level (ECL) of the DHVs deployed to their clinic site. The legend below should be used to determine which ECL is required for the tasks of DHVs at the clinic:

ECL I: Hospital ReadyECL II: Clinically ReadyECL III: Active LicenseECL IV: Training/Experience

Qualifications and CredentialingVolunteers who are deployed through the DHV program will have had their licenses verified electronically within the 24 hours prior to deployment. Thus, you can be assured that a licensed volunteer had a valid, unencumbered license at the time of deployment. Any board certifications or DEA numbers will also be verified prior to deployment. In addition, volunteers’ work is verified within six months of deployment. Thus, you will be informed if a volunteer has recent hospital or clinical experience. All DHVs will be sworn in as Disaster Service Workers prior to deployment.

Joint Commission Standards dictate that healthcare facilities should verify the qualifications of each credentialed volunteer within 72 hours of the demobilization of the volunteer.




Legal Responsibilities and LiabilitiesVolunteers processed and delivered through county agencies are sworn Disaster Service Workers with workers’ compensation liability coverage. In addition to this coverage, many federal and state laws exist to protect disaster volunteers. It is important for each clinic to carefully consider their own liability protection needs, and enact policies, procedures, and waivers as they see fit. For more information on existing legislation, see Appendix 6c: Disaster Volunteer Legal Summary.

Orientation and TrainingThe onboarding process for DHVs should include shadowing and/or mentoring for 1-2 hours, a tour showing volunteers storage and resource locations, reporting structures, and other important places.

Utilization StrategiesFill out the matrix provided in Appendix 7, and described on page 12 of this Guidance Document, to determine how you will utilize your requested DHVs during an emergency.

DemobilizationSee the “Demobilization Section” under General Volunteer Management for the steps involved in volunteer demobilization.

In addition to those steps, clinic staff should inform the Department of Health Services Department Operations Center (DHS DOC) of the demobilization of each DHV, and ensure that the following forms are sent to the DHS DOC:

PsySTART Staff Self-Triage System form (Found in Appendix 3e) ICS 226 Form (Individual Performance Rating) (Found in Appendix 4c)

X. Affiliated VolunteersAn affiliated volunteer is an individual who is affiliated with either a governmental agency or NGO and who has been trained for a specific role or function in disaster relief or response during the preparedness phase.

Requesting of Affiliated VolunteersTo request affiliated volunteers from an outside agency, fill out the “Affiliated Volunteer Personnel Request Form” in Appendix 2d and send the form to the Community Clinic Association of Los Angeles County (CCALAC):

Email: [email protected] Fax: (213) 250-2525 Phone: (213) 201-6500

Prior to emergency personnel being deployed to an incident, the requestor and provider should agree upon who will provide logistical support, including transportation, lodging, feeding, and specialized equipment and materials.



Qualifications and CredentialingThe credentialing of affiliated volunteers may vary depending on the affiliate organization in question, so specific qualifications desired or required for certain tasks should be denoted on the Volunteer Request Form.

Legal Responsibilities and LiabilitiesAffiliate volunteers might not be sworn in as DSWs and therefore may or may not be covered by the county for liability purposes. Clinics receiving non-DSW volunteers should include the signing of a Liability Release Form in their onboarding process.

Utilization StrategiesYour clinic should develop an internal policy addressing the use of affiliated volunteers during emergencies. You should use your judgment in determining how you will use these volunteers. Below we have provided some utilization strategies:

Crowd control Non-medical service control Clean-up Safety and building inspections Data entry and clerical support Animal care Interpreting Construction

Demobilization

See the “Demobilization Section” under General Volunteer Management for the steps involved in volunteer demobilization.

In addition to these steps, clinics should also notify the home (i.e., sending) organization of the demobilization of the affiliated volunteer. All volunteer forms, including Disaster Volunteer Registration Form, ICS 226 (Individual Performance Review) and HICS 252 or 253 forms, should be sent to the sending organization.

