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State of California—Health and Human Services Agency
California Department of Public Health

AFL 20-46.3
September 7, 2021

All Facilities

Requests for Urgent Staffing Resources for COVID-19
(This AFL supersedes AFL 20-46.2)


All Facilities Letter (AFL) Summary

  • This AFL clarifies the process for requesting staffing resources for healthcare facilities and alternate care sites during the COVID-19 pandemic.
  • This AFL provides a quick reference guide for multi-jurisdictional responses to emergencies and disasters in California.
  • This AFL provides clarification regarding the costs facilities will incur when accessing staffing resources. Facilities requesting staffing resources through the state staffing contract will have to pay the full cost. 

NOTE: This AFL has been rescinded and is no longer in effect.​

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.  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 their 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), or through other staffing contracts. If state resources are available, 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 for all costs associated with CalMAT staff deployed to the facility. When staff are deployed the deployment team will confirm the contracted staffing rate with the facility.
  4. Facility operators will be required to reimburse the state for all costs associated with contracted medical staff. When staff are deployed the deployment team will confirm the contracted staffing rate with the facility.

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 Cassie Dunham

Cassie Dunham
Acting Deputy Director


Staffing Process Flowchart (PDF) or ADA version (PDF)
SEMS, MHOAC & RDMHC/S Program Quick Reference (PDF)

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