Military Health System – We’re Not That Different….

1. COL William B. Grimes, MHA, FACHE Joint Conference: South Texas HFMA | Central Texas ACHE Friday, August 27, 2010 Military Health System – We’re Not That Different…. The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the U.S. Government, the Department of Defense, or any of its agencies.

3. PICTURES SSG Richard A. Blakley KIA 06Jun2006 Al Kahalidiyah

4. Secretary of Defense “This program -- the military health-care program in 2001 was $19 billion. In 2010, it's $50.7 billion. It's only going to go up. And it is absorbing an increasing percentage of our budget. We absolutely want to take care of our men and women in uniform and our retirees, but at some point….” Secretary of Defense Robert M. Gates February 01, 2010 Source: http://www.globalsecurity.org/military/library/news/2010/02/mil-100201-dod02.htm

5. We’re Big But Not So Different • Quick Facts: • 9.5M Covered Lives • $49M Annual Program (Revenue) • 135,437 Military and Civilian Personnel • 59 Impatient Hospitals/Medical Centers • 364 Ambulatory Clinics • Key Drivers: • Customer & Staff Satisfaction • Quality Healthcare (Joint Commission, HEDIS, ORYX, National Patient Safety Goals) • Access to Care • Cost

6. How the Money Flows Congress Appropriates Office of Management and Budget - Apportions Comptroller - Allots TMA issue military construction funding allocation documents to design and construction agents TMA Planning, Budgeting & Execution US Army Corps of Engineers Naval Facilities Engineering Command US Air Force Facility Engineers Army MEDCOM Naval Bureau of Medicine and Surgery Air Force Surgeon General TMA Financial Operations TMA Contract Resource Management

7. DSG CG/TSG Japan Korea RDC RDC TAMC Army Regions – Direct Care WESTERN RMC NORTHERN RMC EUROPE RMC Ft. Lewis MAMC Ft. Belvoir RDC WAMC SOUTHERN RMC WBAMC CDAMC DDEAMC WASH DC RDC PACIFIC RMC FSH BAMC RDC

8. Japan Korea TAMC TRICARE Regions – Purchased Care TRICARE Regional Office - West TRICARE Regional Office - North TRICARE Europe TRICARE PACIFIC TRICARE Regional Office - South

9. Carl R. Darnall Army Medical Center Gatesville Waco - Hillcrest, Providence, & VA 60 miles Scott & White 25 miles Temple Temple VA CRDAMC 25 - 35 Miles 25 miles King’s Daughters Lampasas Metroplex Georgetown 155 Miles 40 Miles Scale: 25 mi. BAMC Slide 9 of 25

10. CRDAMC FY08 – FY10 Budgets

11. Fort Hood Mass Casualty5 November 2009 13 Killed, 43 Wounded “You, you and you panic…the rest come with me” Unknown Marine Gunnery Sergeant The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the U.S. Government, the Department of Defense, or any of its agencies.

12. First Minutes and Hours 911 call, First responders (police), area secure and ambulances on scene within 7 minutes First casualties by POV 5 minutes later and Mass Casualty Code Gray activated Local Community air and ground evacuation assistance Initial Hospital care Stand-up of hospital EOC

13. Some Specifics Early 23 GSW victims to CRDAMC, rest 3 hospitals with 6 EMS agencies Site cleared w/n 50 minutes of casualties, ED within 1 hour for surgical cases and 2.5 hours altogether Evacuation based on capacity not extent of trauma – several transferred from CRDAMC and local community hospital after stabilization Size and speed of the event made crowd control and triage difficult

14. Initial Minutes/Hours Challenges • First responders outstanding, but….. • Multiple trained combat lifesavers and medics went into combat mode without planned onsite triage. Secondary triage at ED. • Scene evacuation based on capacity vs. trauma. • Experienced ED providers and surgical staff with ED residency program on site. • EMS treatment and release at scene. • Inadequate tracking of patients at time of evacuation from scene.

15. Initial Minutes/Hours Challenges • Communication and information sharing • III Corps/Garrison IOC – Proper Liaison • Hospital EOC – Internal Communication • Security Situation • Early media reporting inaccuracies • Outlying Medical Staff Communication • Local community, commands and units information • Higher HQ – multiple organizations

16. First 12 Hours – Immediate Care • Initial BH teams locally • Chaplains, CRDAMC Staff, Resiliency Campus • Care of caregivers • Initial requests for external BH Support, media support (pull and push) • Initial media engagement by III Corps • Hotlines • Patient tracking – numbers and status

17. Immediate Care Challenges • No “off the shelf” crisis response plan for external support. • Patient tracking made difficult by • Rapid evacuation • HIPAA • No on-site medical liaison • No specific MOA for MASCAL Communication

18. First 24 hours • Media Engagement • Coordination medical with HQ • Press conferences vs. interviews – need plan • Hospital functions • Taking care of Staff • Implications of event • VIPs – morale opportunity (continues > 24 hr) • Patient and staff visits; • Unit leaders

19. Hasty Task Organization

20. Day 2 and Beyond • Organizing external assets • Crisis Response Teams • Traumatic Event Management • Development of BH plan • Hospital Staff with Corps planner • Request for DA assistance • Communication and Unity of Effort • Updates and assessments • Security, allocation of resources

21. Crisis Response Teams

23. Consequence Mgmt Challenges • Continuous operations – routine + crisis • Patient location – continuity of care vs. unit • Risk Communication – outside assistance • Community Outreach • BH Plan Review • Incorporate critics and outside providers • Continuous Community Assessment • Investigations, AARs, Awards/Recognition

24. Thought… • “When written in Chinese, the word ‘crisis’ is composed of two characters. One represents danger, and the other represents opportunity.” • John F. Kennedy, April 12, 1959 at the convocation of the United Negro College Fund, Indianapolis, IN

25. COL William B. Grimes, MHA, FACHE Joint Conference: South Texas HFMA | Central Texas ACHE Friday, August 27, 2010 Military Health System – Not That Different…. The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the U.S. Government, the Department of Defense, or any of its agencies.