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NDMS Operational Readiness: A Proposed OWG Sail Plan

NDMS Operational Readiness: A Proposed OWG Sail Plan. CAPT Arthur J. French MD FACEP Operations Workgroup NDMS Conference 2006. Vision vs. Policy. CAVEAT! NDMS Section sets policy- we assist in development and implementation

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NDMS Operational Readiness: A Proposed OWG Sail Plan

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  1. NDMS Operational Readiness: A Proposed OWG Sail Plan CAPT Arthur J. French MD FACEP Operations Workgroup NDMS Conference 2006

  2. Vision vs. Policy CAVEAT! NDMS Section sets policy- we assist in development and implementation OWG “vision” is where we hope to sail together based upon what we see as current capability gaps

  3. NDMS OWG 2006 Goals • Develop Concept of Operations (CONOPS) • Aligned with NDMS “Capstone” documents i.e. “nesting” • Address “Report on the NDMS 2005 Hurricane Response” (Malcolm Pernie) • Develop recommendations for logistics, training, and C4I aligned with CONOPS defined operational capabilities

  4. CONOPS Concept of Operations - (DOD) A verbal or graphic statement, in broad outline, of a commander's assumptions or intent in regard to an operation or series of operations. The concept of operations frequently is embodied in operation plans; The concept is designed to give an overall picture of the operation.

  5. CONOPS vs FOG vs SOP • Level 1 CONOPS: Overview, a brief concept summary of a disaster-related function, team, or capability. • Level 2 Standard Operating Procedure or Operations Manual: A complete reference document, with procedures for performing a single function (SOP), or a number of interdependent functions (Ops Manual). • Level 3 Field Operations Guide (FOG): A durable pocket or desk guide, containing essential nuts-and-bolts information needed to perform specific assignments or functions. • Level 4Job Aid/Task Books: A checklist or other aid for job performance or job training.

  6. “Nesting” of NDMS CONOPS & SOPs • National Homeland Security Strategy • HSPDs/PDDs • Department of Homeland Security • National Response Plan & NIMS • DHS & HSC “Capstone” documents • Department of Health and Human Services • Agency for Healthcare Research and Quality • CDC & NIOSH • DoD/SBCCOM Improved Response Program

  7. HLS Capstone Documents • National Planning Scenarios • DHS Universal Task List 2.1 (Dec 2004) • DHS Target Capabilities List: Version 2.0 (Jan 2005) • HSPD-8 National Preparedness Goal (Dec 2005) • DHS National Preparedness Guidance? • Found at WWW.LLIS.GOV

  8. Nuclear Detonation Radiation Device Biological- Anthrax Biological-Influenza Biological- Plague Chemical- Nerve Agent Chemical- Industrial Chemical- Blister Chemical- Chlorine Explosion- IED Earthquake Hurricane Food contamination Foreign Animal Disease National Planning Scenarios:The NDMS “World of Work”

  9. DHS Universal Task List 2.1 • NDMS-related Tasks • Incident Management • Command and Control • Do we need an NDMS Response Team Task List? • NDMS Mission Essential Tasks Lists? • Team & position specific? • Scope of practice for clinical providers?

  10. DHS Target Capabilities List: Version 2.0 • How do we define capabilities of NDMS Response Teams and type teams per NIMS typing scheme? • Does/ should one size fit all missions? • Currently only one type of DMAT/VMAT • Should NDMS team typing be based on predesignated team capabilities versus operational readiness metrics?

  11. HSPD-8 National Preparedness Goal • “Standards for preparedness assessments and strategies” • Critical Tasks • Associated Conditions • Performance Standards • Competency-based training • Performance assessment standards • Preparedness scorecards

  12. How Do We Incorporate HSPD-8 Capability Elements Into NDMS? • Personnel • Planning • Organization & Leadership • Equipment & Systems • Training • Exercises, Evaluations, and Corrections • Personnel • Facilities

  13. Team Capabilities & Typing: What’s Important & Why? • NIMS aligned capability-based team typing to manage resources efficiently • Type 1 not better than Type 2/ Type 3 • Clinical operational capabilities (DMATs) • Non-clinical operational capabilities • Response capability “building blocks” • Unit • Individual

  14. Proposed Clinical Capability Parameters (DMAT) • Defined Echelons/Levels of Care • Critical care vs acute care vs outpatient care • Staff mix – physicians, nurses, allied health • Biomedical equipment (EKG) • Medical supplies • Pharmacy operations • Laboratory capabilities (I-Stat, POC) • Diagnostic Imaging (US, X-ray, Doppler)

