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Operations Working Group

• 2005 NDMS Conference Presentation
• Charlene Teeter, BSN, RN, Chair
• Jon Jui, MD, MPH
• May 1, 2005

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Operations Working Group (OWG) History

• This committee is the second OWG
• First OWG began in February, 2001
• 2 original working groups Training was the
  first group and then Operations- should have been
  done in reverse but on-line training was being
  developed
• Original group had 2 face-to-face meetings and
  monthly calls

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OWG History - contd

• Current group has met twice (funding issues)
• 1st meeting at 2004 NDMS Conference
  organizational meeting
• 2nd meeting in August, 2004 - cut short by
  Hurricane Season and deployments - only WG to
  have met
• Meeting at 2005 NDMS Conference
• Calls twice monthly unless pressing issues
  require more frequent calls

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WORKING GROUP STRUCTURE
Chief NDMS Section
Management
Operations
Pubs/Docs
Training
Logistics
Admin/Fin
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OPERATIONS WORKING GROUP MEMBERS
Charlene Teeter Chair John Caprio Gary
Christmann New Dale Downey Art French Phyllis
Goodwin Cotton Howell Jon Jui
Barry Kellogg Pat McCoy Cliff Parker Tim
Walton H. James Young Pharmacist
(TBD) Emergency Coordinator (TBD) Indicates
also members of original OWG
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OWG Team Representation
AK1 DMAT
WA1/IMSuRT-W
OR2/IMSURT-W
MI1 DMAT
HQ
MO1 DMAT
PHS1 DMAT
DMORT
SC1 DMAT
DMORT-WMD
OK1 DMAT
VMAT
FL5/IMSuRT-S
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OWG Committee Representation

• Multidisciplinary Committee Team Leader, Deputy
  TL, Admin, Logistics, Training, Communications
• Subject Matter Experts - Physicians, Nurses,
  Medics, NDMS staff, EC, Pharmacist, Forensic
  Specialists, Veterinarian, Haz Mat Specialists.
• DMAT, DMORT, DMORT-WMD, VMAT, IMSURT, NMRT

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Accomplishments of 2001-2003 OWG

• Recommendations on Immunization Policy
• Input on Team Assessment Tool
• Input on criteria for Team Levels
• Response Team Mission Statements
• Began Physical Fitness Standards
• Recommended S.T.A.R.T Triage

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Work Product of 2004-2005 OWG(ITEMS SENT FORWARD
FOR APPROVAL OR ACTION)

• 8-4-04 Submitted Mission Statements for all
  Response Teams and the DMORT FOG for
  approval
• 3-1-05 Resubmitted both with new forms
• 1-3-05 Letter of Concern regarding financial
  issues all teams are experiencing

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Current Work Product contd

• 07-13-04 Formation of Cadaver Dog sub-committee
• 12-07-04 Letter of Concern to MWG regarding team
  501c3 status, ongoing legal and
  financial concerns and sponsorship
  issues

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Current Work Product contd

• 12-22-04 Letter to NDMS Logistics requesting a
  more user friendly format for Basic Load
  Cache
• 12-22-04 Top 5 Priority Issues to MWG
• 03-01-05 Medical Physical Fitness Standards to
  MWG

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Current Work Product contd

• 04-5-05 Revised Med. Phys. Fitness sent to
  MWG
• 04-13-05 Submitted DMORT-WMD Operation Manual
  for approval

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OWG Top 5 Issues

• 1) Team financial concerns including
• 501c3 Status, including team owned cache items
• Team Sponsors
• Unpaid leases, utilities, bills
• Payroll issues
• Budget issues
• Cache re-supply issues
• Inter-agency personnel agreements

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OWG Top 5 contd

• 2) Communication issues
• Lack of verbal written communication
• Lack of Chain-of-command in communication
  with teams
• Lack of lateral vertical communication
  throughout the FEMA/NDMS organization
• Communication between RSB NDMS Staff
• Communication between working groups
  teams
• Communication between NDMS Management and
  Team Commanders

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OWG Top 5 contd

• Cache content review and recommendations
• System description manual/Concept of Operations
• 5) Thomas pack (sick call bag) Team In
  Transit Medical Kit

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Top 5 becomes Top 10,15,20

• Other issues are always being presented that must
  take priority over current issues we are working
  on ex Medical Physical Fitness Standards was
  our 5 became our 2.
• PPE for teams at National Security Special
  Events (NSSE)
• DMAT Basic Load

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NDMS Operations Workgroup Response Team CONOPs
Development Clinical IssuesCAPT Art French MD
FACEP
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NDMS Operations Pelorus

• Develop doctrine Concept of Operations (CONOPS)
• Align with NDMS Capstone documents i.e.
  nesting
• Draft NDMS Systems Operations Manual
• Coordination of logistics, training, and required
  operational capabilities

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CONOPS

• Concept of Operations - (DOD) A verbal or graphic
  statement, in broad outline, of a commander's
  assumptions or intent in regard to an operation
  or series of operations. The concept of
  operations frequently is embodied in operation
  plans The concept is designed to give an overall
  picture of the operation.

