The experiences of racially/ethnically diverse residents and communities in the US in the wake of the wildfires in California, Hurricane Katrina, and other disasters have shown the serious if not fatal lack of their effective engagement in response to these events, confusion around access to and provision of emergency care, and failure to adhere to recommended services guidance and requirements. As one of the most diverse states in the country, California's experience with earthquakes and wildfires has heightened related concerns around the capacity of healthcare providers to effectively meet the needs of diverse communities. The objectives of this study were to: (1) identify barriers and challenges to meeting emergency health needs of these communities during disasters; (2) identify programs and policy gaps in the current environment; and (3) develop recommendations as well as guidance for improvement.

Three methods were used in conducting the study. The project team reviewed and synthesized literature from California and other sources; reviewed 148 Websites; and conducted key informant interviews with 17 officials and community representatives identified through state sources/environmental review during summer/fall 2008.

Research identified four major barriers, challenges, and gaps affecting the provision of effective health care during emergencies: (1) significant lack of community engagement and trust among diverse residents, especially among immigrants who feared deportation actions; (2) cultural misunderstanding that led to misinformation and a related lack of training and education resources for emergency personnel; (3) lack of interpreter/translation services; and (4) insufficient coordination at local, regional, and state levels.

Improvement will require four major actions: (1) effective collaboration between these communities; (2) emergency care providers and other key sectors; (3) resources to increase availability and access to interpreters; and (4) coordination of information and resources to minimize gaps and duplication, and greater flexibility in allocation of funds to meet local emergency medicine priorities.