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National Ambulance Contract. CDR Amy O. Taylor DHHS/ASPR R6 Emergency Coordinator. Cole Bricker DHS/FEMA Region 6 Operations. Federal National Ambulance Service: PURPOSE.
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National Ambulance Contract • CDR Amy O. Taylor • DHHS/ASPR R6 • Emergency Coordinator • Cole Bricker • DHS/FEMA Region 6 • Operations
Federal National Ambulance Service: PURPOSE The purpose of the Federal National Ambulance and Para-transit Support Services contract is to provide a full array of licensed ground and air ambulance services and para-transit services that may be ordered as needed to supplement the Federal and Military response to a disaster, act of terrorism or other public health emergency in any of the 48 contiguous states.
Background • Why a National Ambulance Contract? • Cost • Complexity • Credentials • Coordination • Multi-Agency Effort • GSA • HHS • FEMA
Mission • The Department of Health and Human Services provides technicalassistance to FEMA in support of contracted ground + air ambulances, and para-transit vehicles to support State, tribal and local governments ability to prepare for and respond to the effects of a major disaster.
Centrally managed, regionally coordinated contract • Provide a full array of licensed ground, air ambulance and para-transit services to assist states in accomplishing patient evacuation • May be ordered as needed to supplement response to a disaster, act of terrorism or other public health emergency. • State public health authorities determine there are unmet requirements to rapidly and safely evacuate patients with complex and ongoing medical needs; • Initiate request for Federal assistance.
Authorities • FEMA contract executed through HHS operational support • Can only be utilized within a Stafford Act Activation/Declaration
Performance Requirements Per Zone • GROUND AMBULANCE • 300 ground ambulances (ALS & BLS) • Typically a 70%/30% ALS/BLS split • AIR AMBULANCE • 25 air ambulances, helicopter and/or fixed wing • PARA-TRANSIT • Ability to Transport 3,500 individuals • Not 3,500 vehicles BOTTOM LINE: LIMITED NUMBER OF RESOURCES
Types of Ground Ambulances • Type II – Advanced Life Support, Non-HazMat • Type IV – Basic Life Support, Non-HazMat • Type V – Bariatric Ambulance, ALS • Type VI – Med-Evac Bus, ALS > 4 stretcher patients
EMS Roles • Patient triage, treatment & transport • Hazard recognition • Symptom surveillance & reporting • On-scene medical standby • Redistribution of pts. to free up hosp. beds • Distributing immunizations • Staffing shelters • Staffing emergency departments • Setting up mobile medical units
Para-transit Restrictions • Sending facility responsible for determining host facilities/destinations • One-way distance < 200 miles or 6 hrs. • Multiple trips expected • No medical staff on vehicles • Caregiver must accompany patient if medical care is required • Order by patient type, not by vehicle type • Non-ambulatory, wheelchair bound • Ambulatory with assistance • Ambulatory & no assistance needed
Types of Fixed-Wing Aircraft • Type I – critical care ALS 2+ pts. • Type II – critical care ALS 1 pt. • Type III – ALS 2+ pts. • Type IV – BLS 1 pt. • Type V - Neonatal
Types of Rotary-Wing Aircraft • Type II – ALS 2+ pts., night ops. • Type III – ALS 1 pt., non-night ops. • Type IV – ALS 1 pt., night ops. VFR • Type V - Neonatal Specific
State Considerations • Medical Evacuation Planning (State ESF-8 lead) • Activation Request to FEMA Region (Governor) • Coordination with HHS /ESF-8 regional office
Medical Evacuation Planning Considerations Planning must be performed whether it be deliberate or crisis-action and is a state ESF-8 responsibility. It should include: • Number of patients to evacuate • Patient locations (Pick up Points) • Hospitals • Nursing Homes • Residences • Where will patients go? • Intrastate or Interstate evacuation • Shelter/Hospital Agreements
Medical Evacuation Planning Considerations (cont) • Staging area (Check-In site) locations • Security • Repatriation • Medical Assets • Can this be handled through EMAC? • Will this require Federal augmentation
Activation Request to Region If activating the Federal Ambulance Contract, the state must prepare an ARF identifying the following information (at the very least): • No. of patients to evacuate & condition: • Critical/Intensive Care • Advanced Life Support • Basic Life Support • Check-in site • How they will be used • Local augmentation of 911 dispatch • Transportation/Evacuation of Patients
Needs Identification • State/local identify numbers needing specific type of support during planning. • State incorporates EMAC assets in planning (follow GAP analysis concept). • State works with HHS Region to identify Federal piece. • NOTE: The national contract is NOT a panacea- it is intended to augmentStateandlocal resources.