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Nesting of NDMS CONOPSPolicies Procedures

• National Strategy
• HSPDs/PDDs
• Department of Homeland Security
• National Response Plan NIMS
• DHS HSC Capstone Documents
• Department of Health and Human Services
• ESF-8 SOP (CONOPS)
• Agency for Healthcare Research and Quality
• CDC NIOSH Recommendations
• DoD/SBCCOM Improved Response Program

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Capstone Documents

• Homeland Security Council Planning Scenarios
• DHS Universal Task List 2.0 (Dec 2004)
• DHS Target Capabilities List Version 1.0 (Jan
  2005) www.
• HSPD-8 National Preparedness Goal (Mar 2005) DHS
  National Preparedness Guide (April 2005)

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HSC Planning Scenarios The Top 15! (minus one)

• Nuclear Detonation
• Radiation Device
• Biological- Anthrax
• Biological-Influenza
• Biological- Plague
• Chemical- Nerve Agent
• Chemical- Industrial

• Chemical- Blister
• Chemical- Chlorine
• Explosion- IED
• Earthquake
• Hurricane
• Food contamination
• Foreign Animal Disease

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DHS Universal Task List 2.0

• NDMS-related Tasks
• Incident Management
• Command and Control
• NDMS Response Team Task List?
• Individual Scope of Practice
• Mission Essential Tasks Lists
• Team Position Specific
• Privileging for Clinical Providers?

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DHS Target Capabilities List Version 1.0

• Define capabilities of NDMS Response Teams

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HSPD-8 National Preparedness Goal

• Standards for preparedness assessments and
  strategies
• Critical Tasks
• Associated Conditions
• Performance Standards
• Competency-Based Training
• Mission Essential Tasks Lists

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DHS National Preparedness Guide

• To be developed- March 2005?
• Performance assessments
• Preparedness Scorecards

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How Do We Operationalize HSPD-8 Into NDMS Teams?

• NDMS is a system of systems
• D-O-T-L-M-P-F approach
• Doctrine
• Organization
• Training
• Logistics
• Material
• Personnel
• Facilities

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Operational Readiness MeasurementsC MORE
TEAMS

• Capability Requirements
• Manned
• Organized (ICS)
• Recognized
• Equipped

• Trained
• Exercised
• Assessed
• Maintained
• Sustained ()

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Mission Requirements Capabilities Define
Logistics

• Amateurs talk about strategy- professionals talk
  about logistics
• Logistics makes it happen
• Operations- logistics- training must all be
  aligned

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Leverage Existing Models

• AHRQ CDC
• Alternate Care Site Selection Tool
• Community-Based Mass Prophylaxis A Planning
  Guide for Public Health Preparedness
• Smallpox Response Plan and Guidelines
• Pandemic Influenza A Planning Guide for State
  and Local Officials
• SBCCOM
• Acute Care Center A Mass Casualty Care Strategy
  for Biological Terrorism Incidents
• DoD Joint Clinical Requirements Board
• Air Force SPEAR/EMEDDs- Army SMART

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Operations Issues

• Systems Description Manual
• CONOPS/SOPs
• Mission Essential Tasks Lists
• Defined Competency-Based Training Requirements
• Equipment skills checklist
• Deployment Checklists (job aids)
• Predeployment staging on-scene

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IMSuRT

• International Medical Surgical Response
  TeamConcept Development

John Caprio, FL5 DMAT, IMSuRT-S
Pat McCoy, WA1 DMAT, IMSuRT-W
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Concept Of Operations

• Activation Request By Department Of State To
  Office Of Emergency Response
• 4-6 Hour Response Window
• Fly Direct To Scene Or Intermediate Staging Base.
• Deploy with All Equipment Carried By Team Members
• Possible Airport Base of Operations
• Domestic Response At Request Of OER

