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Command and Control

Command and Control. Joseph A. Barone, Pharm.D., FCCP Professor and Chair Dept. of Pharmacy Practice & Administration Ernest Mario School of Pharmacy. Acknowledgements. Mr. David Gruber, Sr. Deputy Commissioner NJ DHSS. Outline. Command and Control Concepts National Level

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Command and Control

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  1. Command and Control Joseph A. Barone, Pharm.D., FCCP Professor and Chair Dept. of Pharmacy Practice & Administration Ernest Mario School of Pharmacy

  2. Acknowledgements Mr. David Gruber, Sr. Deputy Commissioner NJ DHSS

  3. Outline • Command and Control Concepts • National Level • New Jersey Level • New Jersey Innovations • Future Challenges • Conclusion

  4. Everybody’s Example • Katrina

  5. Command and Control Concepts • There is no one concept that fits all • CC is a fluid state • Applications from the military don’t always fit non-military applications, but are pretty good • CC has exciting health care possibilities • CC offers opportunities for pharmacists

  6. National Level • National Incident Management System (NIMS) • Flexible • Standardized

  7. National Incident Management System Components • Command and Management • Preparedness • Resource Management • Communication and Information Management • Supporting Technologies • Ongoing Management and Maintenance

  8. Command and Management • Incident Command System • Multiagency Coordinating Systems • Public Information Systems

  9. Preparedness • Planning • Training • Exercises • Personnel qualification and certification • Equipment qualification and certification • Mutual aid • Publication management

  10. Communications and Information Management • Incident management communications • Information management

  11. Incident Command System • Standardized on-scene incident management concept • Allows responders to adopt an integrated organizational structure equal to the severity of single or multiple incidents • Not hindered by jurisdictional boundaries

  12. Incident Command System • ICS emergency response functions • Command (incident commander/unified command) • Operations • Planning • Logistics • Finance and administration

  13. Incident Commander • Responsible for all aspects of the response • Establish immediate priorities • Stabilize the incident • Determine objectives and strategy • Monitor incident organization • Ensure health and safety

  14. Joint Medical Command and Control (JMCC) • Natural disasters usually require DoD medical assistance • Command operations • Medical homeland defense planning and response • JMCC intended for natural disasters and CBRNE

  15. Joint Medical Command and Control (JMCC) • Technology is usually not most difficult aspect • Challenge is understanding agency-specific processes and needs of medical planners • “Air Force Portal” under development • Goal is to increase situational awareness of resources near the event

  16. “Air Force Portal” • Use existing infrastructure and technology • Assimilate information from various sources (people, supplies, civilian assets/hospitals) • Distribute information to medical planners in a virtual environment • Modifiable data links (ie. weather for evacuation) • Other military portals coming on line • Other commercial platforms available

  17. “Network-Centric” Emergency Response • Driven by technology • Rapid collection, transfer, and dissemination of information • Arises from network-centric warfare

  18. Emergency Response vs. Military CC • Differences in mission and training • Different skills sets and expertise between emergency responders and military personnel • Similar need to establish CC and build situational awareness in a changing and hostile environment

  19. Network-Centric Challenges • Figure out what information you need • Train the decision makers • Train emergency personnel • Train organizations • PRACTICE • ASSESS • PRACTICE SOME MORE

  20. Network-Centric Challenges • Information overload • Data masquerading as information • Unfiltered information • Conflict with CC hierarchy • Excessive control from above • Uncontrolled improvisation below • Unnecessary networking

  21. National Level

  22. New Jersey Level

  23. Pharmacist Assets • T3 model of pharmacist involvement • Planning, execution, and after action analysis • Participation in CC at many levels • Planning and participating in Strategic National (and local) Stockpile exercises • Identifying and designing processes for safe,effective, and efficient medication distribution

  24. Pharmacist Assets • Staffing POD’s • Contribute to disaster response planning • Design medication prophylaxis and treatment protocols

  25. Public Health Region Team Healthcare Delivery System Emergency Management Health Infrastructure Preparedness & Emergency Response Program

  26. 8.7 million people 566 municipalities 114 local health departments 21 counties 22 lead health agencies 5 planning regions 81 acute care hospitals 9 Medical Coordination Centers 1 Health Command Center New Jersey’s Health System

  27. DHSS Command Medical HAN Admin Federal Cell EMS HCO&A Ops Human Services PIO Hospitals/FQHC/ LTC IT OITS RSS Public Health Off site ops Logistic (SNS/SSS) CDRS Lab Epi Investigation Lab Building Press BENS Public EMS Dispatch EMS TF DHS DEP Phone Gov office PODS LINCS JIC JOC FBI OCT AG HHS CDC Other Agencies/Orgs NJHA Hospitals EMS/General OEM EOC Govt. Agencies Health System Command, Control and Communications

  28. Horizontal and Vertical Integration • Entities outside New Jersey • Federal DHHS (CDC) • DHS, FEMA • NJ State Agencies • Governor’s office • Domestic Security Preparedness Taskforce • Health Care Organizations • Local and County Public Health Agencies • Hospitals and Health Care Providers

