Requests for Urgent Staffing Resources for COVID-19

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AFL 20-46.2 From the California Department of Public Health

August 31, 2020

TO: All Facilities

SUBJECT: Requests for Urgent Staffing Resources for COVID-19
(This AFL supersedes AFL 20-46.1)

All Facilities Letter (AFL) Summary

  • This AFL clarifies the process for requesting staffing resources for healthcare facilities and alternate care sites during COVID-19.
  • This AFL has been updated for clarity and to include a quick reference resource on multi-jurisdictional responses to emergencies and disasters in California.
  • This revision provides clarification regarding the costs facilities may incur when accessing staffing resources.

Urgent Staffing Requests for Healthcare Facilities

Healthcare facilities that experience a sudden spike in staff absenteeism or attrition, creating an urgent staffing shortage, must report these issues as an unusual occurrence to the local California Department of Public Health (CDPH) Licensing and Certification District Office. Unusual occurrence reporting requirements state, facilities must report any occurrence that jeopardizes the health and safety of patients as soon as practical within 24 hours. Although Executive Order N-39-20  (PDF) temporarily suspends enforcement of minimum staffing requirements, this waiver is under the condition that facilities notify CDPH of any staffing shortages that jeopardize operations or patient care. Upon notification, CDPH, in collaboration with the local public health department, will assess the situation and determine whether the facility can continue to operate safely.

At the same time, the county public health department should contact the Medical Health Operational Area Coordinator (MHOAC) to initiate the process of locating resources within the local area. The MHOAC is responsible for managing disaster medical resources, including personnel, equipment, and supplies. The MHOAC will seek available staffing resources from hospitals and healthcare facilities, healthcare coalitions, medical reserve corps, local staffing agencies, etc. CDPH can assist in identifying other resources. The MHOAC will coordinate all efforts to locate resources within the local operational area (OA). If a facility requires ongoing staffing support and a local resource’s ability to continue supplying supplemental staff changes during that period, the MHOAC should work to locate and coordinate supplemental staff through alternate local resources.

If the MHOAC cannot fulfill the staffing needs using local sources, they may request staffing resources from the region via the Regional Disaster Medical Health Coordinator/Specialist (RDMHC/S). If regional resources are not available, inadequate or delayed, the RDMHS will forward the request to the Medical Health Coordination Center (MHCC). For all urgent staffing requests, the RDMHS will need to include the facility name, the number and type of staff needed, and the expected duration of need.

The MHCC will determine if state resources are available through the California Emergency Medical Services Authority’s (EMSA) California Medical Assistance Teams (CAL-MAT), the California Health Corps, or through other staffing contracts. If state resources are available including the Health Corps, they will be deployed to meet short-term staffing needs.

Any deployment of state staff resources is subject to the following requirements:

  1. Deployments of state staff resources are intended to be for limited durations.
  2. Facility operators are responsible for providing all PPE and other necessary equipment.
  3. Facility operators will be required to reimburse the state after 72 hours for all costs associated with CalMAT staff deployed to the facility. Please see the HealthCorp and CalMAT Staffing Resource table.
  4. Facility operators will be required to reimburse the state for all costs associated with Health Corps staff deployed to the facility. Please see the HealthCorp and CalMAT Staffing Resource table.
  5. Facility operators using contract staffing must enter into a memorandum of understanding with the state. Please see the Staffing Contract Rates

If state resources are not available, the MHCC will initiate the process to triage and transport patients throughout the regional healthcare system, in coordination with EMSA, RDMHS, and the MHOAC.

If you have any questions about this AFL, please contact the CDPH Duty Officer at


Original signed by Heidi W. Steinecker 

Heidi W. Steinecker
Deputy Director