National Disaster Medical System

1
National Disaster Medical System Regional
Planning for NDMS Patient Movement and Medical
Care
2
HHS ASPHEP / OPHEP

• Created by legislation (Bioterrorism Act) in Fall
  2002
• Directs and coordinates HHSs efforts to prevent,
  prepare for, respond to, and recover from, the
  public health and medical consequences of a
  disaster or emergency.
• Coordinates implementation of the National
  Response Plan (NRP) and Emergency Support
  Function (ESF) 8.
• Coordinates Federal-level response planning for
  public health and medical consequences of
  terrorism events or natural events and disasters.

3
HHS in NDMS

• HHS is the lead for Emergency Support Function
  8. Specifically, HHS will provide
• Technical assistance and coordination through the
  Secretarys Operations Center (SOC)
• Identify health and medical personnel (e.g. USPHS
  officers) available to augment DMAT staffing and
  to respond to requests for assistance from
  states, and coordinate their deployment
• Track bed availability in non-NDMS hospitals.

4
HHS Secretarys Operation Center

• 24 hour state-of-the- art information and
  operations center with specialized technologies
• Provides a single focal point for information
  sharing, command and control, communications,
  technical assistance and data collection
  supporting the federal health and medical
  response to large scale emergencies
• Facilitates coordination of HHS
• components and resources
• under emergency and
• non-emergency conditions.

5
HHS Regional Emergency Coordinatorsin place as
of 4/2005

• HHS Regions same as FEMA Regions
• RECs responsible for planning and coordination
  of federal medical response to large-scale
  emergencies in Regions

6
Secretarys Emergency Response Team (SERT)

• Activated for incidents of national significance
  requiring federal health medical resources, or
  implementation of ESF 8.
• Provides situational awareness to HHS SOC, ASPHEP
• Typically led by a HHS Regional Emergency
  Coordinator (REC) who will work closely with
  other Federal assets
• Integrates with the local incident managers and
  facilitates support as requested by State and
  Tribal authorities.
• Provide coordinated Federal management of HHS and
  ESF 8 assets during a major public health and
  medical emergency.

7
DHS in NDMS

• Major Components of DHS/NDMS
• Medical Response
• Patient Evacuation
• Definitive Medical Care

8
DHS in NDMS (contd)

• Considerations
• Local medical assets
• Local infrastructure
• Local transportation assets
• Airports/Airstrips
• Mass Transit
• Local Trucking Resources

9
DHS in NDMS (contd)

• Assumptions
• Local health medical assets are
  inadequate
• Patients will originate from multiple
  locations
• Patients MAY be decontaminated
• DOD resources are not committed

10
DHS in NDMS (contd)

• What can NDMS bring to bear?
• DMAT/Specialty Teams More than 8,000
• personnel
• Equipment and Supplies

11
DHS in NDMS (contd)
NDMS Operational Disaster Medical Assistance Teams

AK
Seattle
WA
ME
MT
ND
VT
MI
OR
MN
NH
MA
Worcester
WI
Boston
Westland
SD
ID
Valhalla
RI
WY
Providence
Eugene
CA
PA
Toledo
IA
CT
RI
NV
UT
NE
NJ
San Francisco Bay Area
Dayton
Lyons
IL
IN
OH
DE
CO
MO
WV
MD
KS
VA
St. Louis
KY
San Bernardino
Los Angeles Area
NC
NM
OK
TN
Winston-Salem
AZ
AR
Tulsa
GA
SC
MS
AL
Albuquerque
HI
Maui
San Diego
Jacksonville
Santa Ana
TX
LA
Mobile
USVI
Pensacola
FL
Tampa/St. Petersburg
Guam
Miami
Ft. Myers
PR
Fully Operational Teams
Operational Teams
12
DHS in NDMS (contd)
NDMS Response Teams 25 Disaster Medical
Assistance Teams Fully Operational/Operational
30 Disaster Medical Assistance Teams
Augmentation/Developmental 4 National
Medical Response Teams/WMD 5 Burn Teams
2 Pediatric Teams 1 Crush Medicine Team 3
International Medical/Surgical Teams (includes 2
under development) 3 Mental Health Teams
3 Veterinary Medical Assistance Teams 11
Disaster Mortuary Operational Response Teams (1
WMD) 1 Joint Management Team 20
Nurse/Pharmacist National Response Teams (10
each)
13
DHS in NDMS (contd)

• Medical Care
• NDMS Teams and personnel available to fill
• gaps and augment local resources
• Regional Team personnel engaged locally
• Requirements for Non-Regional Team engagement
• Movement of caches to region

14
DHS in NDMS (contd)

• NDMS Medical Response
• At Disaster Site or PRA
• Triage
• Austere Medical Care
• Casualty Clearing/Staging
• At Local NDMS Reception Area
• Patient Reception

