U.S. Department of Homeland Security Emergency Preparedness and Response Federal Emergency Management Agency NDMS Section

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U.S. Department of Homeland SecurityEmergency
Preparedness and ResponseFederal Emergency
Management Agency NDMS Section Response
Division
Current NDMS Overview
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Briefing Overview

• National Disaster Medical System
• Alignment within Department of Homeland Security
• Background and Origins
• Structure and Components of NDMS
• ESF 8 in the National Response Plan
• NDMS Role in ESF 8
• NDMS Capabilities and Enhancements

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U.S. Department of Homeland Security
Executive Secretary
Commandant of Coast Guard
Legislative Affairs
Secretary ---------------------------------- Deput
y Secretary
Inspector General
Public Affairs
General Counsel
State and Local Coordination
Civil Rights and Civil Liberties
Citizenship Immigration Service Ombudsman
Director, Bureau of Citizenship Immigration
Services
Special Assistant to the Secretary (private
sector)
Director of the Secret Service
Privacy Officer
Small Disadvantaged Business
National Capital Region Coordination
Chief of Staff
International Affairs
Shared Services
Counter Narcotics
Under Secretary Science and Technology
Under Secretary Information Analysis and
Infrastructure Protection
Under Secretary Border Transportation Security
Under Secretary Emergency Preparedness and
Response
Under Secretary Management
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Department of Homeland Security Federal Emergency
Management Agency

• Major Organizational Elements
• Office of National Security Coordination
• Mitigation Division
• Preparedness Division
• Response Division
• Recovery Division

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Detailees
Response Division
Executive Secretary
Advisory Services
Executive Operational Services
Response Services Branch
Logistics Branch
Operations Branch
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Operations Branch
Military Support Team
NDMS Section Jack Beall Section Chief (S)
Urban Search Rescue Section
Incident Response Section
Field Operations Section
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NDMS Section
Jack Beall
Chief
NDMS Section
Medical Systems
System Development Unit
Medical Field Operations Unit
Operations Unit
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Medical Systems Operations Unit

• Mission
• Ensure that operationally-ready resources
  of NDMS can respond to emergency incidents,
  special events, and exercises in a timely and
  efficient manner, and that the operations of
  these resources are sustained for the duration of
  the incident.

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Medical Systems Development Unit

• Mission
• Provide for the ongoing development of the
  National Disaster medical System and its medical
  response, patient evacuation, and definitive care
  components, ensuring the capability of rapid,
  effective, and efficient response.

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Medical Field Operations Unit

• Mission
• Coordinate, and develop regional NDMS
  assets, including Regional Emergency
  Coordinators, for field medical response
  operations.
• Perform critical analysis, provide advice, and
  integrate medical emergency management,
  preparedness, hospital, and health care
  activities in emergency medical response to all
  hazards in DHS regions.

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NDMS Regional Emergency Coordinators
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Roles for NDMS Emergency Coordinators

• Develop regional Federal medical response
  assets
• Liaison between States and FEMA on medical
  response issues
• Review plans and consult with officials on ways
  to integrate NDMS
• into State and local response
• Principal representative for NDMS integration

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• NDMS is a public/private sector partnership
• Federal partners - DHS, HHS, DOD, VA

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Background on the Origins of NDMS
Presidential Initiative

• 1981 - Established Emergency
• Mobilization Preparedness Board
• (EMPB)/Principle Working Groups
• Directed to Develop National Policies and
• Programs for Domestic Disasters and
• National Security Emergencies

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Principle Working Group on Health (PWGH)

• PWGH Addressed Health
• and Medical Issues

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National Security Decision Directive 47 (NSDD-47)

• Approved by the President
• (July, 1982)
• Set forth Emergency Mobilization
• Preparedness Principles for
• National Security Emergencies
• Domestic Emergencies

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NSDD-47
Health
It is the policy of the United States to develop
systems and plans to ensure that sufficient
medical personnel, supplies, equipment, and
facilities will be available and deployed to meet
essential civilian and military health care needs
in an emergency.
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PWGH Developed Plans to Implement NSDD-47

• Identified Key Steps in Establishing a
• Nationwide Mutual Aid Network NDMS
• EMPB Approved Key Steps
• President Approved National Plan of
• Action (March, 1983)
• Established the National Disaster
• Medical System

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National Disaster Medical System
A public / private sector partnership DHS HHS
DOD VA

• A Nationwide Medical Response System to
• Supplement state and local medical resources
  during disasters or major emergencies
• Provide backup medical support to the military/
  VA medical care systems during an overseas
  conventional conflict

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NDMS Organizational Structure
Senior Policy Group (SPG)