XI. Spontaneous Volunteer ManagementIdeally, all volunteers should be affiliated with an established organization and trained for specific disaster response activities. However, the spontaneous nature of individual volunteering is inevitable; therefore it must be anticipated, planned for, and managed. Specialized planning, information sharing, and a management structure are necessary to coordinate efforts and maximize the benefits of volunteer involvement. Clear, consistent, and timely communication is essential to successful management of spontaneous volunteers. A variety of opportunities and messages should be utilized in order to educate the public, minimize confusion, and clarify expectations.

Although the media often present volunteer efforts as exclusively positive, serious issues and risks are commonly associated with massive convergence. Volunteer efforts can be ineffective because


organizations and management system have not prepared for nor considered how to integrate the volunteer resources. As a result, response personnel are diverted from their primary duties to consider how spontaneous volunteers will be used, to create and assign tasks, to manage logistics related to volunteers, and to supervise actions.

With efficient management, however, spontaneous volunteers are a valuable resource to the community and contribute to positive public perception of local government response and recovery efforts.

Qualifications and CredentialingClinics should assume that spontaneous volunteers have no formal qualifications. The Volunteer Coordinator should have each volunteer fill out a Volunteer Application (Appendix 3c) upon arrival, which includes their contact information, availability, occupation and skills, and more. Volunteer Coordinators should also interview all potential volunteers (see Appendix 3b: Disaster Volunteer Interview Record). This will give Volunteer Coordinators an idea of what task to assign each spontaneous volunteer to.

Legal Responsibilities and LiabilitiesIt should be assumed that spontaneous volunteers come with no liability coverage, and should go through the clinic’s standard volunteer onboarding process.

Utilization StrategiesDevelop a system coordinated by the ‘formal’ responders and pre-trained volunteers that can integrate a large number of spontaneous volunteers. This strategy essentially transforms spontaneous volunteers (individuals with or without specialized skills) into an assigned resource.

Your clinic should develop an internal policy addressing the use of spontaneous volunteers during emergencies. You should use your judgment in determining how you will use these volunteers, and use forms provided in Appendix 3 to interview volunteers and determine which skills they possess that could help the clinic’s emergency response efforts. Below are some utilization strategies:

Managing traffic flow Acquiring goods and services from the community Coordinate and process other spontaneous volunteers Sandbagging in the case of a flood Debris removal Resource management (coordinate pick-up and distribution of supplies, clear out spaces,

restock medical supplies in triage stations) Answer phones Distribute food and water Clean up Interface with CERT


XII. ReferencesA Community Clinic Guide to Disaster Response: Incident Management Team Development, The Community Clinic Association of Los Angeles County

California Public Health and Medical Emergency Operations Manual, California Department of Public Health

Emergency Volunteer Center Activation Guide, Voluntary Organizations Active in Disaster, Santa Barbara County

Los Angeles County Disaster Healthcare Volunteers Deployment Operations Manual, Los Angeles County Department of Public Health and Emergency Medical Services Agency

Managing Spontaneous Volunteers in Times of Disaster: Participant Materials, Points of Light Foundation and the Corporation for National and Community Service

Managing Spontaneous Volunteers in times of Disaster: The Synergy of Structure and Good Intentions, Points of Light Foundation and Volunteer Center National Network

Monterey County Volunteer Management Plan, Bay Area Urban Area Security Initiative

Spontaneous Volunteer Management Annex: Marin County Operational Area Emergency Operations Plan, Marin County Office of Emergency Services

“Strategies for Managing Volunteers during Incident Response: A Systems Approach,” Lauren S. Fernandez, Joseph A. Barbera, Johan R. van Dorp

University of Toledo Disaster Volunteer Deployment Management Plan, Emergency Preparedness Task Force

Volunteer Policies and Procedures Handbook, National Association of County and City Health Officials and Mesa County Advanced Practice Center

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