National Disaster Medical System Partnership Overview

1. National Disaster Medical System Partnership Overview

2. NDMS Structural Changes

3. NDMS Structural Changes

4. NDMS Section NDMS Section Chief Jack Beall Program Analyst (2) Chief Medical Officer Chief Nurse Chief Veterinary Officer Program Manager, USPHS Chief Toxicologist Executive Officer System Development Systems Operations Medical Field Operations Operations Support Center

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

6. Roles of DHS • Lead Agency for NDMS • Chair Senior Policy Group & Directorate Staff • Medical Response Assets in DHS • Broad range of expertise • International response capability

7. NDMS Section NDMS Provides the People! Our People are the Heart of the System 107 Teams, over 9,000 personnel nation-wide dedicated to the service of victims caught in the chaos of a natural disaster or terrorist event or other threat to national security.

8. DHS in NDMS (cont’d) • What can NDMS bring to bear? • DMAT/Specialty Teams – More than 8,000 • personnel • Equipment and Supplies

9. DHS in NDMS (cont’d) NDMS Operational Disaster Medical Assistance Teams AK Seattle WA ME MT ND VT MI OR MN Worcester NH MA WI Westland Boston SD ID Valhalla RI Eugene WY Providence CA Toledo PA IA CT RI NV UT NE San Francisco Bay Area Dayton NJ Lyons IL IN OH DE CO MO WV MD KS St. Louis VA Los Angeles Area San Bernardino KY NC NM OK TN Winston-Salem AZ Tulsa AR GA SC Albuquerque MS AL HI Maui San Diego SantaAna Jacksonville TX LA Mobile USVI Pensacola FL Tampa/St. Petersburg Guam Ft. Myers Miami PR Fully Operational Teams Operational Teams

10. DHS in NDMS (cont’d) • 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

11. DHS in NDMS (cont’d) • NDMS Medical Response • At Disaster Site or PRA • Triage • Austere Medical Care • Casualty Clearing/Staging • At Local NDMS Reception Area • Patient Reception

12. NDMS Surge Capacity • Joint Effort between DHS and HHS • 250 bed medical facility for deployment and staffing from NDMS teams • Includes coordination with CDC to manage disease outbreak of know or unknown origins • Coordination with other Federal Partners • New Patient Movement Concepts • Responsibility in Definitive Care

13. DHS in NDMS (cont’d) • Patient Movement • Coordinated inter-agency process • Identification of a need to move a patient • Admission of a patient at a destination • medical facility

14. DHS in NDMS (cont’d) • NDMS Roles: • Patient Stabilization • Staffing of Regional EVAC Points (REP) • Staffing of Patient Reception Areas (PRA) • Patient Preparation • Patient Regulation

15. DHS in NDMS (cont’d) • Additional Transport Providers • ESF-8 Partners: • Department of Transportation • General Services Administration • U.S. Postal Service • American Red Cross • Private Contractors

16. DHS in NDMS (cont’d) • 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

17. HHS in NDMS • HHS is the lead for Emergency Support Function #8. Specifically, HHS will provide: • Technical assistance and coordination through the Secretary’s 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.

18. Role of the ASPHEP • Created by legislation (Bioterrorism Act) in Fall 2002 • Directs and coordinates HHS’s 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.

19. HHS Secretary’s 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.

20. Ongoing Initiatives • Surge Capacity Planning • Hospital Tracking • Strategic Planning • Computer Based Modeling • Federal Medical Contingency Stations • National Security Special Events & Emergency Responses • Summer Olympics (Athens, Greece) • Reagan Funeral (Washington, DC) • RNC & DNC (New York City & Boston) • Bush inauguration (Washington, DC) • 2004 Florida Hurricanes x 4 • Exercises • Top Officials (TOPOFF 3)

21. DoD in NDMS • Support agency to ESF 8, Public Health and Medical Services • 1. Coordinate Patient Movement - DoD is lead for patient movement in collaboration with other federal agencies. Responsible for movement of patients on DoD resources. • Provides transportation assets, medical crews, patient regulating teams • Transportation medical assets include: • Aero-medical Evacuation Kits • Patient Movement Equipment • Civilian Reserve Air Fleet in Homeland Incident

22. DoD in NDMS • Coordinate Patient Movement (Cont) • Global Patient Movement Requirements Center (GPMRC) located at Scott AFB (O’Fallon, Illinois – St. Louis area) • Performs Medical Regulating • Coordinates the Transportation - Bed plan • Transportation Command Regulating and Command and Control Evacuation System (TRAC ES) • Combines transportation, logistics, and clinical decision elements into seamless patient movement; capable of assessing/prioritizing medical requirements, assigning proper resources; distributing relevant data 2