Coordination • Pre-Event • HHS Regional Emergency Coordinators work with States to determine if medical evacuation assistance may be necessary and identify potential check-in sites for assets. • Finalize State coordination of requirements. • State ID’s potential types and numbers. • During the Event • Monitor usage • State ID’s types and numbers • Post-Execution • Forward draw-down and demobilization plan
Caveats • Regions work through HQs • No individual direct contact with contractor prior to activation • ESF #8 manages, FEMA pays • Joint decision-coordination process • Under utilization= demobilization • State/ local exhaust available support • Own contracts/assets • Mutual aid and EMAC
Check In • Ground Ambulance - verify quantity at Check-in • ALS (usually 70%) • BLS (usually (30%) • Para-transit (seats) • Verify quantity at check in • 25% of seats must have working wheelchair lifts • Air – Verify quantity at check in. This may occur at a separate check in site from the ground assets. • COTR must validate check-in times for each asset 29
Inspection “Contractor is responsible for maintaining all provisioning necessary to resupply all ambulances provided pursuant to any task order for extended periods” – SOO Section C-4 • COTR Inspections (Random) • Medical Supply Inspections • Expiration Date • Type of supplies required are adequate for tasks assigned • Personnel Credentials • State DOT may perform vehicle inspections as well
Equipment Issuance Transportation Management Services (TMS) contractor support staff will be at the check in site to tag each ground asset with a GPS transponder • Used for deployed evacuation assets across the evacuation transportation enterprise • Plots and tracks assets in real time using Sprint i365 GPS enabled phone • Provides long-term historical tracking information • Provides online (web-based) real-time reporting through Telenav • Enables quick setup and management – anytime from anywhere
BESS Kit Contents Adhesive Placard 12V Y-Adapter 120V AC Charger Laminate Placard Corrugated Container Box Portable 12V DC Power Pack Sprint i365 12V DC Charger
Reporting / Tracking The COTR must • Provide regular status reports – frequency will be set by the National COTR. These reports will capture information on mobilization, missions being performed, asset utilization, inspections, demobilization, etc • Coordinate with state representatives at staging areas and issue work orders to the contractor for missions (which will assign certain assets to a specific purpose for a duration of time) • Adjust work orders as mission requirements demand • Maintain a spreadsheet that tracks work order progress
Asset Utilization • How many assets are redlined and why? • Maintenance Issues • Assets should never be down due to driver rest requirements • COTRs must identify how many assets are on missions out of total available (percent utilization)? • Asset Utilization is the key metric used to lead demobilization coordination calls with the states.
ICS 220 Operational Status Reports (measures asset utilization) • Ground ambulance • Para-transit • Air Ambulance
Demobilization • COTR is responsible for demobilization coordination • ESF-8 liaison at state EOC • RRCC • JFO • OHA • FEMA National COTR
Deployments • Hurricane Dean Aug 08 $15M • Hurricane Gustav/Ike Aug 08 $120M • Presidential Inauguration Jan 09 $8M
Successes • Met performance requirement • Deployed safely • Logistical support • Mission Ready • Accomplished assigned missions
Challenges • Check in process • Direct resource communication & tracking • Resource utilization • Inter-agency coordination • Logistics leveraging • Costs
Summary • Planning • State and HHS region coordinate • Project assets needed/ staging • Activation • Deploy assets to staging area • FEMA placards for vehicle ID • State/local briefing; credentialing (if necessary) • Deployment • Resources deploy from sating area to site(s) • Once assets leave staging area, assigned to state • State/ local gov’t provide medical direction; patient distribution and tracking • Demobilization • Once task(s) or assignments complete, or asset no longer needed