15
DHS in NDMS (contd)

• Patient Movement
• Coordinated inter-agency process
• Identification of a need to move a patient
• Admission of a patient at a destination
• medical facility

16
DHS in NDMS (contd)

• Medical Movement Functions
• Patient Stabilization Preparation
• Patient Movement Request
• Patient Reporting Regulating
• Patient Staging
• Patient Movement Management
• Embarkation
• Debarkation
• Coordination with Various System Elements

17
DHS in NDMS (contd)

• NDMS Roles
• Patient Stabilization
• Staffing of Regional EVAC Points (REP)
• Staffing of Patient Reception Areas (PRA)
• Patient Preparation
• Patient Regulation

18
DHS in NDMS (contd)

• Additional Transport Providers
• ESF-8 Partners
• Department of Transportation
• General Services Administration
• U.S. Postal Service
• American Red Cross
• Private Contractors

19
DHS in NDMS (contd)

• Possible NDMS Actions
• NDMS-Contracted Transport
• Air and/or Ground
• NDMS Training patient regulation
• Coordinated with Global Patient Movement
• Requirements Center (GPMRC)
• Increased interface/planning between NDMS
• Regional Emergency Coordinators and partners
• at regional level

20
This Briefing is Classified UNCLASSIFIED
Department of Defense Regional Planning for NDMS
Patient Movement and Medical Care DoD
Perspective/Emerging Concepts
Lt Col Jim Baxter NORAD/USNORTHCOM Medical
Coordinator
UNCLASSIFIED
21
Overview
UNCLASSIFIED

• Emerging Concepts-Regional Approach
• NDMS National Security Special Event Plan
  (Example)
• Joint Task Forces-Civil Support/Other
• Patient Movement/Medical Support Challenges
• Questions

UNCLASSIFIED
22
Emerging Concepts/Potential Missions
UNCLASSIFIED
for a Land Forces Component Command

• Medical C2 on a regional basis
• Versus a deployable function
• Medical Response Forces
• Foundation created by installation assets
• Augmented by deployable forces in region
• Medical Sustaining Forces
• Larger, more robust than Medical Response Forces
• Deployable Hospitals
• Casualty Receiving Ships
• Designated consequence management response forces
• NDMS assets for patient movement and
  hospitalization
• Augment Medical Response Forces in affected region

UNCLASSIFIED
23
UNCLASSIFIED
Emerging Medical Concepts

• A regionally based theater concept for HSS
  responses
• Flexible enough to respond to all hazards, to
  include natural disasters and terrorist
  threats/events
• Full spectrum operations prevent-deter-mitigate-
  respond
• Fosters total force integration
  Active-Reserve-Guard
• Generates an evolving concept for medical C2 in
  this theater (i.e. regional medical task forces)
• Response options build incrementally thereby
  creating Force Package Options (FPO)
• Local Installation
• State Regional
  Operational
• National Strategic-Theater

UNCLASSIFIED
24
UNCLASSIFIED
NRP Influence on NC Planning (U)
UNCLASSIFIED
25
Joint Strategic Capabilities Plan (JSCP)
UNCLASSIFIED

• (U) Joint Strategic Capabilities Plan
• (U) CJCSI 3110.01 signed 22 Feb 2005
• (U) Logistics Supplement to JSCP
• (U) CJCSI 3110.03C
• (U) March 2005 - Final Draft for GO/FO level
  review

UNCLASSIFIED
26
Logistics Supplement to JSCP
UNCLASSIFIED

• (U) Provides logistics planning guidance to the
  combatant commanders, Chiefs of the Services, and
  heads of DoD agencies in support of the tasks
  assigned in the JSCP
• (U) Enclosures
• (U) AResponsibilities
• (U) B--Logistics Planning and Tasks
• (U) C--Materiel Planning Guidance
• (U) D--Support Force Planning Guidance
• (U) E--Health Service Support Planning Guidance
• (U) F--Operational Engineering Support Planning
  Guidance
• (U) G--Contract Administration Services Planning
  Guidance
• (U) H--Special Operations Support Planning
  Guidance
• (U) I--Logistics Sustainability Analysis

UNCLASSIFIED
27
Health Service Support Planning Guidance
UNCLASSIFIED

• (U) Appendix C to Enclosure E
• (U) Purpose. This appendix provides joint HSS
  planning guidance in support of JSCP-assigned
  tasks. It specifically highlights planning
  considerations for HLD and CS operations.
• (U) Objectives. Homeland Defense (HLD) and
  Civil Support (CS) operations require a shift
  from current planning methods to support MCO.
• (U) Enclosure E was significantly modified to
  delineate Health Service Support (HSS) by Major
  Combat Operations, Stability Operations and
  Homeland Defense.

