National Disaster Medical System Regional Planning for NDMS Patient Movement and Medical Care

1. National Disaster Medical System Regional Planning for NDMS Patient Movement and Medical Care

2. HHS ASPHEP / OPHEP • 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.

3. 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.

4. 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.

5. HHS Regional Emergency Coordinatorsin place as of 4/2005 • HHS Regions same as FEMA Regions • REC’s responsible for planning and coordination of federal medical response to large-scale emergencies in Regions

6. Secretary’s Emergency Response Team (SERT) • Activated for incidents of national significance requiring federal health & medical resources, or implementation of ESF #8. • Provides situational awareness to HHS SOC, ASPHEP • Typically led by a HHS Regional Emergency Coordinator (REC) who will work closely with other Federal assets • Integrates with the local incident managers and facilitates support as requested by State and Tribal authorities. • Provide coordinated Federal management of HHS and ESF #8 assets during a major public health and medical emergency.

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

8. DHS in NDMS (cont’d) • Considerations: • Local medical assets • Local infrastructure • Local transportation assets • Airports/Airstrips • Mass Transit • Local Trucking Resources

9. DHS in NDMS (cont’d) • Assumptions: • Local health & medical assets are inadequate • Patients will originate from multiple locations • Patients MAY be decontaminated • DOD resources are not committed

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

11. 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

12. DHS in NDMS (cont’d) NDMS Response Teams 25 Disaster Medical Assistance Teams – Fully Operational/Operational 30 Disaster Medical Assistance Teams – Augmentation/Developmental 4 National Medical Response Teams/WMD 5 Burn Teams 2 Pediatric Teams 1 Crush Medicine Team 3 International Medical/Surgical Teams (includes 2 under development) 3 Mental Health Teams 3 Veterinary Medical Assistance Teams 11 Disaster Mortuary Operational Response Teams (1 WMD) 1 Joint Management Team 20 Nurse/Pharmacist National Response Teams (10 each)

13. 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

14. 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

15. 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

16. DHS in NDMS (cont’d) • Medical Movement Functions • Patient Stabilization & Preparation • Patient Movement Request • Patient Reporting & Regulating • Patient Staging • Patient Movement Management • Embarkation • Debarkation • Coordination with Various System Elements

17. 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

18. 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

19. 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

20. This Briefing is Classified UNCLASSIFIED Department of Defense Regional Planning for NDMS Patient Movement and Medical Care DoD Perspective/Emerging Concepts Lt Col Jim Baxter NORAD/USNORTHCOM Medical Coordinator UNCLASSIFIED

21. UNCLASSIFIED Overview • Emerging Concepts-Regional Approach • NDMS National Security Special Event Plan (Example) • Joint Task Forces-Civil Support/Other • Patient Movement/Medical Support Challenges • Questions UNCLASSIFIED

22. UNCLASSIFIED Emerging Concepts/Potential Missions … for a Land Forces Component Command • Medical C2 on a regional basis • Versus a deployable function • Medical Response Forces • Foundation created by installation assets • Augmented by deployable forces in “region” • Medical Sustaining Forces • Larger, more robust than Medical Response Forces • Deployable Hospitals • Casualty Receiving Ships • Designated consequence management response forces • NDMS assets for patient movement and hospitalization • Augment Medical Response Forces in affected region UNCLASSIFIED

23. UNCLASSIFIED Emerging Medical Concepts • A regionally based theater concept for HSS responses • Flexible enough to respond to all hazards, to include natural disasters and terrorist threats/events • Full spectrum operations … prevent-deter-mitigate-respond • Fosters total force integration … Active-Reserve-Guard • Generates an evolving concept for medical C2 in this theater (i.e. regional medical task forces) • Response options build incrementally thereby creating Force Package Options (FPO) … • Local Installation • State Regional Operational • National Strategic-Theater UNCLASSIFIED

24. CONPLAN 2002 Base Plan FOCUS NRP Base Plan HLD Annexes NIMS HLS Appendices CS Base Plan ESF Annexes ALL HAZARDS Includes Natural Disasters Annexes Spt Annexes Appendices Related Plans CONPLAN 0500 Incident Annexes (DSCA) CBRNE CM Response Annexes Appendices Appendices MACDIS + Military Assistance for Civil Disturbances NRP CIS Annexes Appendices UNCLASSIFIED NRP Influence on NC Planning (U) UNCLASSIFIED

25. UNCLASSIFIED Joint Strategic Capabilities Plan (JSCP) • (U) Joint Strategic Capabilities Plan • (U) CJCSI 3110.01 signed 22 Feb 2005 • (U) Logistics Supplement to JSCP • (U) CJCSI 3110.03C • (U) March 2005 - Final Draft for GO/FO level review UNCLASSIFIED