23. DoD in NDMS • TRANSCOM Regulating and Command & Control Evacuation System (TRAC ES) Benefits: • Seamless transition from peacetime to natural • disaster, contingencies and wartime • In-transit visibility of patient location and status • Integrates different modes of transportation (air/ground/sea) for patient movement • Advanced planning capabilities to develop precise plans and projections in resource constrained environments • Effective use of existing transportation resources • Projects limitations and patient movement “bottlenecks” • Situational awareness for patient recipient hospitals 2

24. DoD in NDMS • Coordinate Definitive Patient Care • Twenty Six (26) Federal Coordinating Center Areas of Responsibility in CONUS • 8 Air Force FCCs w/ 10 AORs 7 Army FCCs 9 Navy FCCs • US Northern Command coordinates NDMS Bed Reporting • DoD participating in NDMS hospital training needs assessment survey • Participate in Medical Inter-Agency Coordination Group (MIACG) Evans Army Medical Center

25. DoD Process When NDMS Is Activated DHS Activates NDMS Emergency Ops Center SECDEF ASD HD Exec Sec Activation Coordination ------- (OASD HA) Personnel & Readiness Joint Staff NMCC NORTHCOM DWC JFCOM Ops Ctr TRANSCOM JMOC Services Ops Ctrs SG SG SG SG GPMRC SGs access data from GPMRC FCCs Bed reporting

26. DoD in NDMS • National and Regional Exercises • TOPOFF 3 • Ardent Sentry – US NORTHCOM • Positive Response – Joint Staff • Lifesaver 2004 – Keesler AFB • Ultimate Caduceus 2005 – Seattle/Tacoma/Spokane

27. DoD in NDMS • 4. DoD Initiatives • Development of a National Patient Movement, Regulating and Medical Tracking System • One of DHS’ Interagency Security Plan initiatives • Description of DoD Aero-medical Evacuation Teams, Equipment and Supplies • For use by FEMA/ NDMS – create patient movement and definitive care teams • Will supplement DoD (and VA) in a mass casualty event • Development of medical readiness evaluation and metrics for DoD and VA Federal Coordinating Centers

28. VA in NDMS • VA Manages 43 of the 66 Federal Coordinating Centers that are responsible for coordinating the reception, care, and return of patients evacuated under the NDMS. • NDMS is one of the missions assigned to the Veterans Health Administration’s Emergency Management Strategic Healthcare Group (EMSHG)

29. EMSHG Organization Chart Chief Consultant Executive Assistant Director CEM Program Specialist Planning Specialist Administrative Officer Computer/Telecom Spec. Budget Analyst Operations Specialist Western District Manager Program Specialist Central District Manager Program Specialist Eastern District Manager Program Specialist Exercise/Training Specialist Western District (6 VISNs) 9 Area Emergency Managers 6 Management Assistants Central District (8 VISNs) 14 Area Emergency Managers 8 Management Assistants Eastern District (8 VISNs) 14 Area Emergency Managers 8 Management Assistants

30. VA in NDMS • VA Readiness Operations Center • VHA/EMSHG Operations • Veterans Integrated Service Networks (VISNs) • VA Federal Coordinating Centers (FCCs)

31. VA in NDMS • Exercise Nifty Nugget (1978)

32. VA in NDMS • Exercise Nifty Nugget (1978) • Civilian-Military Contingency Hospital System (CMCHS) (1980)

33. VA in NDMS • Exercise Nifty Nugget (1978) • Civilian-Military Contingency Hospital System (CMCHS) (1980) • Emergency Mobilization Preparedness Board (EMPB) (1981)

34. VA in NDMS • Exercise Nifty Nugget (1978) • Civilian-Military Contingency Hospital System (CMCHS) (1980) • Emergency Mobilization Preparedness Board (EMPB) (1981) • Public Law 97-174 (1982)

35. VA in NDMS • Exercise Nifty Nugget (1978) • Civilian-Military Contingency Hospital System (CMCHS) (1980) • Emergency Mobilization Preparedness Board (EMPB) (1981) • Public Law 97-174 (1982) • NDMS (1984)

36. VA in NDMS • Exercise Nifty Nugget (1978) • Civilian-Military Contingency Hospital System (CMCHS) (1980) • Emergency Mobilization Preparedness Board (EMPB) (1981) • Public Law 97-174 (1982) • NDMS (1984) -- VA Signed MOU in 1986

37. We know the past and the present — What is the future of NDMS?