• Members
• Director, Response Division, Emergency
• Preparedness and Response, DHS
• (Chair)
• Assistant Secretary for Public Health
• Emergency Preparedness, HHS
• Assistant Secretary of Defense,
• Health Affairs
• Undersecretary for Health, VA
• Responsibilities
• Set policy and Goals for National
• Medical Preparedness
• Oversee Directorate Staff

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Major Components of NDMS

• Medical Response
• Patient Evacuation
• Definitive Medical Care

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NDMS Medical Response
Lead Responsibility - DHS

• Assist in Assessment of Health/Medical Needs
• Provision of On-Scene Medical Services
• Victim Identification/Mortuary Services
• Veterinary Medical Services

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NDMS Medical Response
(DHS Lead)

• DMAT/Specialty Teams - More
• than 9,000 personnel
• Equipment and Supplies

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NDMS Medical Response Disaster Medical Assistance
Teams (DMATs)

• Volunteer Groups Affiliated with NDMS
• Approximately 35 Persons per Team (gt
  9,000 personnel)
• Variety of Health/Medical Skills
• Locally Sponsored
• Community Based
• Local/ State Asset

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NDMS Medical Response DMAT FUNCTIONS
At Disaster Site

• Triage
• Primary Medical Care
• Casualty Clearing/Staging

At Local NDMS Reception Area

• Patient Reception

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NDMS Medical Response SPECIALTY TEAMS

• Pediatric
• Burn
• Disaster Mortuary Operational Response Teams
  (DMORTs)
• Urban Search and Rescue Medical Team
• Mental Health
• Veterinary Medical Assistance Teams (VMATs)
• National Medical Response Teams (NMRTs)
• International Medical Surgical Response Teams
  (IMSuRTs)

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DMATs and Specialty Teams

• Members are Intermittent Federal Employees
• (Public Law 107-188)

• Importance of Federalization
• Licensure / Certification
• Liability
• Compensation

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Management Support Team (MST)

• Responds to Disaster Area

• Provides Management Support to Deployable Teams

• Uses Incident Command System (ICS) for C2
• Logistics
• Communications
• Operations
• Finance / Procurement
• Plans

• Interface with Local Disaster Management System

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NDMS RESPONSE TEAMS

• 25 Disaster Medical Assistance Teams - (Fully
  Operational/Operational)
• 30 Disaster Medical Assistance Teams -
  (Augmentation/Developmental)
• 4 National Medical Response Teams / WMD
• 4 Burn Teams
• 2 Pediatric Teams
• 1 Crush Medicine Team
• 3 International Medical / Surgical Teams
• 2 Mental Health Teams
• 4 Veterinary Medical Assistance Teams
• Disaster Mortuary Operational Response Teams (1
  WMD)
• National Pharmacist Response Teams
• 10 National Nurse Response Teams
• 1 Management Support Team(s)
• 
  Includes 2 under development

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NDMS Operational Disaster Medical Assistance Teams
AK
Seattle
ME
WA
MT
ND
VT
MN
Eugene
NH
Worcester
Boston
MA
WI
OR
Valhalla
SD
MI
CT
ID
Westland
Providence
WY
PA
NJ
Toledo
IA
San Francisco Bay Area
RI
Dayton
MD
NE
DE
OH
IN
WV
MO
IL
UT
NV
CO
CA
VA
St. Louis
KS
KY
Winston-Salem
San Bernadino
TN
NC
Tulsa
SC
Los Angeles Area
Albuquerque
OK
San Diego
NM
AR
AL
GA
Maui
AZ
MS
LA
Santa Ana
Jacksonville
HI
TX
USVI
Tampa/St. Petersburg
FL
Miami
USVI
GUAM
PR
Fully Operational Teams
Operational Teams
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CapabilitiesSingle Team 35 person - D 1Care
Provided
Augment Standard Med-Surgical Ward - 50
Patients Casualty Collection Center - 150
Patients (Similar to NDMS Reception
Center)

• Outpatient Facility
• - 250 pts. Per day
• Treatment with Limited Holding Capacity
• (Alternative Care Facility)
• - 160 patients per day

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CapabilitiesEntire NDMS System - Day 3 (1100
Personnel)Care Provided
Augment Standard Med-Surgical Wards - 1400
Patients Casualty Collection Centers - 4200
Patients

• Outpatient Facilities
• 5000 pts. Per day
• Treatment with Limited Holding Capacity
• (Alternative Care Facilities)
• - 224 In patients
• - 4500 Out patients per day

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NDMS Patient Evacuation
Lead Responsibility - DOD

• Provide Patient Movement from the Disaster Area
• Utilize All Types of Transportation
• Primarily Relies on Aeromedical

