9/19/2013. Patient Evacuation: Federal Capabilities. Agenda. Federal National Ambulance Contract

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1 United States Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response Patient Evacuation: Federal Capabilities David Kerschner RN, HHS Regional Emergency Coordinator UW EMS and Trauma Conference Seattle, Washington September, 2013 Agenda Federal National Ambulance Contract Overview of National Disaster Medical System (NDMS) Patient Tracking Patient Movement Challenges 2 Federal National Ambulance Contract The purpose of the Federal National Ambulance and Para-transit Support Services contract is to provide a full array of licensed ground and air ambulance services and Para-transit services that may be ordered as needed to supplement the Federal and Military response to a disaster, act of terrorism or other public health emergency. 3 1

2 Jointly administered by FEMA (contract funding) and HHS/ASPR (contractor s technical representative) Assets must arrive at designated location within 24 hours of contract activation GROUND AMBULANCE 300 ground ambulances each zone (ALS & BLS) Requested and deployed in Strike Teams Includes vehicle maintenance and crews for 24/7 staffing AIR AMBULANCE 25 air ambulances, helicopter and/or fixed wing Support crews deploy with aircraft PARA-TRANSIT Ability to Transport 3,500 individuals 4 Situation State Public Health Authorities determine there are unmet requirements to rapidly and safely evacuate patients with complex and ongoing medical needs initiate request for Federal assistance. 5 Mission The Department of Health and Human Services will provide technical assistance to FEMA in support of contracted ground and air ambulances and Para-transit vehicles to support State, tribal and local governments ability to prepare for and respond to the effects of a major disaster. 6 2

3 Need Identification State/locals identify numbers needing specific type of support during planning. State incorporates EMAC assets in planning (follow GAP analysis concept). State works with Region to identify Federal piece. 7 Request Process State identifies event specific requirement to RRCC (Regional Response Coordination Center) ESF#8 in RRCC prepares Action Request Form (ARF) Forward ARF to National Response Coordination Center (NRCC) and HHS State incurs 25% cost share- will not process without State signature 8 Activation Process HHS prepares list of detailed requirements based on the capabilities and numbers requested Forwards to FEMA Operations/Logistics and ESF #8 in NRCC FEMA executes 40-1 and forwards to Contracting Officer Contracting Officer executes Task Order 9 3

4 Coordination Pre-Event HHS Regional Emergency Coordinators work with States to determine if medical evacuation assistance may be necessary and identify potential check-in sites for assets. Finalize State coordination of requirements. State ID s potential types and numbers. During the Event Monitor usage State ID s types and numbers Post-Execution Forward draw-down and demobilization plan 10 Execution Ambulances start moving Within 6 hours of Task Order In place within 24 hours of Task Order (within zones) Check-in at Mob Center, FOSA or other location Turned over for tactical control by FEMA Logistics in concert with ESF #8 LNO. 11 National Disaster Medical System NDMS is a coordinated effort of HHS, DoD, VA and DHS (FEMA), in collaboration with the States and other appropriate public or private entities. Partner agencies provide a continuum of care Complementary assets 12 4

5 3 Major Components of NDMS Medical Response Lead - HHS Patient Evacuation Definitive Care Lead - DoD Lead VA/DoD DMAT IMSuRT NVRT DMORT DoD Aeromedical Evacuation Fixed Wing Federal Coordinating Centers NDMS Hospitals 13 DoD Patient Movement 14 NDMS Patient Evacuation Patients to be evacuated by NDMS are inpatients DoD has the lead and the responsibility to evacuate NDMS patients from the APOE/AMP(s) to FCC(s) NDMS Patient Evacuation Components Patient Movement Request Patient Regulating (TRAC2ES) Patient Tracking (JPATS) Aeromedical Staging Aeromedical Evacuation/Lift (primarily fixed wing) Patient Reception & Distribution (FCCs & NDMS Hospitals) Patient Return to Home of Record 15 5

