Medical Disaster Emergency Preparedness Programs

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VA-DoD Primary Receiving Center (PRC) NDMS
Federal Coordinating Center (FCC) Training Course
Military Contingency
National Disaster
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Course Overview
Purpose To ensure efficient Patient Reception
Program Management and Operations in support of
the VA-DoD Contingency Plan, or, a National
Disaster where Federal Assistance is requested
under the National Disaster Medical System
(NDMS) Target Audience

• DoD and VA PRC Coordinators (e.g., EPCs)
• PRC Reception Team Leaders
• PRC Directors and Commanders

• DoD and VA FCC Coordinators
• FCC Reception Team Leaders
• FCC Directors and Commanders

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Course Prerequisites

• TRANSCOM Medical Regulating and Command and
  Control Evacuation System (TRAC2ES)
• FEMA IS-100 Intro to Incident Command System
  (ICS)
• FEMA IS-120 Intro to Exercises

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Course Outline - Academics

• VA-DoD Contingency System Overview
• National Disaster Medical System Overview
• Patient Reception Program Management
• Patient Regulating
• TRAC2ES
• Air Operations Orientation
• Tours
• - 3 75th Aerospace Medicine Squadrons Air
  Staging Facility
• - AMC Tanker / Airlift Control Center
• Scott AFB Flightline

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Course Outline - Academics

• Patient Reception Team Operations
• Joint Patient Assessment and Tracking System
• Patient Movement Items
• Logistics
• Military Patient Management Issues
• NDMS Patient Management Issues
• PRC/FCC Plans Development
• Facilitated Discussions
• Services and VA Forums

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VA-DoD Contingency System Overview
At the end of this session participants should be
able to describe the VA-DoD Contingency Plan and
the functions of PRCs, including the roles and
responsibilities of PRC directors and coordinators
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National Disaster Medical System Overview
Participants should also be able to describe the
NDMS including its components, activation, the
function of FCCs, and the roles and
responsibilities of FCC directors and coordinators
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VA-DoD Contingency System

• History
• Applicable statutes and references
• Military contingency scenarios
• PRCs and SSCs roles and responsibilities
• Command and Control
• PRC activation and deactivation
• Funding of PRC operations
• Communications systems orientation

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VA-DoD Contingency System
History

• Cold War
• 1982 Congressional Hearings
• 65 VA Medical Centers dubbed PRCs

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VA-DoD Contingency System
Applicable Statutes and References

• Public Law 97-174 Defense Health Resource
  Sharing and Emergency Operations Act (1982)
• MOA between VA and DoD regarding VA furnishing
  health care services to members of the armed
  forces during a war or national emergency (2006)

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VA-DoD Contingency System
Applicable Statutes and References (contd)

• DoDI 6000.11 Patient Movement (1998)
• DoDD 3020.36 Assignment of National Security
  Emergency Preparedness (NSEP), Responsibilities
  to DoD Components (1993)
• VHA Handbook 0320.04 VA-DoD Contingency Plan
  (2007)

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VA-DoD Joint Strategic Plan GOAL 6 Joint
Medical Contingency /Readiness Capabilities
VA and DoD will collaborate to ensure that plans
and readiness capabilities adequately support
DoD combatant command contingency
requirements. This collaboration will include the
following planning, training, and exercise
activities Joint planning to ensure VA support
of DoD contingency requirements Collaborative
training and exercise activities to enhance
joint contingency plans and, Improvement of
joint readiness capabilities.
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Service Level Guidance
The HEC Contingency Planning Working Group will
develop Departmental plans to support the revised
VA/DoD MOA and Contingency Plan and ensure that
all VA and DoD Primary Receiving Centers (PRCs)
complete local plans to support the VA/DoD MOA
and Contingency Plan by April 1, 2009. Publish
DoD Instruction, Department of Defense and
Department of Veterans Affairs Responsibilities
regarding VA Furnishing Health Care Services to
members of the Armed Forces During a War of
National Emergency and Joint Contingency
Plan/Readiness Programs. Estimated Completion
Date October 31, 2008. Military Departments and
VHA provide Service level program implementation
guidance to support the VA/DoD Contingency Plan
by February 28, 2009.
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Objective 6.2
OBJECTIVE 6.2 Collaborate on training and
exercise activities that support the VA/DoD
Contingency Plan. STRATEGY 6.2(b) The HEC
Contingency Planning Working Group/Exercise
sub-group will review the Chairman of the Joint
Chiefs of Staff Exercise Program to ensure that
joint tasks (e.g., patient movement within the
continental United States) are included in at
least one National Level Exercise
annually. STRATEGY 6.2(c) The HEC Contingency
Planning Working Group will facilitate one
tactical joint patient movement/reception or
disaster response exercise at each VA and DoD PRC
every three years beginning in October 2009.
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Military Contingency Scenarios Inter-theater
Movements
VA-DoD Contingency System
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Military Contingency Scenarios Inter-Regional
Movements
VA-DoD Contingency System
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VA-DoD Contingency System