  29. Federal and National Collaboration • Centers for Disease Control and Prevention (CDC) • Health Resource Services Administration (HRSA) • Federal Emergency Management Agency (FEMA) • United States Public Health Service (USPHS) • Department of Homeland Security (DHS) • Department of Justice (DOJ) • Association of State and Territorial Health Officials (ASTHO) • National Association of County City Health Officials (NACCHO)

  30. Interstate Collaboration • Mid-Atlantic Public Health Preparedness Conference (NJ, PA, MD, DE) • Metro Planning Workgroup (NJ, NYC, NY, CT) • Executive level preparedness and response meetings Top areas of discussion: Surge capacity Communications Credentialing

  31. REGIONALIZATION • Why: • Pre-event administration • State/local linkage • Event management • Focused operations • Coordination of resources • Increased surge capacity • Who: • DHSS Regional Coordination Teams • Emergency Management (MCCs) • Public Health • Health care delivery • How: • Population • Capability • Geography

  32. Local Health Local Health County Health Primary Care Hospital Hospital Local OEM Local OEM Long Term Care County OEM Regionalization Preparedness Public Health Region Teams Regional Coordinator MCCs Health System Liaison Exercise Coordinator EMS Liaison Local Planners Emergency Management Healthcare Delivery System

  33. EMS Task Force Concept EMS Task Force 1 Public Health Regions 1 & 2 UASI EMS Task Force 2 Public Health Regions 3 & 4 ODP EMS Task Force 3 Public Health Region 5 MEDPREP NJ EMS Task Force • A DHSS/DSPTF Effort • UASI, ODP and MEDPREP Funded • DHSS asset/coordinated with OEM

  34. DHSS Command and Control– federal, state and local partners • Joint Operations Center (JOC)/ Joint Field Office (JFO) • Federal • DHS, FBI, DHHS, CDC • State • Attorney General’s Office, NJDHSS, OEM Federal/state • NJDHSS • Health Command Center (HCC) • Receipt/Stage/Storage Site (RSS) • Emergency Communication Center (ECC) • State Police Office of Emergency Management (OEM) • Emergency Operations Center (EOC) State Acute care hospitals County OEMs Local Local health departments

  35. New Jersey Developments

  36. New Jersey Developments • MEDPREP • HEPAC • HIPPOCRATES

  37. HippocratesNew Jersey’s Health System Situational Awareness Application

  38. Regional Medical Coordination Center MCC Hospital State Regional Team FQHC Other Health Entities New Jersey’s Health EmergencyResponse System NJDHSS HCC HACC Statewide Emergency Management System MCC MCC MCC MCC MCC

  39. What is Hippocrates ? • Situational awareness application (routine/emergent) • Integrated, web-based suite accessible anywhere, anytime • Health infrastructure preparedness and emergency response information • Displays real-time data for informed decision-making during a health emergency • Customized access so individuals or groups see only what they need • Developed and owned by NJ DHSS

  40. Health Infrastructure Preparedness and Emergency Response HIPPOCRATES Preparedness and Hippocrates

  41. Application Development • Initiated development in 2003 • Piloted during TOPOFF 3 in April 2005 • Identified additional requirements • Seamless integration of additional health applications • Increased map area • New functions such as search • Bi-directional Email communication and document sharing • Additional reporting and summary statistics • New opportunities for advanced analysis • Refined Version 1.0 requirements in Fall 2005 • User Acceptance Testing in Summer 2006 • Launched Version 1.0 in December 2006 • More rollouts occurring now

  42. Incidents Advanced and BasicLife Support Acute and Non-Acute Care Hospitals Events Points of Distribution Weather/Traffic Blood Banks Medical Stockpile RSS MedicalStockpile Locations Health Departments SitStat Surveys Post Offices Schools Roads Municipalities Counties Surrounding State Counties Hospitals fromSurrounding States Hospital Divert Status Long Term Care Ambulance Locations Command Centers BASE MAP LAYERS REAL-TIME FEEDS Dynamic Data Integration HIPPOCRATES HEALTH LAYERS

  43. Future Challenges

  44. Overarching Goals • Allow planners and responders to work together to prepare and respond • Activities should occur without regard to agency or geography • Various platforms and portals will need to work together

  45. The Horizon • CBRNE event • Influenza pandemic • SARS-like • GPS on/in individual users • Handling mass fatalities • Legal issues in community containment measures

  46. Exercise Vigilant Shield ‘08 • Part of TOPOFF 4 • United States Northern Command • NORAD • Aerospace detection and defense events across the venues of Oregon, Arizona, and Guam • Will exercise aerospace defense, aerospace control, maritime warning, and coordination of air operations in a disaster

  47. TOPOFF-4 • 15,000 participants • Prevention exercise - law enforcement and intelligence communities • HHS - radiologic emergency public health issues • DoD - global terror threat mitigation

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