6 NDMS Lift Capacity Patient Evacuation commences 36 hours from notice System can move 500 patients per day (up to 20% critical) Requires (4) operational APOEs Limited capability for patients Suggest the following patients be evacuated by other modes High-acuity burn NICU and PICU Psychiatric (if requires medical supervision) 16 Limiting Factors Patient Movement Requests Number of patients; over period of time (approximately) FEMA Mission Assignment (MA) to DoD Identification of APOE/AMP(s) (need DoD approval of airfields) Rate of delivery to the APOE/AMP(s) right patient right airhead right order/time Acuity of patients (higher acuity = less patients) Litter/Ambulance space, number of patients/plane Critical CCATT, Equipment, O2 (20% max) Vented CCATT, Equipment, O2 # Non-medical attendants (i.e. pediatric patients - 20% max) 17 Aero-Medical Evacuation (AE) Process Designated Regional Coordinator (DRC) if identified State EOC/DOH DOC USTRANSCOM Submits Patient Movement Request (PMR) PMR AE Liaison PMR PMR PMR Global Patient Movement Air Mobility Command (AMC) Joint Patient Requirements Center Tanker Airlift Control Center (TACC) Movement (GPMRC) Team (JPMT) Local Hospital State Controlled Medical Airfield Incident Evacuation Aircraft Commander DASF MAC ST Hospitals Load APOE/AMP Patients According to Scheduled Aircraft Missions JPATS Team EPLO Ambulances Normally Move to AMP 1 2 Hrs AELT CRE Prior to Arrival of Aircraft Mission () Built and Crews Alerted (Msn #, Time, Loc, Etc) Ambulances dispatched to hospitals to pick up patients and move to the APOE APOD/FCC Normally Within miles of APOD NDMS Hospital JPATS SAT 18 6

7 MD VT NH MA CT NJ DE RI 9/19/2013 NDMS Federal Coordinating Centers (FCCs) AK WA MT ND MN ME OR ID WY SD WI MI NY Army FCC CA NV AZ UT CO NM TX NE KS OK IA IL MO AR IN KY TN PA OH WV VA NC SC Navy FCC Air Force FCC VA FCC MS AL LA GA FL USVI HI GUAM PR 19 FEDERAL PATIENT TRACKING HOSP HOSP HOSP HOSP APOE JFO DCO/E PM SAT JRMPO DASF/MAC ST JPRT State EOC JPMT PMR Manifest TRAC2ES TACC GPMRC APOD Manifest FCC (DOD & VA) NDMS Hospital JPATS/At Risk Registry TRAC2ES ITV JPATS/At Risk Registry NDMS PATIENT VISIBILITY STATE/HHS USTRANSCOM FCC/HHS/STATE 20 Acronyms AE AMC AMP APOE APOD CCAT DASF DSCA FCC GPMRC JPATS JPMT MAC ST PMR SAT TACC TRAC2ES TRANSCOM Aeromedical Evacuation Air Mobility Command Aeromedical Marshalling Point Aerial Port of Embarkation Aerial Port of Debarkation Critical Care Air Transport Team Domestic Aeromedical Staging Facility Defense Support to Civil Authorities Federal Coordination Center Global Patient Movement Requirements Center Joint Patient Assessment Tracking System Joint Patient Movement Team NDMS DMAT Mobile Acute Care Strike Team Patient Movement Request USPHS Service Access Team Tanker/Airlift Control Center TRANSCOM Regulating and Command & Control Evacuation System Transportation Command 21 7

8 Return Movement of Domestic Medical Evacuees Involves returning patients who were evacuated through Federal ESF#8 Destination locations could include home, originating facilities, intermediate care facilities HHS Service Access Teams (SATs) shall ensure proper services afforded medical evacuees SAT will serve as patient advocates and provide medical and human services case management Patients will be tracked through the system using JPATS 22 NDMS Patient Movement; The Challenges Takes 2-3 days to get this system fully ramped up from a cold start. Has finite capacity. Not a flexible system that can be parted out. It uses the hospitals within the NDMS system Does not prioritize in-state relocation Repatriation is an HHS reasonability. Done through contract. Requires a Stafford Act Declaration or a Public Health Emergency. Requires EMS transport from Hospital to APOE 23 Questions? David Kerschner david.kerschner@hhs.gov