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Medical Evacuation Functions

• Patient Reporting
• Patient Regulating
• Patient Movement Request
• Patient Staging
• Patient Lift
• Embarkation
• Debarkation
• Coordination with Various System Elements

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NDMS Definitive Medical Care
Lead Responsibility - DOD/VA

• Federal Coordinating Centers (FCCs)
• Concentrated in Major Metropolitan Areas
• Air Access
• Available Hospital Support
• Patient Reception and Distribution Capabilities

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NDMS Definitive Medical Care

• Network of approximately 1,800
• non-Federal hospitals
• 62 FCCs, which coordinate in
• excess of 82 receiving areas

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NDMS Definitive Medical Care Federal Coordinating
Centers (FCCs)
WA
AK
MT
ND
ME
MN
VT
OR
NH
WI
MA
SD
NY
RI
CT
ID
WY
MI
CA
IA
PA
NV
NJ
NE
OH
MD
DE
IL
UT
CO
WV
IN
KS
VA
MO
KY
NC
AZ
OK
NM
TN
SC
TX
AR
AL
MS
LA
GA
FL
USVI
HI
GUAM
PR
Army FCC Navy FCC Air Force FCC VA FCC
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NDMS Federal Coordinating Centers
Responsibilities

• Coordinate NDMS Definitive Medical Care in
• Assigned Local Areas
• Solicit and Organize Community Support
• Services
• Enroll Non-Federal Local Hospitals in NDMS
• Coordinate Bed Availability
• Coordinate with Local / State Authorities on
• Preparing of Local NDMS Patient Reception Plans
• Plan and Conduct Annual NDMS Exercises
• NDMS Operations During Activation

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Role of Participating Hospital

• Voluntary Commit Hospital Support to NDMS

• Provide Bed Availability Information to Local
• NDMS Federal Coordinating Center

• Treat NDMS Patients

• Participate in NDMS Exercises

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Circumstances for Which NDMS May be Activated

• Presidential Declaration of Disaster or
  Emergency

• State Request for Major Medical Assistance
• NTSB Request to Support Transportation Accident
• Military Contingency - Overseas Conventional
• Armed Conflict Involving U.S. Forces

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NDMS Readiness Activities

• Maintenance of Plans
• Training
• Exercises
• Special Events
• Annual Conferences

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Partial Listing of Endorsement for NDMS

• American Burn Association
• American Hospital Association
• American Medical Association
• American Nurses Association
• American College of Emergency Physicians
• American College of Surgeons Committee on
  Trauma
• American College of Healthcare Executives
• American Red Cross
• Emergency Nurses Association
• National Association of State EMS Directors
• National Association of Emergency Medical
  Technicians
• National Emergency Management Agency
• National Fire Protection Association
• National Funeral Directors Association
• Society for Academic Emergency Medicine

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NDMS Activations
Somerset County Terrorist Hijacking
IMF Meeting
Papal Visit
New York Ice Storm
Indiana Storms
Transportation Accidents TWA 800 Alaska Air
Egypt Air 990 Quincy, IL Monroe, MI Guam
Bourbonaise, IL train wreck Wilkes-Barre, PA
(Executive Air) American Airlines Flight 587
New York City World Trade Center Terrorist Attack
Oklahoma City Bombing Tornados
Grand Forks Floods
Winter Ice Storms
Kosovar/ Ft Dix Refugees
2002 Winter Olympic Games
2001 Presidential Inaugural
NATO 50th
Pentagon Terrorist Attack
Walker County, Georgia
1996 Olympic Games
Northridge Earthquake
Wildfires
Hantavirus
Tropical Storm Allison
Floods Midwest, Southwest, Houston, Southeast
Georgia, California, Northwest, Oregon,
Minnesota, North Dakota, Kentucky, Idaho, Ohio,
Nevada, Hawaii, Texas, West Virginia
Hurricanes Floyd, Dennis, Lenny, Eduardo,
Bertha, Hortense, Marilyn, Opal, Andrew, Fran,
Georges, Brett, Hugo, Emily, Isabel
Hurricane Iniki
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2004 NDMS Hurricane ResponsesDemonstrated
Capability
(Augmentation personnel 316 - Total personnel
800)

• Storms Alerted Teams Deployed Teams Total
  Patients
• Charley 3 12 3,782
• Frances 10 8 1,461
• Ivan 11 13 3,446
• Jeanne 5 2 961
• Totals 29 35 9,740

