National Ambulance Contract

1. National Ambulance Contract • CDR Amy O. Taylor • DHHS/ASPR R6 • Emergency Coordinator • Cole Bricker • DHS/FEMA Region 6 • Operations

2. 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.

3. Background • Why a National Ambulance Contract? • Cost • Complexity • Credentials • Coordination • Multi-Agency Effort • GSA • HHS • FEMA

4. 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.

5. 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.

6. Authorities • FEMA contract executed through HHS operational support • Can only be utilized within a Stafford Act Activation/Declaration

7. Contract Zones

8. 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

9. Resources

10. Ground Ambulance Services

11. 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

12. 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

13. Para-Transit Services

14. 6 Types of Para-Transit Vehicles

15. 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

16. AIR AMBULANCE SERVICES

17. 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

18. 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

19. Performance Requirements Per Zone

20. State Considerations • Medical Evacuation Planning (State ESF-8 lead) • Activation Request to FEMA Region (Governor) • Coordination with HHS /ESF-8 regional office

21. 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

22. 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

23. 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

24. 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.

25. 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

26. 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

27. How does it work?

29. 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

30. AMR/FEMA Vehicle Placard

31. Check-In Form

32. 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

33. 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

34. 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

35. 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

36. 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.

37. Patient Encounter Form

38. ICS 220 Operational Status Reports (measures asset utilization) • Ground ambulance • Para-transit • Air Ambulance

39. Demobilization • COTR is responsible for demobilization coordination • ESF-8 liaison at state EOC • RRCC • JFO • OHA • FEMA National COTR

40. Demobilization, Check-Out Form

41. Lessons Learned

42. Deployments • Hurricane Dean Aug 08 $15M • Hurricane Gustav/Ike Aug 08 $120M • Presidential Inauguration Jan 09 $8M

43. Successes • Met performance requirement • Deployed safely • Logistical support • Mission Ready • Accomplished assigned missions

44. Challenges • Check in process • Direct resource communication & tracking • Resource utilization • Inter-agency coordination • Logistics leveraging • Costs

45. 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

46. QUESTIONS ?