• Primary Receiving Center (PRC)
• Military Treatment Facility (MTF) or VA Medical
  Center (VAMC) designated for coordinating and/or
  providing treatment to sick and wounded military
  personnel returning from armed conflict or
  national emergency
• PRCs may be but not necessarily designated as
  Federal Coordinating Centers of the National
  Disaster Medical System. (Review
  Responsibilities in the Program Implementation
  Plan for VA-DoD Contingency Plan)

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VA-DoD Contingency System

• 84 Primary Receiving Center (PRC)
• 5 Air Force
• 7 Navy
• 15 Army
• 57 VA

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United States Air Force PRCs
VA-DoD Contingency System

• 79th Medical Group, Andrews AFB, Maryland
• 81st Medical Group, Keesler AFB, Mississippi
• 88th Medical Group, Wright-Patterson AFB, Ohio
• 60th Medical Group, Travis AFB, California
• 3rd Medical Group, Elmendorf AFB, Alaska
• In addition, the Michael O'Callahan Federal
  Hospital is designated as a PRC and is a Joint
  VA/DoD Facility located on Nellis AFB, Nevada.

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United States Navy PRCs
VA-DoD Contingency System

• National Naval Medical Center, Bethesda, MD
• Naval Medical Center Portsmouth, Norfolk, VA
• Naval Hospital Jacksonville, Jacksonville,
  Florida
• Naval Hospital Pensacola, Pensacola, Florida
• Naval Hospital Camp Lejeune, Jacksonville, NC
• Naval Hospital Camp Pendleton, Orange County, CA
• Naval Medical Center San Diego, San Diego,CA

Naval Hospital Pensacola (Pensacola, Florida)
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United States Army PRCs
VA-DoD Contingency System

• Walter Reed Army Medical Center, Washington, DC
• Eisenhower Army Medical Center, Augusta, GA
• Martin Army Hospital, Ft Benning, GA
• Winn Army Hospital, Ft Stewart, GA
• Blanchfield Army Hospital, Ft Campbell, KY
• Womack Army Medical Center, Ft Bragg, NC
• Moncrief Army Hospital, Ft Jackson, SC
• Reynolds Army Hospital, Ft Sill, OK
• Beaumont Army Medical Center, Ft Bliss, TX
• Brooke Army Medical Center, Ft Sam Houston, TX
• Darnell Army Hospital, Ft Hood, TX
• Evans Army Hospital, Ft Carson, CO
• Tripler Army Medical Center, Honolulu, HI
• Bassett Army Hospital, Ft Wainwright, AK
• Madigan Army Medical Center, Ft Lewis, WA

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Veterans Affairs PRCs
VA-DoD Contingency System
Atlanta VAMC (Decatur, GA) Bay Pines VA HCS
(FL) Birmingham VAMC (AL) Boise VAMC (ID) Brooks
VAMC (Shreveport, LA) Cincinnati VAMC
(OH) DeBakey VAMC (Houston, TX) Dingell VAMC
(Detroit, MI) Dole VAMROC (Wichita, KS) Durham
VAMC (NC)
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Veterans Affairs PRCs (contd)
VA-DoD Contingency System
Hayden VAMC (Phoenix, AZ) Hefner VAMC (Salisbury,
NC) Hines VAH (IL) Johnson VAMC (Charleston,
SC) Kansas City VAMC (MO) Lexington VAMC
(KY) Louisville VAMC (KY) McGuire VAMC (Richmond,
VA)Miami VAMC (FL) Minneapolis VAMC (MN)
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Veterans Affairs PRCs (contd)
VA-DoD Contingency System Overview
Montgomery VAMC (Jackson, MS) N Texas HCS, Dallas
VAMC (TX) New Mexico VA HCS (Albuquerque,
NM) North Chicago VAMC/DoD Federal Facility
(IL) Northampton VAMC (MA) Oklahoma City VAMC
(OK) Philadelphia VAMC (PA) Portland VAMC
(OR) Providence VAMC (RI) Roudebush VAMC
(Indianapolis, IN)
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Veterans Affairs PRCs (contd)
VA-DoD Contingency System
S Arizona VA HCS (Tucson, AZ) San Francisco VAMC
(CA) San Juan VAMC (PR) St Louis VAMC (St Louis,
MO) Stokes VAMC (Cleveland, OH) Syracuse VAMC
(NY) Tenn Valley HCS, Nashville Campus (TN) VA
Boston HCS, W Roxbury Campus (MA) VA C Ark HCS,
Towbin Center (Little Rock, AR) VA Central Iowa
HCS, Des Moines Div (IA)
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Veterans Affairs PRCs (contd)
VA-DoD Contingency System
VA Conn HCS, W Haven Campus (CT) VA E Colorado
HCS (Denver, CO) VA Greater Los Angeles HCS
(CA) VA Hudson Valley HCS, Castle Point (NY) VA
Loma Linda HCS (CA) VA Long Beach HCS (CA) VA
Maryland HCS, Baltimore VAMC (MD) VA Nebraska / W
Iowa HCS, Omaha Div (NE) VA NJ HCS, East Orange
Campus (NJ) VA NY Harbor HCS, Brooklyn Campus (NY)
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Veterans Affairs PRCs (contd)
VA-DoD Contingency System
VA Pittsburgh HCS, University Dr Div (PA) VA S
Nevada HCS OCallahan Fed Hosp (Las Vegas) VA
Salt lake City HCS (UT) VA West NY HCS (Buffalo,
NY) VAMC Memphis (TN) VAMC Stratton (Albany,
NY) VAMC ROC Wilmington (DE) Zablocki VAMC
(Milwaukee, WI)
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PRC, SSC and ISC Roles and Responsibilities
VA-DoD Contingency System
Secondary Support Centers Military Treatment
Facility (MTF) or VA Medical Center (VAMC)
designated to accept transfers from or sharing
resources with a Primary Receiving Center so as
to maximize health care services support to DOD.
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United States Air Force SSCs
VA-DoD Contingency System

