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The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination

The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination. Emily Kidd, MD Assistant Professor, UT Health Science Center San Antonio Project Director – Texas Disaster Medical System Texas Hospital Association September 14, 2012. What are ESFs?.

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The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination

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  1. The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination Emily Kidd, MD Assistant Professor, UT Health Science Center San Antonio Project Director – Texas Disaster Medical System Texas Hospital Association September 14, 2012

  2. What are ESFs? • Emergency Support Functions • Provide the structure for coordinating Federal, State, and Local response to an incident • Mechanism for grouping functions most commonly utilized for response to disasters and emergencies • Each ESF has a Primary Agency and Support Agencies

  3. What are ESFs? • ESF #1 – Transportation • ESF #2 – Communications • ESF #3 – Public Works and Engineering • ESF #4 – Firefighting • ESF #5 – Emergency Management • ESF #6 – Mass Care and Sheltering • ESF #7 – Logistics Management / Resource Support • ESF #8 – Public Health and Medical • ESF #9 – Search and Rescue • ESF #10 – Oil and Hazardous Materials Response • ESF #11 – Agriculture and Natural Resources • ESF #12 – Energy • ESF #13 – Public Safety and Security • ESF #14 – Long-term Community Recovery • ESF #15 – External Affairs

  4. What are ESFs? • ESF #8 – Public Health and Medical

  5. ESF – 8 CoordinationPrimary Functions Health and Medical Supplies and Equipment - general and medical shelters - facilities - EMS Evacuation - coordinate medical ground and air assets - coordinate staging - coordinate facility evacuations and destinations - coordinate embarkation/reception triage/shelter placement In-hospital care - facilitate resources

  6. ESF – 8 CoordinationPrimary Functions Assessment of Health & Medical Needs - P. H. infrastructure - Mental Health services - hospital dialysis and LTC facilities & Capacity - EMS - home bound population Health Surveillance - general and medical shelters - hospitals, dialysis and LTC facilities - illness, injury, deaths Medical Care Personnel - coordinate and manage deployed staff and teams - facilitate resources

  7. ESF – 8 CoordinationPrimary Functions • Food/Drug/Medical Device - food safety - pharmacy services - supplies and Equipment - O2 • Mental Health Services - Disaster behavioral health - Substance abuse services • Mortuary Services - facilitate victim ID - coordinate mortuary services/cemetery

  8. ESF – 8 CoordinationPrimary Functions • Public Health / Medical information - risk messaging - worker health and safety - EMS - public health policy and guidance • Recovery - re-entry of evacuees - infrastructure - vector

  9. ESF – 8 CoordinationMission • Management of public health and medical resources during a disaster • Communication with/among public health and medical resources and partners • Support incident management for health and medical activities and needs

  10. ESF – 8 CoordinationCenters of Operation in Texas Local EOC Regional Medical Operations Centers (RMOC) Disaster District State Operations Center (SOC)

  11. ESF – 8 CoordinationObjectives • Set overall public health and medical service priorities • Maintain and disseminate situational awareness • Be central point for communications, coordination, and resource management for health and medical services • Facilitate development of public health guidance • Facilitate resource needs and allocation • Manage and track critical resources assigned

  12. ESF-8 Public-Private Partnership ESF-8 Capacity

  13. What is TDMS?

  14. ESF-8 OrganizationalChallenges

  15. EpiTeams Food Safety MSN Shelters HPP CAT Hospital Planning RAT GETAC D/EP Committee ESRD Network TxMAT M-IST PCC TMF DOG DMS EMTF BAT PHEP MMU CASPER RN Strike Team FNSS ?!?! AST & ASTL

  16. TDMS – Texas Disaster Medical System The Texas Disaster Medical System is the collaboration of all public health and acute medical care preparedness initiatives within the State of Texas relating to the mitigation of, response to, and recovery from natural and manmade disasters and other significant events within any region in Texas, with respect to Emergency Service Function (ESF)-8 functions. Courtesy TDEM Website

  17. Where does TDMS get its authority? The Texas Disaster Medical System (TDMS) Steering Committee was established under the direction of the Texas Department of State Health Services (DSHS) in 2010. DSHS is the lead agency for Emergency Support Function (EDF)-8 (Public Health & Medical Services) per the state of Texas Emergency Management plan, Annex H, Texas Government Code §§ 418.042, 418.043(13), and 418.173(a).

  18. TDMS Steering Committee TDMS Steering Committee Public Health Acute Care

  19. Who is represented on the TDMS Steering Committee? • Local Public Health Authorities • Local Health Departments • Regional Public Health Authorities • Regional Health Departments (HSRs) • Texas Department of State Health Services • Trauma Service Areas / Regional Advisory Councils • Hospitals and the Texas Hospital Association • Hospital Emergency Management • Academic Medicine • EMS Agencies – Rural, Urban, & Fire-based • Texas Division of Emergency Management

  20. The First Year….

  21. TDMS Goals • Ensure highest level of readiness to respond • Ensure coordination, communication and collaboration among partners • Ensure understanding of roles and responsibilities of partners • Maintain updated list of ESF-8 resources

  22. Planning and Coordination • Bring together all partners from public health and acute care • Reveals gaps and overlaps • Facilitates better understanding of roles and responsibilities • Provides for continuous improvement • Partner workgroups at local jurisdiction, regional/multijurisdictional and state

  23. Planning and Coordination Functions • Access all current plans; de-conflict and coordinate • Compile list of available resources, assess gaps and overlaps • Establish mutual aid agreements • Develop organizational model for MOC and assign participants • Develop communications plan among partners

