In the aftermath of October's fires, physicians, hospitals and public health agencies are taking the opportunity to bolster disaster response skills, in the unfortunate event that an emergency strikes the region again. While the fires hit San Diego County hardest, parts of the six counties Southern California Physician covers suffered serious damage, including San Bernardino, Orange and Los Angeles Counties.

"The most important lesson, I think, is that you need to be prepared for these things ahead of time with a plan," says Rodney Borger, MD, vice president of the San Bernardino County Medical Society and director of Arrowhead Regional Medical Center's emergency department in Colton. As unit commander of the San Bernardino County Medical Reserve Corps, Dr. Borger supervised the Oct. 22 deployment of volunteers to help people displaced or harmed by the fires. The corps set up a field clinic at the National Orange Show fairground in San Bernardino, where the American Red Cross established an evacuee shelter. (See Page 39 for more details.)

For nearly a week, Dr. Borger and about 50 other volunteers worked around the clock treating more than 1,000 evacuees, mostly for minor injuries and respiratory problems. But a few critical illnesses required transportation to hospitals, and one woman went into labor. The volunteers also helped to document evacuees and organize records, and they distributed medications, wheelchairs, bandages and other items donated to the shelter.

"In every disaster there are always things you could do differently," Dr. Borger says. For its part, the MRC could more smoothly coordinate with other groups, such as Arrowhead Regional Medical Center and Kaiser Fontana, and the next time it will be more prepared, he says.

In Santa Clarita, two back-to-back events led Henry Mayo Newhall Memorial Hospital to streamline some emergency preparations: a pileup of about 15 big rigs on Interstate 5, followed by wildfires one week later. "We have a lot of physicians who have young children," says Director of Planning and Marketing Andie Bogdan, noting that public schools closed during the fires. "We learned that we need to have a mechanism for an ad hoc, quickly organized form of childcare, so that physicians can easily come in." The hospital will be working on such a program with private schools in the area, she adds.

Newhall Memorial medical staff members have also enthusiastically updated their contact information in response to a mailed request from the hospital's safety officer, Bogdan says.

In Los Angeles County, the fires provided "good experience for us to get [staff] into an actual shelter to deal with healthcare issues," says Deborah Davenport, director of community health services for the Los Angeles County Department of Public Health, which staffed shelters and disaster assistance centers, along with the Red Cross. Frequently, evacuees leave medication, eyeglasses and other essentials at home--problems that physicians should know shelters are prepared to handle, she says. Streamlining staff transportation to shelters and rotating shifts would improve future operations, she adds.

"From my standpoint, the interesting impacts were coordinating with the people at the emergency operating center to help with the response, not only in Orange County, but in neighboring counties as well," says Eric Handler, MD, Orange County public health officer. His department tracked fire-related injuries, hospital beds, available ambulance strike teams and other metrics, and staffed shelters with physicians and public health nurses, he says. The public health departments of Orange and Los Angeles counties sent ambulance teams to help in San Diego, according to county spokespeople.

But disaster response can always improve. This month, Dr. Handler will meet with his counterparts in Riverside, San Bernardino and San Diego to do a "hotwash," he says, "to see what we could do better to communicate and coordinate across county lines."