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Summary

• IMSuRT Provides Rapidly Deployable Medical
  Surgical Care To US Citizens World Wide
• Interface With NDMS For Other Response Teams and
  Hospital Reception in Continental US.
• 60 Member Humanitarian Aid Package
• Training/Equipment Must Support Rapid Deployment

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DMORT
Cotton Howell
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DMORT Mission

• To scientifically identify and return the remains
  of the victims of a disaster to their family in
  the most professional and dignified manner as
  possible

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FEMA DMORT Regions
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DMORT Specialties

• Forensic Pathologist
• Forensic Anthropologist
• Forensic Dentist /Odontologist
• Forensic Finger Printing Specialist
• Forensic Radiologist
• Funeral Director / Embalmer
• Photographer
• DNA Specialist
• Medical Legal Specialist

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DMORT Operational Areas

• Psychological Support Services
• Morgue Operations (Postmortem)
• Coordination with Other Agencies
• Media Management / PIO
• Family Assistance Center (Antimortem)
• Information Resource Systems
• Recovery of Human Remains

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DMORT Mobile Morgue
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DMORT Never Forget

• Funeral Directors will be the last people to let
  you down!

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DMORT - WMD
Dale W. Downey
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DMORT - WMD
From This
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DMORT - WMD
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DMORT - WMD
NDMS OPERATIONS WORK GROUP
A lot of thought and frustrations
Eventually leads to a lot of action !!!
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NDMS

Past Not a lot of thought was given to the
different TYPES of teams and their individual
needs and concerns Present A lot of caution was
used so as not to cause ill effects to one type
of team while creating positive issues for another
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NDMS

• Several different issues were assigned to our
  group but the group took the tasks in great
  stride and built on the energy to make our system
  work better for not only the teams, but for the
  people we serve as well

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NDMS

• DMORT-WMD TEAM
• Operations Manual
• Mission Statement
• PPE Standardization
• Physical Fitness Standard

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NDMS
On occasion I had to wonder if we were ever going
to get anywhere with our proposals and ideas We
have !
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DMORT Mass Fatality K9 Section

• Not a stand-alone team
• K9s and their Handlers referred to as a Unit
• K9 Unit Handlers are Members of DMORT in their
  Regions
• Will operate under the DMORT ICS

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Proven Not Potential

• K9s will be fully trained and proven in finding
  human remains on actual cadaver searches.

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Why DMORT K9 Units?

• To maximize the effectiveness and efficiency of
  the DMORT mission.
• To work within the DMORT system and by DMORT
  standards.

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Duties

• Understanding DMORTs mission, procedures,
  policies and associated issues.
• Searching any area, location, structure or
  conveyance in which mass fatalities have occurred
  without risking a life to make a recovery.
• To expedite finding human remains, intact or
  fragmented for the purpose of recovery,
  preparation and disposition.

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Cadaver Dog or Mass Fatality K9?
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NDMS OWG VMAT Barry Kellogg VMDVMAT-1
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NDMS OWG - VMAT

• Dont ever forget the duck tape.. or is it Duct
  Tape???

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What is a VMAT ?

• Veterinary
• Medical
• Assistance
• Team

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VMAT Mission

• Assess and evaluate the needs of the local
  veterinary infrastructure
• Provide veterinary medical treatment and care
• Address public health issues
• Assist the local veterinary infrastructure until
  operations can resume

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VPLC (Veterinary Program Leadership Committee)

• 3 Members from each of four VMAT Teams
• New England VMAT-1
• Baltimore MD VMAT-2
• North Carolina VMAT 3
• Minnesota VMAT-5

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Upcoming Issues

• Central Cache Organization
• Team Cache
• NDMS burn rates for budgets
• Uniform deployment requirements
• 501c3 and financial issues
• Sponsorship issues
• Veterinary Technician Licensing Requirements
• BDU Color

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Challenges to Our Progress

• Delayed response from above on pending issues
• Lack of written guidance (ie inconsistent
  message relayed to different groups)
• Different Priorities for Working Group based on
  changing situational needs
• Communications deficit from upper management
  (conference calls are venting spot due to lack of
  decision makers on calls)
• Administrative support of FWGs

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Invitation to Participate

• NDMS at-large members wishing to serve on a
  specific WG
• Submit names with a short resume to their Team
  Commander for approval
• Forward list to MWG liaison
• Selection according to current needs
• Criteria for assignment may include Region,
  team type, specific skill set

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Team Input for Future Initiatives

• Questions/Concerns?
• Thank You for supporting your working group
  members.

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OWG Contact

• Charlene Teeter, Chair
• Operations Working Group
• charleneteeter_at_comcast.net

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