26. UNCLASSIFIED Logistics Supplement to JSCP • (U) Provides logistics planning guidance to the combatant commanders, Chiefs of the Services, and heads of DoD agencies in support of the tasks assigned in the JSCP • (U) Enclosures: (U) A—Responsibilities (U) B--Logistics Planning and Tasks (U) C--Materiel Planning Guidance (U) D--Support Force Planning Guidance (U)E--Health Service Support Planning Guidance (U) F--Operational Engineering Support Planning Guidance (U) G--Contract Administration Services Planning Guidance (U) H--Special Operations Support Planning Guidance (U) I--Logistics Sustainability Analysis UNCLASSIFIED

27. UNCLASSIFIED Health Service Support Planning Guidance (U) Appendix C to Enclosure E • (U) Purpose. This appendix provides joint HSS planning guidance in support of JSCP-assigned tasks. It specifically highlights planning considerations for HLD and CS operations. • (U) Objectives. Homeland Defense (HLD) and Civil Support (CS) operations require a shift from current planning methods to support MCO. • (U) Enclosure E was significantly modified to delineate Health Service Support (HSS) by Major Combat Operations, Stability Operations and Homeland Defense. UNCLASSIFIED

28. UNCLASSIFIED Appendix C to Enclosure E (1 of 3) (U) Medical Response Forces • (U) The development of Medical Response Forces at the installation level creates the foundation all joint operations build upon. JFCs will augment Medical Response Forces in affected areas with Medical Response Forces in unaffected areas. If augmentation of installation assets is not enough to manage the HLD or CS situation, then JFCs employ Medical Sustaining Forces. • (U) Services will develop UTCs at the installation level to counter current asymmetric threats. At a minimum, Services will develop UTCs for disease investigation, vaccination, preventive medicine, veterinary, medical logistics distribution, mental health, patient decontamination, and medical treatment at all existing Medical Treatment Facilities to support the installation commander, the joint force commander, and, when directed, the lead federal agency. UNCLASSIFIED

29. UNCLASSIFIED Appendix C to Enclosure E (2 of 3) (U) Medical Sustaining Forces. • (U) USNORTHCOM will develop medical sustaining force modules that will enhance capabilities found in the Initial Entry Force (IEF) and Medical Response Forces found on installations. Resources will be drawn from multi-component units and placed on a rotational schedule to respond to catastrophic events involving mass casualties and fatalities. Force modules will include deployable hospitals, available casualty receiving ships, a hospital ship, and mortuary affairs teams, at a minimum. UNCLASSIFIED

30. UNCLASSIFIED Appendix C to Enclosure E (3 of 3) (U) Medical Response Forces • (U) HSS concepts of operation require the integration of active, reserve, and guard assets and the employment of fixed and deployable assets from their home base in order to create habitual joint response relationships within DoD and with local-state-national organizations. HSS concepts must include the following components: • (U) Regionalization. HSS concepts for response to HLD or CS missions will focus on the augmentation and expansion of steady-state and Medical Response Forces found on installations, vice the projection of forces. Command and control of fixed and deployed HSS assets will focus on the designation of regional medical commands to support JFCs. These concepts minimize the burden on limited transportation assets, reduce the deployed footprint, and advocate steady-state relationships between HSS organizations and community counterparts. UNCLASSIFIED

31. UNCLASSIFIED Example: NDMS/CONOPS Potential Strategic Patient Movement: National Special Security Event UNCLASSIFIED

32. Supported Command USNORTHCOM N-NCSG, Medical Opns Cell Colorado Springs, Colorado Supporting Command USTRANSCOM / Air Mobility Command Global Patient Movement Req Center Scott Air Force Base, Illinois Supporting Command USJFCOM Norfolk, VA V UNCLASSIFIED Proposed activation of FCCs and AE HubsISO NSSE Presidential Inauguration (Planning Only) VA FCC Philadelphia PA: Inbound Hub: McGuire AFB VA FCC Bedford MA Inbound Hub: Westover ARB I Navy FCC Newport RI: Inbound Hub: Green International II AF FCC Dayton-Wright Patterson OH: Inbound Hub: Wright-Patterson AFB VA FCC Castle Point NY: Inbound Hub: Stewart International VA FCCs NY, and Brooklyn NY: Inbound Hub: Newark International VA FCC Pittsburgh PA: Inbound Hub: Pittsburgh International III VA FCC Lyons NJ Inbound Hub: Newark International AF FCC Wilmington–Dover DE Inbound Hub: Dover AFB Presidential Inauguration/NCR Outbound Hubs: Andrews AFB, Dulles, BWI 9 VA FCC Richmond Inbound Hub: Richmond International UNCLASSIFIED

33. UNCLASSIFIED Joint Task Forces - Med/DCO/JRMPs • Joint Task Force-Civil Support (JTF-CS) is an active unit • CBRNE Consequence Management Response Force (CCMRF) • Enabling Force, with various initial response capabilities • Other Joint Task Forces for consequence management can stand up as required • Example: National Special Security Events in National Capital Region (NCR) result in stand-up of JTF-NCR-Med • Joint Regional Medical Planners play increasingly vital role as liaisons between Disaster Control Officers, JTF-Meds, and USNC UNCLASSIFIED