UNCLASSIFIED
28
Appendix C to Enclosure E (1 of 3)
UNCLASSIFIED

• (U) Medical Response Forces
• (U) The development of Medical Response Forces at
  the installation level creates the foundation all
  joint operations build upon. JFCs will augment
  Medical Response Forces in affected areas with
  Medical Response Forces in unaffected areas. If
  augmentation of installation assets is not enough
  to manage the HLD or CS situation, then JFCs
  employ Medical Sustaining Forces.
• (U) Services will develop UTCs at the
  installation level to counter current asymmetric
  threats. At a minimum, Services will develop
  UTCs for disease investigation, vaccination,
  preventive medicine, veterinary, medical
  logistics distribution, mental health, patient
  decontamination, and medical treatment at all
  existing Medical Treatment Facilities to support
  the installation commander, the joint force
  commander, and, when directed, the lead federal
  agency.

UNCLASSIFIED
29
Appendix C to Enclosure E (2 of 3)
UNCLASSIFIED

• (U) Medical Sustaining Forces.
• (U) USNORTHCOM will develop medical sustaining
  force modules that will enhance capabilities
  found in the Initial Entry Force (IEF) and
  Medical Response Forces found on installations.
  Resources will be drawn from multi-component
  units and placed on a rotational schedule to
  respond to catastrophic events involving mass
  casualties and fatalities. Force modules will
  include deployable hospitals, available casualty
  receiving ships, a hospital ship, and mortuary
  affairs teams, at a minimum.

UNCLASSIFIED
30
Appendix C to Enclosure E (3 of 3)
UNCLASSIFIED

• (U) Medical Response Forces
• (U) HSS concepts of operation require the
  integration of active, reserve, and guard assets
  and the employment of fixed and deployable assets
  from their home base in order to create habitual
  joint response relationships within DoD and with
  local-state-national organizations. HSS concepts
  must include the following components
• (U) Regionalization. HSS concepts for response
  to HLD or CS missions will focus on the
  augmentation and expansion of steady-state and
  Medical Response Forces found on installations,
  vice the projection of forces. Command and
  control of fixed and deployed HSS assets will
  focus on the designation of regional medical
  commands to support JFCs. These concepts
  minimize the burden on limited transportation
  assets, reduce the deployed footprint, and
  advocate steady-state relationships between HSS
  organizations and community counterparts.

UNCLASSIFIED
31
UNCLASSIFIED
Example NDMS/CONOPS Potential Strategic Patient
Movement National Special Security Event
UNCLASSIFIED
32
Proposed activation of FCCs and AE HubsISO NSSE
Presidential Inauguration (Planning Only)
UNCLASSIFIED
VA FCC Philadelphia PA Inbound Hub McGuire AFB
VA FCC Bedford MA Inbound Hub Westover ARB
Navy FCC Newport RI Inbound Hub Green
International
I
II
AF FCC Dayton-Wright Patterson OH Inbound Hub
Wright-Patterson AFB
VA FCC Castle Point NY Inbound Hub Stewart
International
VA FCCs NY, and Brooklyn NY Inbound Hub Newark
International
VA FCC Pittsburgh PA Inbound Hub Pittsburgh
International
III
VA FCC Lyons NJ Inbound Hub Newark International
AF FCC WilmingtonDover DE Inbound Hub Dover AFB
Presidential Inauguration/NCR Outbound Hubs
Andrews AFB, Dulles, BWI
9
VA FCC Richmond Inbound Hub Richmond
International
UNCLASSIFIED
33
Joint Task Forces - Med/DCO/JRMPs
UNCLASSIFIED

• Joint Task Force-Civil Support (JTF-CS) is an
  active unit
• CBRNE Consequence Management Response Force
  (CCMRF)
• Enabling Force, with various initial response
  capabilities
• Other Joint Task Forces for consequence
  management can stand up as required
• Example National Special Security Events in
  National Capital Region (NCR) result in stand-up
  of JTF-NCR-Med
• Joint Regional Medical Planners play increasingly
  vital role as liaisons between Disaster Control
  Officers, JTF-Meds, and USNC

UNCLASSIFIED
34
Patient Movement/Medical Support Challenges
UNCLASSIFIED

• Collaborative planning, and ongoing communication
  is critical
• Integration with local response (FCCs are key)
• Level of support is requirements, and
  scenario, driven
• Competing demands for limited DoD
  resourcesmanpower, supplies/equipment, transport
  (no dedicated medical lift)
• Potential transport support missions include
• Manpower/emergency response supplies, to bolster
  on scene support
• Deployable hospitals/equipment to expand
  capabilities on scene
• Mass casualty moves out of disaster area to
  Federal Coordinating Centers/NDMS beds