• Wilford Hall Medical Center (59th Medical Wing)
  supporting Brooke Army Medical Center (Ft. Sam
  Houston)

SupportingRole
Wilford Hall Medical Center (59th Medical Wing)
Brooke Army Medical Center (Ft. Sam Houston)
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United States Navy SSCs
VA-DoD Contingency System

• Naval Hospital Bremerton supporting Madigan Army
  Medical Center (Ft. Lewis)

SupportingRole
Naval Hospital Bremerton
Madigan Army Medical Center (Ft. Lewis)
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United States Army SSCs
VA-DoD Contingency System

• There are no United States Army Secondary Center
  Designations

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PRC, SSC and ISC Roles and Responsibilities
VA-DoD Contingency System
Installation Support Center VA Medical Center
proximal to a military installation designated to
provide health care services and other health
care resource support to military forces in the
event of armed conflict or national emergency.
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VA-DoD Contingency System
Activation

• Secretary of Defense requests priority treatment
  of active duty personnel
• Secretary of VA sets priorities of treatment
• VA-DoD Liaison enhanced
• VA Primary Receiving Centers implement local
  plans
• USTC / GPMRC regulates patients

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VA-DoD Contingency System
Command and Control

• Services
• Veterans Health Administration
• USNORTHCOM
• USTRANSCOM/GPMRC
• PRCs
• SSCs

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VA-DoD Contingency System
Funding of PRC Operations

• Peacetime / steady state funding to train, equip,
  exercise
• Funding for operations
• Funding for patient care

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VA-DoD Contingency System
Communications

• Services HF radio and INMARSAT networks
• Conventional phones and E-mails
• TRANSCOM Medical Regulating and Command and
  Control Evacuation System (TRA2CES)

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VA-DoD Contingency System
Summary

• Applicable statutes and references
• Military contingency scenarios
• PRCs and SSCs roles and responsibilities
• Command and Control
• PRC activation and deactivation
• Funding of PRC operations
• Communications systems orientation

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VA-DoD Contingency System and NDMS Overview
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NDMS Overview

• National Response Framework (NRF)
• NRF Tiered Response
• NDMS Partnership, Activation and Components
• Federal Coordinating Centers
• Roles and Responsibilities

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National Response Framework (NRF) 2008

• The National Response Framework provides
  structures for implementing national-level policy
  and operational coordination for domestic
  incident response.
• The term response includes
• c

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Tiered Nature of Disaster/Emergency Response
(Domestic)
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The NRF and NDMS

• The NRF utilizes the National Disaster Medical
  System (NDMS), as part of the Department of
  Health and Human Services, Office of Preparedness
  and Response, under Emergency Support Function 8
  (ESF 8), Health and Medical Services, to support
  Federal agencies in the management and
  coordination of the Federal medical response to
  major emergencies and federally declared
  disasters including
• Natural Disasters
• Major Transportation Accidents
• Technological Disasters
• Acts of Terrorism including Weapons of Mass
  Destruction Events

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NDMS Partnership
VA Provides Definitive Care
HHS Provides Response Teams
DOD Provides Patient Movement and Definitive
Care
DHS FEMA Provides Funding
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NDMS Activation

