The report describes the rapid and effective response by each Division of the Department of Public Health during the emergency period immediately following the earthquake. This coordinated response facilitated a quick recovery and return to normal Department operations within 2 days.

Program managers were asked to submit recommendations on how to improve the emergency response system in the event of a larger disaster.

Highlights from each section of the report follow.

The Director of Health, the Associate Director, and the Chief Paramedic responded immediately to the earthquake by reporting to the City's Emergency Operations Center. This team worked through the evening with the Mayor's Office and other department's assessing damages and needs and directing emergency medical operations. The Deputy Director of Operations remained at 101 Grove Street to oversee evacuation activities, damage assessment and the response to community problems. The next day a DPH Command Center was established at Laguna Honda Hospital to further coordinate damage assessment and implement response plans until normal activity could be resumed at 101 Grove Street.

Within two hours of the earthquake the number of ambulances on the streets increased from 10 to 30. 186 ambulance dispatches occurred between 5:04 p.m on October 17 and 2:00 am on October 18th. Mutual Aid ambulances were dispatched from San Mateo, Santa Clara, and Marin counties with 10 ambulance units on standby in Sacramento. A large number of DPH paramedics volunteered off-duty to assist and worked for extended periods of time. Central Medical Emergency Dispatch communications remained 100-percent operational as designed. All critical calls received prompt ambulance response, treatment, and transportation. Additional phone lines were installed to accept incoming calls.

Within 48 hours, environmental health staff conducted a complete survey of food establishments and water potability throughout the City. Throughout the week following the earthquake, environmental health staff disseminated public notices regarding water and sewage conditions in the Marina District. Efforts were coordinated with the Water Department, the Department of Public Works and PG&E to minimize the threat to public health and safety and provide on site information.

Emergency Response staff of the Toxics and Safety Services Program responded to several hazardous materials incidents calls immediately following the earthquake. Hazardous Waste and Hazardous Materials staff assisted in assessing and inspecting hazardous materials spills, chemical incidents, removal of hazardous wastes and assessment of underground storage tank leaks. Hazardous Materials staff distributed an earthquake advisory to over 7,500 businesses in the City. Asbestos inspections were conducted throughout the week following the earthquake,

The Employee Assistance Program was forced to move program operations as 170 Fell Street was condemned. Staff moved headquarters to 101 Grove Street and continued to provide individual, group and telephone counseling. EAP staff developed a Critical Incident Post-traumatic Stress Assessment which will be distributed to all City employees. Ongoing earthquake-related stress groups are being provided to City employees.

San Francisco General Hospital (SFGH) established an emergency command post, immediately performed damage surveys, evacuated outlying buildings, and accounted for all patients. The hospital's emergency auxiliary generator provided full power for the entire hospital within minutes. Staff worked overtime and received and treated a large portion of the earthquake-related casualties. The building sustained moderate structural damage. The hospital is planning to drill wells for a secondary back-up water supply.

Laguna Honda Hospital (LHH) sustained a large amount of structural damage, however patients were rapidly secured and no one was injured. Implementation of the written disaster plan ensured a quick response and accounting of all patients and staff. LHH provided food and shelter to persons displaced by earthquake damage, and temporarily housed several DPH units.

In coordination with the Department of Social Services, Community Public Health, and Community Substance Abuse Services, Mental Health provided 24-hour crisis-counseling teams at the three Red Cross shelters in the days immediately following the earthquake. The teams, which include psychiatrists, psychologists, nurses, and psychiatric social workers, have been staffed by Mental Health staff, contract staff, and volunteers from UC Langley- Porter, Letterman Veterans' Hospital, State Department of Mental Health, and other counties. Emergency centers and phone numbers were identified for mental health crisis counseling and referral. Crisis counseling units continue to provide services in the Red Cross shelters during the day and evening hours.

Community Substance Abuse Services (CSAS) staff maintained triage and detoxification services in coordination with Mental Health, Community Public Health, and DSS at the Red Cross Shelters. Twenty-four-hour drug and alcohol counseling and detox services were provided at all three shelters by CSAS staff, contract agencies, and volunteers until November 3. Effective November 4, 24-hour coverage by the substance abuse triage team has been consolidated at the Polk Street Shelter with transportation from the other shelters available as needed to Polk Street or other appropriate services.

The Health Care for the Homeless staff from the Tom Waddell Clinic provided 24-hour medical assistance to the Red Cross shelters and other community shelters with the assistance of the DSS/CSAS/Mental Health triage system. Additional medical staff hours from the Health Centers were allocated to the Tom Waddell Clinic to accommodate increased referrals. Staff helped orient church groups who were opening up new shelters. Program Directors were on 24-hour call during the days immediately following the earthquake.

Public Health nurses were assigned to work with the triage teams at Marina Middle School, Moscone Center, and St. Ignatius shelters, and continue to provide services to residents in the Presidio and Polk Street shelters. The five District Health Centers and two Neighborhood Centers offered reduced services on October 18, 19 and all services were restored on the 20th. The WIC program distributed infant formula at SFGH.

Staff worked as part of a multi-disciplinary team to organize services for the displaced homeless. The Office of Senior Services provided case management and counseling at senior residences and continued to provide information and referral telephone services. Outreach to seniors in hotels, and at the Presidio provided ongoing assessment of seniors' needs.

Administration contacted all staff and all AIDS contract agencies to coordinate activities. The AIDS office staff was temporarily relocated until 25 Van Ness was safe for occupancy. Medical assistance was provided to the Watsonville area two days after the earthquake. Other staff volunteered help to other DPH units.