The Inland Counties Emergency Medical Agency (ICEMA) is responsible for coordinating emergency medical services and trauma care across San Bernardino and Riverside counties. ICEMA designates trauma centers, hospitals, and EMS providers and ensures an effective emergency response system. During disasters, all hospitals may receive trauma patients through medical mutual aid agreements within and across counties and states. Trauma centers play an important role but the system is scalable to handle surge from any size incident.

1. Inland Counties
Emergency Medical Agency
The Role of Trauma Centers
In Disasters

2. ICEMA Mission
Ensure an effective system of quality patient care
and coordinated emergency medical response that
best serves the public, our most important
stakeholder.
This is accomplished by planning, implementing and
evaluating an effective EMS system for all
participants and stakeholders.
ICEMA mission is in line with the County Vision at
all levels of organization.

3. California EMS Regulations
California Health and Safety Code, Division 2.5
The local EMS agency shall plan, implement, and evaluate an emergency medical services system,
in accordance with the provisions of this part, consisting of an organized pattern of readiness and
response services based on public and private agreements and operational procedures (1797.204)
California Health and Safety Code, Division 2.5
Requires the LEMSA Medical Director to establish policies and procedures pertaining to medical
control including dispatch, patient destination, patient care guidelines, and quality assurance
(1797.220)
California Code of Regulations, Title 22
Requires the Medical Director of the LEMSA to maintain medical control by developing written
medical policies establishing the requirements for the initiation, completion, review, evaluation
and retention of patient care records (Chapter 4. Section 100169)

4. ICEMA Responsibilities/Services
 EMS System Organization, Management and Maintenance
 Paramedic Accreditation, EMT Certification and Continuing Education
 Prehospital Treatment and Medical Control
 EMS and Hospital Communications Coordination
 Ground and Air Ambulance Transportation
 Public Information and Education
 Regional Trauma, Stroke and STEMI Specialty Care Center Designation and Oversight
 Data Collection and Evaluation
 Continuous Quality Improvement
 Disaster Medical and Resource Management

5. ICEMA Designated EMS Providers
39
ALS
Providers
1,300
Paramedics
36
BLS
Providers
3,000
EMTs
21
Receiving
Hospitals
240
MICNs
6
EMS Aircraft
Providers
80
Flight
Nurses

6. ICEMA Designated Hospitals
21
Paramedic
Receiving
Hospitals
8
Base Hospitals
2
Adult/1
Pediatric
Trauma
Centers
6
STEMI
Receiving
Centers
6
Neurovascular
Stroke
Receiving
Centers

7. Trauma Center
Overview
• All Trauma Centers are licensed acute care
hospitals
• All provide specialized care at one of four
levels of designation
• Level I and II
– Similar personnel, services and resources
• Surgeons and OR teams must be available 24/7
– Primary difference
• Level I conducts research and provides training

8. Trauma Center
Overview
• Level III and IV
– Generally provide initial stabilization
– Transfer to Level I or II as needed
– Greatest difference between Levels I and II
• Surgical capabilities not in house 24/7
• Surgeons and OR Teams on call back
• Level I and II Pediatric
– Focus specifically on pediatric trauma patients
– Level I also requires research and training

9. Inland Empire
Trauma Centers
• San Bernardino County
– Loma Linda University Medical Center-Level I Adult and Pediatric
• Loma Linda
– Arrowhead Regional Medical Center-Level II
• Colton
• Riverside County-All Level II
– Desert Regional Medical Center
• Palm Springs
– Riverside University Health System
• Moreno Valley
– Riverside Community Hospital-Level II Adult and Pediatrics
• Riverside
– Inland Valley Medical Center
• Wildomar
• Los Angeles County
– Antelope Valley Hospital-Level II
• Lancaster

10. Hospitals in a Disaster
• In a major disaster all hospitals
become trauma centers
• All have Emergency Medicine physicians
experienced in trauma management
• Patients that exceed a community hospital's
abilities can be transferred as the incident
stabilizes
• Continuation of care is a normal process
• Disasters will likely delay or prevent transfers

11. Mutual Aid Coordination
• California divided into six Governor's
Office of Emergency Services Regions
• Inland Empire in Region VI
• Trauma Centers routinely
receive cross border patients
• Medical Health Operational Area Coordinators manage
in-county resources
• Regional Disaster Medical Health Coordinators assist
during disasters
– Large numbers of patients are involved
– Acquisition of personnel needed to support an incident
– Other resources

12. Medical Health Mutual Aid
• California Disaster and Civil Defense Master Mutual Aid Agreement-1950
– Established the framework for the use of Mutual Aid assets
– 11 County OES Regions I and VI M/H Mutual Aid aggreement-1997
– An outcome of the Northridge Earthquake
• ICEMA/Public Health/Behavioral Health MOU-2013
– Identifies the lead roles of the EMS Administrator and the Health Officer who share the
Medical Health Operational Area Coordinator (MHOAC) positon
– Medical incidents-ICEMA
– Health-Public Health
• The Riverside County EMS Agency Director is the Region VI Regional Disaster
Medical Health Coordinator (RDMHC)

14. EMS
Response

16. Northridge Eathquake-1994
• Magnitude 6.7
• Fatalities - 57
• Injuries - > 8,700
• Most patients managed within respective
affected counties
• All Medical/Health coordinator levels engaged
• M/H mutual aid was primarily for personnel
• No significant patient movements out of OAs

17. Hurricane Katrina-1995
• Category 5
• Fatalities - Approximately 1,836
• Injuries - Unknown
• Displaced - > 1 million people
• Impacted area - > 90,000 square miles
• National Disaster Medical System
• International Mutual Aid

18. Trauma Centers
• The use of trauma centers in disaster is scalable
• All hospitals must be ready to receive major
trauma patients
• Mutual aid levels:
County
Region
State
Federal
International

19. Questions?

20. ICEMA Contact Information
Tom Lynch,
EMS Administrator
Office: 909.388.5830
Cell: 909.841.6876
Fax: 909.388.5825
tom.lynch@cao.sbcounty.gov
ICEMA Duty Officer 24/7 number: 909.208.8618
ICEMA
1425 South “D” Street
San Bernardino, CA 92415-0060
Mail Code 0060