• Governor requests federal assistance under the
  Robert T. Stafford Disaster Relief and Emergency
  Assistance Act
• State Health Officer requests activation under
  Public Health Emergency
• ASD (HA) requests activation when number of
  Military patients exceed the capability of the
  Military Healthcare System and VA Medical Systems

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NDMS Three Components
Seamless Medical Continuum of Care
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NDMS Definitive Care

• Federal Coordinating Center (FCC)
  A facility located in a metropolitan
  area of the United States responsible for day to
  day coordination of planning and operations in
  one or more assigned geographic NDMS Patient
  Reception Areas

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FCC Function in a Disaster

• Patients evacuated from a disaster area arrive at
  the FCC patient reception area
• Patients are off-loaded, triaged and staged
  pending further regulating to a local NDMS
  hospital
• FCCs monitor status of NDMS patients treated in
  NDMS hospitals

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Directors Responsibilities

• Appoints and/or identifies the FCC or PRC
  Coordinator responsible for the day-to-day
  operation and readiness
•  
• Establish and maintain the support of area
  hospitals, government agencies, volunteer
  organizations and others within the immediate
  area
•  
• Ensure the development, exercise and evaluation
  of local Patient Reception Area plans

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Directors Responsibilities

• Conduct a full-scale exercise at least once every
  three years
•  
• Ensure that FCC or PRC staff, as well as
  applicable federal, state and local government
  and private sector personnel receive appropriate
  orientation or training in operations
•  
• Activate local PRA plans as indicated in
  activation notifications

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Directors Responsibilities

• Ensure that bed availability reporting, as well
  as reception, sorting, staging, transportation
  and hospitalization of arriving patients occurs
  efficiently.
•  
• Provide administrative support for patient
  control and proper patient accounting.

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Coordinators Principal Responsibilities

• Establish and maintain active participation and
  support of local hospitals, health associations,
  EMS, emergency management agencies, police and
  fire services
• Ensure that representatives of NDMS member
  hospitals, as well as representatives of local
  emergency management agencies, EMS agencies,
  public safety, police and fire services are
  provided annual orientation to the PRA plan

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Coordinators Principal Responsibilities

• Ensure that FCC staff and other individuals
  designated to augment the FCC staff annually
  receive detailed education and training
• Ensure that a PRT is developed for each PRA
• Collect bed availability data from each
  participating non-Federal hospital and report to
  the DoDs GPMRC as directed

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Coordinators Principal Responsibilities

• Ensure 24/7 communications are established with
  GPMRC for the receipt of regulating decisions,
  evacuation mission information and patient
  medical data.
• Ensure an accounting method is in place to
  account for patients regulated but not yet
  received, and for patients in the PRA.
• Coordinate fiscal information to support the
  processing of financial claims reimbursement.

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NDMS Overview Summary

• National Response Framework (NRF)
• NRF Tiered Response
• NDMS Partnership, Activation and Components
• Federal Coordinating Centers
• Roles and Responsibilities

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VA-DoD Contingency System and NDMS Overview
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Questions?
VA-DoD Primary Receiving Center (PRC) NDMS
Federal Coordinating Center (FCC) Training Course
Military Contingency
National Disaster
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NDMS References

• National Response Framework, 2008
  http//www.fema.gov/emergency/nrf/
• DoD Directive 6010.22 "National Disaster Medical
  System," January 21, 2003 (Currently under
  revision)
• NDMS Memorandum of Agreement among the
  Departments of Homeland Security, Health and
  Human Services, Veterans Affairs and Defense
  (NDMS Federal Partners MOA), 24 October 2005
  http//fhp.osd.mil/ndms/docs/NDMS_Partners_MOA_24_
  Oct05.pdf
• DoD Directive 3025.1, "Military Support to Civil
  Authorities (MSCA)", January 15, 1993
  http//www.dtic.mil/whs/directives/corres/html/302
  501.htm
• DoD Instruction 6000.11 "Patient Movement,"
  September 9, 1998. (Currently under revision)

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Federal Coordinating Centers

• As of April 2009
• All VA PRCs are also FCCs
• Air Force FCCs
• Andrews Air Force Base, MD
• Keesler Air Force Base, MS
• Travis Air Force Base, CA
• Wright Patterson Air Force Base, OH

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Federal Coordinating Centers

• As of April 2009
• Army FCCs
• Beaumont Army Medical Center, TX
• Fort Jackson, SC
• Dwight D. Eisenhower Medical Center, GA
• Madigan Army Medical Center, WA
• Brooke Army Medical Center, TX
• Tripler Army Medical Center, HI

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Federal Coordinating Centers

• As of April 2009
• Navy FCCs
• Walter Reed National Military Medical Center, MD
• Naval Hospital Jacksonville, FL
• Naval Medical Center Portsmouth, VA
• Naval Medical Center San Diego, CA
• Naval Hospital Camp Pendleton, CA