  15. Can We Align Team Types With Mission Scenarios? • Type 1- Level 1/2 emergency department with ICU (without surgery) • Type 2- Level 2/3 community hospital emergency department without ICU • Type 3- Outpatient clinic/ urgent care center • Type 4- Forward needs assessment/ advance BOO C4I-coordinating team

  16. Team Typing Versus Team Readiness: A Difference? • Should all teams have same operational readiness requirements? • Ability to deploy within specified time with full team • Training & qualifications current • Passed team performance assessment • Team typing  team readiness • Team type = groups of designed operational-clinical capabilities • Team readiness = ability to meet their type-defined operational-clinical capabilities

  17. Individual Target Capabilities • Front End Analysis: What is the NDMS responder’s “world of work”? • Human performance technology approach • Operational work • Clinical work • Defined Competency-Based Training Requirements • Equipment skills checklist • Deployment Checklists (job aids/ tasks books)

  18. Beyond CONOPS: Other Potential Areas of OWG Focus • Patient safety and quality improvement • Standardization of procedures • Defined privileges & qualifications • Triage doctrine • Surge operations models • Patient movement doctrine (PRT) • Clinical practice guidelines

  19. Clinical Privileging • Privileging vs credentialing vs qualifications • Privileging applies to scope of patient care • Qualifications applies to skills • All physicians should be “resuscitationists” • Require ACLS-EP, PALS,ATLS, FCCM? • Establish core NDMS acute care privileges? • Define minimum competencies e.g. GMO • Non-intensivist critical care providers? • ED/ICU RNs

  20. Which Triage System is Best? • Need ESF-8 standardization • NDMS • VA • DoD • HHS • Primary triage – situationally dependent • START? • Sacco Triage Method ? • Secondary triage - disease vs. injury? • AHRQ Emergency Severity Index

  21. Patient Movement Issues • Patient Reception Team SOPs • Patient transport equipment (litters-gurneys) • Joint medical operations • NDMS-DoD-VA interoperability • State-local- EMS aeromedical interoperability • DoD medical regulating procedures/policies • NDMS-DoD common patient movement items • Integrated critical care modules (SMEED, LSTAT)

  22. How Can We Leverage Existing Federal Models? • AHRQ & CDC • “Alternate Care Site Selection Tool” • “Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness” • “Smallpox Response Plan and Guidelines” • “Pandemic Influenza: A Planning Guide for State and Local Officials” • SBCCOM Improved Response Program • “Acute Care Center: A Mass Casualty Care Strategy for Biological Terrorism Incidents”

  23. Surge Capacity Protocols • HHS-DoD Improved Response Program • HHS Agency for Healthcare Research and Quality (AHRQ) • Surge operations models & protocols • Centers for Disease Control and Prevention (CDC) • Bioterrorism/ pandemic protocols

  24. Possible Clinical Guidelines? • Infectious disease Rx (SARS, influenza) • Critical care surge triage • Physician-nurse staff ratios • Indications for mechanical ventilation • CBRNE triage-treatment • Palliative Rx • Dialysis criteria & priority of patients

  25. C4I – Situational Awareness • Command, Control, Communications, Computers, and Intelligence • “Battlefield information dominance” elements • Team comms, wireless LANs, telemedicine • Electronic Patient Tracking • PDAs (BMIS-T) performance support systems • Electronic Medical Records – decision support • Use of patient simulators for NDMS FTXs? • Tabletop computer modeling and simulation for NDMS command & control exercises

  26. C4I Interoperability • DHS SAFECOM Project • “Statement of Requirements for Public Safety Wireless Communications & Interoperability” • Integrated Wireless Network (IWN) • Integrated Patient Tracking Initiative • COMCARE Alliance

  27. Tiered IMT (MST) Deployment? • Do we need Type 1, 2, & 3 IMTs? • Group Supervisors? • Group/ Task Force IMT C4I teams scaled & aligned with missions & geography to maintain span of control in AOR • How should IMT be staffed? • External - FT/PT NDMS, NDMS-1 • Internal - recruit from on-scene team staffs • IMT position qualifications-designations?

  28. NDMS Is a “System of Systems”The OWG Can’t Do This Alone! • Intra-NDMS collaboration • NDMS staff • Senior Medical Policy Group • MWG, DPWG, TWG, & LWG • External collaboration • ACEP Disaster Section • Electronic collaboration- Disaster Help

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