  24. Planning and Coordination Functions (con’t) • Determine how local and regional plans integrate with state plans • Develop written documents for plans and resources • Disseminate plans to all partners • Communicate gaps and capabilities to DSHS and TDMS Steering Committee

  25. State of Texas Emergency Management Plan ESF-8 (Public Health and Medical) Plans and Resources State of Texas ESF-8 Strategy Document Identification and Coordination of all ESF-8 plans, initiatives, and resources in Texas MSN Shelters Food Safety AST & ASTL CAT GETAC D/EP Committee Epi Teams CASPER EMTF FNSS TMF TxMAT

  26. TDMS Overview Document • Strategic framework and resource guide for P.H. and medical response and recovery • Guidelines, protocols, concepts, tasks, responsibilities, resource management information • Proposes MOC structure for ESF-8 coordination • Not intended to supplant local plans

  27. The MOC(Medical Operations Center) • During response and recovery both acute care and public health must come together quickly • Single organization for ESF-8 coordination • MOC is not stand alone but is integrated into incident command • Flexible and scalable based upon the incident

  28. MOC Structure

  29. MOC Development Partners • Single Jurisdiction • Local public health • RAC • EMS • Local EM • Local health authority • Hospitals/nursing homes • ME/JP • DME providers • Medical staffing agencies • Mental Health Centers • Disability community • Multi-jurisdictional • DDC/Regional coordinators • RAC • DADS • DARS • Community mental health centers • Disability community • ME/JP

  30. Incident Scenarios • Hurricane • Flooding • Wildfire • Catastrophic disease (including pandemic) • Drought / Water Loss • Tornado • Radiologic Emergency • Food Contamination Attack / Food Borne Illness

  31. Resources Spectrum of Resources • Equipment (e.g. AMBUS) • Equipment with Crew (e.g. Mobile Medical Unit) • Teams with Equipment (e.g. Ambulance Strike Teams) • Persons with Skills (e.g. Physicians, Epidemiologists)

  32. RESOURCE TYPE External attributes that are obvious Measurable Countable “Things” Unlikely to change Quantitative - Descriptive Definition “Equipment” or “Teams” CREDENTIAL Internal attributes that are not obvious Skills Knowledge Ability Can to be transitory Vetted Identity Badge to combine Identity and Attributes “Persons” TDMS Resource Typing and Credentialing

  33. TDMS Training Levels • Basic knowledge related to an integrated TDMS emergency response and its key components • The target audience is all existing or potential participants of the TDMS • Core knowledge and skills that are common to most of the TDMS technical teams or activities • The target audience is individual TDMS members • Advanced TDMS team training • The target audience is individuals or entire units assigned to specialized TDMS teams (e.g., MMU, MIST, RAT, CAT, BHAT)

  34. Issues / gaps identified (so far….) • Need for standardized training curricula and schedules for almost every response / resource group • Overlap of emergency response personnel on multiple team rosters • Coordination with Texas Military Forces resources • Funding responsibilities • Liability coverage of medical response personnel • Continuation of funding of teams/assets • Our role in medical component of mass-care sheltering • FNSS integration into plans and operations • Integration with federal response systems (timing, resource typing, availability, etc.) • Mass Fatality planning

  35. Issues / gaps identified (so far….) • Patient tracking issues • Standardized patient records • Patient records management • HIPAA compliance during a disaster • Use of MRCs / VOADs / volunteers • Integration of Medical Operations Centers into TDEM organizational chart • Medical Operations Centers functions and purpose • Integration of MOCs across the State

  36. Emergency Medical Task Force

  37. ESF-8 Coordination in Action • TDMS Components active during wildfire response • State medical operations center • DDC medical operations center • Ambulance Bus • CAT Team • Ambulance Strike Teams • Mobile Medical Team (MMT/MMU) • Pharmacy services • Disaster behavioral health

  38. ESF-8 Coordination in Action • TDMS Components active during wildfire response, con’t • Medical support in general shelters • DME/ Medical supplies • Public Health • Shelter surveillance • Public health messaging • Epi surveillance • Infection control • Assessment

  39. ESF-8 Coordination in Action

  40. ESF-8 Coordination in Action

  41. ESF-8 Coordination in Action

  42. Onward into the future…

  43. Public Health and Healthcare Preparedness Capabilities • Consistent with national preparedness strategies • Capabilities-based planning and implementation • Provides national guidance with a “whole of community” and “all of nation” approach • Serve as the foundation for the 2012 HPP-PHEP cooperative agreements

  44. Public Health and Healthcare Preparedness Capabilities Healthcare Emergency Management TDMS Public Health Public Health and Healthcare Preparedness Capabilities 10 Essential Services of Public Health National Preparedness Core Capabilities

  45. TDMS Intersects “The Critical Three”

  46. Healthcare and Public Health Capabilities • Public Health Emergency Preparedness (PHEP) awardees address 15 public health preparedness capabilities • Hospital Preparedness Program (HPP)awardees address 8 healthcare preparedness capabilities

  47. Capabilities Overview • Fifteen (15) public health and eight (8) healthcare preparedness capabilities • Numerical designations cross PHEP and HPP • Based on NHSS, PPD-8, NRF, NIMS and CPG101 • Intent: • Continuity of essential public health and healthcare services to the community post-disaster • Effective management ESF-8 challenges • Ensure ESF-8 priorities and resource needs are addressed during response and recovery

  48. Capabilities Overview

  49. Current Projects… • Full scale patient movement exercise • How do we improve patient participation in STEAR (old TAR / 211) • ESRD Coalition • ESF-8 coordination in regions • Inclusion of Texas Military Forces • Mass Fatality Planning

  50. Questions and Discussion

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