34. UNCLASSIFIED Patient Movement/Medical Support Challenges • Collaborative planning, and ongoing communication is critical • Integration with local response (FCCs are key) • Level of support is “requirements,” and “scenario,” driven • Competing demands for limited DoD resources…manpower, supplies/equipment, transport (no dedicated medical lift) • Potential transport support missions include: • Manpower/emergency response supplies, to bolster on scene support • Deployable hospitals/equipment to expand capabilities on scene • Mass casualty moves out of disaster area to Federal Coordinating Centers/NDMS beds UNCLASSIFIED

35. UNCLASSIFIED Patient Movement/Medical Support Challenges Strategic Patient Movement/NDMS activation • Must consider all transport resources, not just DoD air assets • Patients decontaminated? Outbound hubs in safe zone? • Staging area locations; transport to staging areas (who?) • Coordination between local, regional, and DoD regulators/clinicians • DoD deployable regulating support limited (FCCs/local VA/DoD?) • Clinical validation of patients for air movement (coordination) • Numbers and types of patients; special equipment/care needs • Tracking, and throughput/reception issues UNCLASSIFIED

36. UNCLASSIFIED Questions https://www.noradnorthcom.mil/SG/ UNCLASSIFIED

37. VA in Regional Response At the present time the Veterans Health Administration (VHA) is organized into 21 Veterans Service Integrated Networks (VISNs) which include all 50 States, Puerto Rico, the Virgin Islands, and Guam.

38. Veterans Health Administration 21 Veterans Integrated Service Networks

39. VA in Regional Response • VA Office of Operations and Readiness • VHA/EMSHG Operations • VISN • VA Medical Facilities

40. VA in Regional Response • VA Office of Operations and Readiness • VHA/EMSHG Operations • VISN Federal Region • VA Medical Facilities

41. VA in Regional Response (Possible) Associated VISNs & Regions VISNRegionVISN Region 1 1 18 6 3 2 15 7 4 3 19 8 7 4 21 9 12 5 20 10

42. VA in Regional Response Bottom Line VA has the flexibility to plan and respond locally, regionally, or nationally, as may be required, to effect maximum resource utilization for and in response to any domestic disaster or emergency.

43. Questions?

44. UNCLASSIFIED BACK-UP SLIDES UNCLASSIFIED

45. UNCLASSIFIED Available NDMS Beds and Throughput for Selected FCCs *Available bed and throughput figures represent data reported as part of the national bed reporting exercise that occurred on 19 January 2005. Available bed figures should be used as planning factors and not actual beds for medical regulating during an event. USNORTHCOM and USTRANSCOM will work with DoD Components and NDMS partners to obtain actual bed data in case of an event requiring medical regulation and patient movement. FCC SITES LISTED ABOVE ARE IDENTIFIED FOR PLANNING PURPOSES ONLY…THEY ARE NOT BEING ACTIVATED; HOWEVER, THEY WERE COORDINATED WITH NDMS PARTNERS DURING SEVERAL PLANNING SESSIONS. 10 UNCLASSIFIED

46. UNCLASSIFIED Available NDMS Beds and Throughput for Selected FCCs *Available bed and throughput figures represent data reported as part of the national bed reporting exercise that occurred on 19 January 2005. Available bed figures should be used as planning factors and not actual beds for medical regulating during an event. USNORTHCOM and USTRANSCOM will work with DoD Components and NDMS partners to obtain actual bed data in case of an event requiring medical regulation and patient movement. FCC SITES LISTED ABOVE ARE IDENTIFIED FOR PLANNING PURPOSES ONLY…THEY ARE NOT BEING ACTIVATED; HOWEVER, THEY WERE COORDINATED WITH NDMS PARTNERS DURING SEVERAL PLANNING SESSIONS. 11 UNCLASSIFIED

47. Surgeon/Clinician 1/0/0 Deputy Surgeon (GS Conversion) 0/0/1 Chief, Medical Operations Branch 1/0/0 Chief, Medical Plans Branch 1/0/0 Medical Operations Manager 0/1/0 Preventive Medicine Officer 1/0/0 Medical Intelligence Planner 1/0/0 Medical Planner Logistics 1/0/0 Patient Movement Operations Officer 1/0/0 Mission Assignments Officer 2/0/0 Veterinary Medicine Officer 1/0/0 Medical Operations NCO 0/1/0 Medical Planner Clinical Lab/Blood 0/0/1 Medical Readiness Manager 0/1/0 UNCLASSIFIED JTF-CS Surgeon General Officer/Enlisted/Civilian C=3/1/2 (6) P=7/2/0 (9) UNCLASSIFIED

48. UNCLASSIFIED Potential JTF-CS Initial Response Assets Medical C2 – Bde level Medical C2 – Bn level Area Support Medical Company X 3 PM Detachment (Sani) SMART-HS SMART-BURN SMART-EMR SMART-SM SMART-MC3T SMART-NBC SMART-PC Theater Epi Team Air Ambulance Co Med Log Distribution Co EMEDS +25 AFRAT CBIRF UNCLASSIFIED