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National Response Plan
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National Response PlanEmergency Support
Functions (ESFs)
1. Transportation Department of
Transportation 2. Communications Dept. of
Homeland Security/NCS 3. Public Works and
Engineering Army Corps of Engineers FEMA 4.
Firefighting Department of Agriculture Forest
Service 5. Emergency Management FEMA 6. Mass
Care, Housing and Human Services FEMA and
American Red Cross
7. Resource Support General Services
Administration 8. Public Health and Medical
Services Department of Health and Human
Services 9. Urban Search and Rescue Federal
Emergency Management Agency 10. Oil and Hazardous
Materials Environmental Protection Agency DHS,
U.S. Coast Guard 11. Agriculture and Natural
Resources Department of Agriculture Department of
Interior 12. Energy Department of Energy
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National Response PlanEmergency Support
Functions (ESFs) (Continued
13. Public Safety Security Departments of
Homeland Security Justice 14. Long-term
Community Recovery and Mitigation Departments of
Homeland Security/FEMA 15. External Affairs -
Department of Homeland Security/FEMA
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Support Annexes

• Financial Management
• International Coordination
• Logistics Management
• Private Sector Coordination
• Public Affairs
• Science and Technology
• Tribal Relations
• Volunteer and Donations Management
• Worker Safety and Health

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Incident Annexes

• Biological Incident
• Catastrophic Incident
• Cyber Incident
• Food and Agriculture Incident
• Nuclear/Radiological Incident
• Oil and Hazardous Materials Incident
• Terrorism Incident Law Enforcement and
  Investigation

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ESF 8 Role in theNational Response Plan
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ESF 8 - Health Medical Services

• Lead Federal Agency Department of Health and
• Human Services
• .
• Supporting Departments and Agencies
• Department of Homeland Security
• Department of Veterans Affairs
• Department of Defense
• Department of Transportation
• Department of Agriculture
• Department of Energy
• Department of Justice
• Environmental Protection Agency
• General Services Administration
• American Red Cross
• National Communications System
• Office of U.S. Foreign Disaster Assistance
• U.S. Postal Service

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Roles of Emergency Support Function 8

• 1. Assessment of Public Health and Medical Needs
• 2. Health Surveillance
• 3. Medical Care Personnel
• 4. Health/Medical Equipment and Supplies
• 5. Patient Evacuation
• 6. In-Hospital/Patient Care
• Safety and Security of Human Drugs, Biologics,
  Medical Devices, and Veterinary Drugs
• Blood and Blood Products
• Food Safety and Security
• Agriculture Safety and Security
• 11. Worker Health/Safety
• All-Hazard Public Health and Medical
  Consultation, Technical Assistance,
• and Support
• 13. Behavioral Health Care
• 14. Public Health and Medical Information
• 15. Vector Control
• 16. Potable Water/Wastewater Solid Waste
  Disposal
• 17. Victim Identification/Mortuary Services
• 18. Protection of Animal Health
  NDMS supported

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Disaster Response
Joint Preliminary Damage and Needs Assessment
Mayor/County Executive
Emergency/Disaster
Local First Responders
Governor
DHS/FEMA Regional Director
Informs
Requests Aid from
Alert
Reports To
Governor Declares State Emergency/ Disaster
DHS Secretary/ FEMA Director
Activates Local EOC
Activates State EOC
Work with Volunteer Organizations
IIMG, NRCC, OFAs
Gov. Requests Emergency/ Major Disaster
Declaration
FEMA Regional Operations
Contacts
Disaster Field Operations
President of the United States
Local State Federal
Emergency Support Functions
Disaster Declaration
Provides
PFO, FCO, SFLEO
Emergency Response Team
Sets Up
Supports
Appoints
Joint Field Office
State Coordinating Officer
Joins
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Disaster Response Operations
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FEMA National Emergency Operations Center
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FEMA Operations Center (FOC)
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NDMS Operations Support Center (OSC)
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Regional Operations Center
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Disaster Field Office
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FEMA/NDMS Surge Capacity Enhancements

• Procurement of organic team transportation
  assets
• Total of 93 vehicles - 6.44 million
• Three (3) trucks per each fully operational and
  
• operational team
• Standardization of medical response team caches
• Procurement of additional medical and
  pharmaceutical
• caches
• Fourteen (14) full caches - 6.1 million
• Seventeen (17) partial caches - 1.6 million

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FEMA/NDMS Surge Capacity Enhancements (Contd)

• FEMAs 2005 budget includes 20 million for
• Medical surge capability planning
• Developing two (2) prototype medical care surge
  
• facilities (fixed mobile)
• Exercise and evaluation.

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National Disaster Medical System Room 713 Federal
Center Plaza 500 C Street, S.W. Washington, D.C.
20472
[phone] 1-800-USA-NDMS FAX
1-800-USA-KWIK http//ndms.fema.gov
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