UNCLASSIFIED
35
Patient Movement/Medical Support Challenges
UNCLASSIFIED

• Strategic Patient Movement/NDMS activation
• Must consider all transport resources, not just
  DoD air assets
• Patients decontaminated? Outbound hubs in safe
  zone?
• Staging area locations transport to staging
  areas (who?)
• Coordination between local, regional, and DoD
  regulators/clinicians
• DoD deployable regulating support limited
  (FCCs/local VA/DoD?)
• Clinical validation of patients for air movement
  (coordination)
• Numbers and types of patients special
  equipment/care needs
• Tracking, and throughput/reception issues

UNCLASSIFIED
36
Questions
UNCLASSIFIED
https//www.noradnorthcom.mil/SG/
UNCLASSIFIED
37
VA in Regional Response
At the present time the Veterans Health
Administration (VHA) is organized into 21
Veterans Service Integrated Networks (VISNs)
which include all 50 States, Puerto Rico, the
Virgin Islands, and Guam.

38
Veterans Health Administration 21 Veterans
Integrated Service Networks
39
VA in Regional Response

• VA Office of Operations and Readiness
• VHA/EMSHG Operations
• VISN
• VA Medical Facilities

40
VA in Regional Response

• VA Office of Operations and Readiness
• VHA/EMSHG Operations
• VISN Federal Region
• VA Medical Facilities

41
VA in Regional Response
(Possible) Associated VISNs Regions VISN
Region VISN Region 1 1
18 6 3 2 15 7 4
3 19 8 7
4 21 9
12 5 20 10

42
VA in Regional Response
Bottom Line VA has the flexibility to plan and
respond locally, regionally, or nationally, as
may be required, to effect maximum resource
utilization for and in response to any domestic
disaster or emergency.

43
Questions?
44
UNCLASSIFIED
BACK-UP SLIDES
UNCLASSIFIED
45
UNCLASSIFIED
Available NDMS Beds and Throughput for Selected
FCCs
Organizations in FEMA Region I Available Beds Throughput
FCC Bedford (VA) 845 200
FCC Newport (Navy) 123 100
SUB-TOTAL 968 300
Organizations in FEMA Region II Available Beds Throughput
FCC Castle Point (VA) 741 250
FCCs New York, and Brooklyn (VA) 331 110
FCC Lyons (VA) 746 200
SUB-TOTAL 1818 560
Available bed and throughput figures represent
data reported as part of the national bed
reporting exercise that occurred on 19 January
2005. Available bed figures should be used as
planning factors and not actual beds for medical
regulating during an event. USNORTHCOM and
USTRANSCOM will work with DoD Components and NDMS
partners to obtain actual bed data in case of an
event requiring medical regulation and patient
movement. FCC SITES LISTED ABOVE ARE IDENTIFIED
FOR PLANNING PURPOSES ONLYTHEY ARE NOT BEING
ACTIVATED HOWEVER, THEY WERE COORDINATED WITH
NDMS PARTNERS DURING SEVERAL PLANNING SESSIONS.
10
UNCLASSIFIED
46
UNCLASSIFIED
Available NDMS Beds and Throughput for Selected
FCCs
Organizations in FEMA Region III Available Beds Throughput
FCC Pittsburgh (VA) 1634 300
FCC Philadelphia (VA) 1019 350
FCC Wilmington-Dover (AF) 82 25
FCC Richmond (VA) 265 150
SUB-TOTAL 3000 825
Organizations in FEMA Region V Available Beds Throughput
FCC Dayton-Wright-Patterson (AF) 412 25
SUB-TOTAL 412 25
TOTAL ALL REGIONS 6198 1710
Available bed and throughput figures represent
data reported as part of the national bed
reporting exercise that occurred on 19 January
2005. Available bed figures should be used as
planning factors and not actual beds for medical
regulating during an event. USNORTHCOM and
USTRANSCOM will work with DoD Components and NDMS
partners to obtain actual bed data in case of an
event requiring medical regulation and patient
movement. FCC SITES LISTED ABOVE ARE IDENTIFIED
FOR PLANNING PURPOSES ONLYTHEY ARE NOT BEING
ACTIVATED HOWEVER, THEY WERE COORDINATED WITH
NDMS PARTNERS DURING SEVERAL PLANNING SESSIONS.
11
UNCLASSIFIED
47
UNCLASSIFIED
JTF-CS Surgeon General
Officer/Enlisted/Civilian C3/1/2 (6) P7/2/0 (9)
UNCLASSIFIED
48
Potential JTF-CS Initial Response Assets
UNCLASSIFIED
Medical C2 Bde level Medical C2 Bn level Area
Support Medical Company X 3 PM Detachment
(Sani) SMART-HS SMART-BURN SMART-EMR SMART-SM
SMART-MC3T SMART-NBC SMART-PC Theater Epi
Team Air Ambulance Co Med Log Distribution
Co EMEDS 25 AFRAT CBIRF
UNCLASSIFIED