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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. Bruce Clements, MPH Director, Community Preparedness Section Texas Dept of State Health Services Rick Bays Director, Response and Recovery Unit Texas Department of State Health Services Emily Kidd, MD

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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 Bruce Clements, MPH Director, Community Preparedness Section Texas Dept of State Health Services Rick Bays Director, Response and Recovery Unit Texas Department of State Health Services Emily Kidd, MD Assistant Professor, UT Health Science Center San Antonio Project Director – Texas Disaster Medical System

  2. TDMS Update

  3. Emergency Support Function 8, Public-Private Partnership ESF-8 Capacity

  4. National Preparedness Strategies • Public health and healthcare preparedness is part of a national preparedness strategy • Presidential Policy Directive 8: National Preparedness • “…aimed at strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber attacks, pandemics, and catastrophic natural disasters.” • “…aimed at facilitating an integrated, all-of-Nation, capabilities-based approach to preparedness.” 4

  5. Vision and Strategy Alignment Homeland Security Presidential Directives OPHPR Strategic Plan Pandemic and All-Hazards Preparedness Act (PAHPA) National Health Security Strategy (NHSS) National Preparedness GoalCore Capability List Public Health and Healthcare Preparedness Capability Development Conceptualizing and Defining Public Health Emergency Preparedness Trust for America’s Health Ready or Not Health Preparedness Capability Prioritization Project Project Public Health Ready * Note: Partner documents are not an exhaustive list, shown for representation purposes only

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

  7. TDMS Intersects “The Critical Three”

  8. HHS may activate the NDMS to provide aid to victims of a public health emergency or to be present at locations at risk of a public health emergency. HHS is the lead federal agency for Emergency Support Function #8 (ESF#8): Public Health and Medical Services.  DSHS may activate TDMS to provide aid to victims of a public health emergency or to be present at locations at risk of a public health emergency. DSHS is the lead state agency for Emergency Support Function #8 (ESF#8): Public Health and Medical Services.  NDMS and TDMS

  9. 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

  10. 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

  11. Capabilities Overview

  12. 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

  13. Illustrating and Communicating ESF-8 Complexity • Acute Healthcare and Public Health • Two sets of distinct functions that strongly influence each other • They can stand alone but are much stronger together • Can’t be too close • Complete integration is not possible (placing acute care in public health or vice versa) • Can’t be too far apart • They strongly influence each other

  14. ESF-8 Coordination: The Keystone Collaboration of public health and acute medical care preparedness

  15. 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)

  16. 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

  17. PLAN EVALUATE/ IMPROVE ORGANIZE/ EQUIP EXERCISE TRAIN TDMS Process • Collaborative planning • Response hierarchy coordination • Role and responsibility clarification • Sequencing response actions • Focusing resources on risks • Defining resources and support • Improvement processes The TDMS process is a forum for collaborative planning for healthcare and public health stakeholders to refine preparedness and response

  18. 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

  19. 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).

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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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

  30. MOC Structure

  31. MOC Development Partners • Single Jurisdiction • Local public health • 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

  32. 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 - medical volunteer management

  33. ESF – 8 CoordinationPrimary Functions Health and Medical Supplies and Equipment - general and medical shelters - facilities - EMS - Pharmacy and Oxygen Evacuation - coordinate medical ground and air assets - coordinate staging - coordinate facility evacuations and destinations - coordinate embarkation/reception triage/shelter placement Patient Care - facilitate management of medical surge - hospital census and bed availability

  34. ESF – 8 CoordinationPrimary Functions • Food Safety and Security - food safety in shelters - food safety during recovery - food borne illness outbreak • Mental Health Services - Disaster behavioral health - Substance abuse services • Mortuary Services - assist in Family Assistance Centers - coordinate mortuary services/cemetery

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

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

  37. Incident Scenarios

  38. Incident Scenarios • Awareness of injury risks • Medical care for sheltered individuals • Evacuation • Stress Reactions • Preventing disease in congregate care settings • Mass Fatalities • Medical Surge • ESF-8 Coordination and Management To name a few……..

  39. Incident Scenarios

  40. 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)

  41. Pilot Courses • Not Throwing Caution to the Wind: 4/32:30 Deployment Safety • Exec. Overview of WebEOC in Texas 4/4 10:00 • ESF8 Resource Roundup 1 4/4 2:30 • ESF8 Resource Roundup 2 4/4 4:00 • Going Down Range: Deployment Basics 4/5 10:00

  42. Emergency Medical Task Force

  43. Ambulance Strike Teams Currently 32 ASTs engaged, 150+ units • 5 Ambulances/AST (25 total) • Pre-identified teams • No-notice regional deployment • Statewide tasked missions • Common communications

  44. Mobile Medical Units 16-32 bed capacity Provide emergency stabilizing care and transfer Staffed with physicians, nurses, techs, logistics, clerical, etc 6-12 hr launch time for 72-96 hr deployment Standardized cache of supplies, pharmaceuticals, and capabilities

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