# Presentation: 526209

## Global Patient Movement Requirements 

**Global Patient Movement Requirements **
**Center (GPMRC)**

***Objective:  ***
***At the end of this session the participants should understand the Global Patient Movement Requirements Center (GPMRC) roles and responsibilities during contingencies.***

**Notes:**
-Good Morning/Afternoon , I’d like to introduce myself, and Welcome you to the Primary Receiving Center Course.   I am LT Geoffrey Young , MSC, USN , Chief, Readiness and Training Branch for the Global Patient Movement Requirements Center here at Scott AFB.  I have been at GPMRC for the last 2 years.

-The purpose of my briefing is to provide an overview of GPMRC, it’s roles and responsibilities during times of Military emergency/contingency.

## Overview

***Guidance***
***Alert Notifications***
***Regulating***
***Throughput Calculations***

**Global Patient Movement Requirements **
**Center (GPMRC)**

***Overview***

**Notes:**
- We will briefly discuss Guidance associated with Patient Movement.

The Alert Notification process, and GPMRC’s Role.

Discuss Regulating practices and policies.

And cover throughput calculations and their importance.

## Guidance

*** ******Public Law 97-174, Section 2 (b)***
*** ******DoDD 6010.22 – National Disaster Medical System ******	******(Jan 03)***
*** ******DoDD 6000.12 – Health Services Operations and ******	******Readiness (Jan 98)***
*** ******DoDI 6000.11 – Patient Movement (Sep 98)***
*** ******AFJI 41-315 – Regulating to and within the CONUS***
*** ******Joint Pub 4-02 – Health Service Support (Oct 06)***
*** ******VA-DoD Memorandum of Agreement  (Nov 06)***

**Global Patient Movement Requirements **
**Center (GPMRC)**

***Guidance***

**Notes:**
As you will note these are the primary publications which guide us in Patient Movement.
Also discussed but not listed are the Air Force 11 Series, and 41 Series.  These instructions provide detailed information related to the use of/ and policies related to “Fixed-Wing” assets.

## Activate the NDMS in time of war or national emergency involving armed conflict when the DoD and the VA bed capability is insufficient to provide adequate treatment for military casualties.

The Assistant Secretary of Defense for Health Affairs (ASD(HA)) shall activate NDMS Federal Coordinating Centers (FCCs) with sufficient civilian hospital beds to support a military conflict when casualties exceed the combined VA-DoD Contingency Hospital System. 

Deactivation of the NDMS system will occur when projected casualties may be supported by VA-DoD facilities alone; the ASD(HA) shall deactivate the NDMS FCC/civilian in-patient support.

***The Assistant Secretary of Defense for Health Affairs (ASD(HA)) shall activate NDMS Federal Coordinating Centers (FCCs) with sufficient civilian hospital beds to support a military conflict when casualties exceed the combined VA-DoD Contingency Hospital System. ***
***Deactivation of the NDMS system will occur when projected casualties may be supported by VA-DoD facilities alone; the ASD(HA) shall deactivate the NDMS FCC/civilian in-patient support.***

**Global Patient Movement Requirements **
**Center (GPMRC)**

***DoDD 6010.22 Mission Statement***

**Notes:**
- Under para 4. “Policy” in DoDD 6010.22, National Disaster Medical System or NDMS it provides a succinct statement which I feel encompasses the “Mission” statement. 

## NDMS/VA-DoD Alert/Notification Process

**USD /P&R**

**NCA**
**SECDEF**

**ASD/HA**
**OASD/HA**

**USHS/VA**

**TRANSCOM**

**NORTHCOM**

**FEMA**
**Asst Dir RR&R**

**SGs access data from GPMRC**

**Bed reporting**

**Joint Staff**
**NMCC**

**OSD Exec Sec**

***NDMS/VA-DoD Alert/Notification Process***

**VA/DoD Contingency Hospitals**

**NAVY SG**

**ARMY SG**

**Air Force SG**

**GPMRC**
**Notifies Services**

**VA FCCs**

**DHHS/OEPR**

**NDMS OSC**

**TRANSCOM**
**VA reports bed capability & capacity to the Global Patient Movement Requirements Center**

**JFC/CC**
**CONUS Med Ops Plan**

**Rgulation/Movement/Reception to VA/DoD and NDMS MTF’s**

**USTC/SG**

**JDOMS**

**USD /P&R**

**NCA**
**SECDEF**

**ASD/HA**
**OASD/HA**

**USHS/VA**

**TRANSCOM**

**NORTHCOM**

**FEMA**
**Asst Dir RR&R**

**SGs access data from GPMRC**

**Bed reporting**

**Joint Staff**
**NMCC**

**OSD Exec Sec**

**VA/DoD Contingency Hospitals**

**NAVY SG**

**ARMY SG**

**Air Force SG**

**GPMRC**
**Notifies Services**

**VA FCCs**

**DHHS/OEPR**

**NDMS OSC**

**TRANSCOM**
**VA reports bed capability & capacity to the Global Patient Movement Requirements Center**

**JFC/CC**
**CONUS Med Ops Plan**

**Rgulation/Movement/Reception to VA/DoD and NDMS MTF’s**

**Bed reporting**

**USTC/SG**

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
The VA/DoD Hospital System is activated first in the following manner;

The SECDEF determines that DoD needs VA medical care resources because of military conflict or other type of National Emergency that is generating military casualties beyond the capabilities of Military Medical Treatment Facilities (MTF).
SECDEF notifies the SECVA, in writing, of any need for medical care contingency support.
SECVA commits VA to provide support and communicates this commitment to the SECDEF in writing.
If it is then determined that DoD and VA capacity will become overwhelmed , the ASD/HA – has the authority to activate the civilian component (NDMS) to provide previously committed beds for military casualties.

GPMRC will notify “Service Surgeons” of the need for “Bed Reporting” and frequency of reports during the period of the contingency.
USH/VA notifies VA FCCs to begin “Bed Reporting”

## JP 4-02 Health Service Support 31 Oct 06

**Global Patient Movement Requirements **
**Center (GPMRC)**

***JP 4-02 Health Service Support 31 Oct 06***

**Notes:**
Keys statements on this excerpt;
Evacuation of Casualties to highly developed medical capabilities in the Joint Operational Area and locations outside the Theater for advanced medical services and rehabilitative care.
Decreased medical footprint and increased PM requirements demand a more interdependent medical community.
Improved interagency partnerships
Multinational partnerships 

## Global Patient Movement Requirements 

**Yokota**

***TPMRC will validate the PMR.  GPMRC will then coordinate with TACC and the MCC to complete the lift bed plan for patients returning to CONUS***

**McChord**

**GPMRC**

**USTC**

**TACC**

**AMC**

**ICMOP**
**DOD/Network/VA/NDMS**

**JFCOM**

**TPMRC**

**Travis**

**Miramar**

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
Example of potential contingency scenario;
 If an outbreak of hostilities occur in Korea?
JPMRC deploys forward to establish a “JTF-K” PMRC 
JPMRC will submit “PM” requirements to TPMRC-P GPMRC
TPMRC-P is responsible for theater-wide PM (e.g., medical regulating and AE scheduling) and coordinates with theater Medical Treatment Facilities to allocate the proper treatment assets required to support its role. The TPMRC communicates this transport to bed plan to the theater Service transportation component or other agencies responsible for executing the mission. The TPMRC coordinates with the GPMRC for inter-theater PM. 
GPMRC coordinates with transportation components/agencies.

## Regulating: VA-DoD MOU ’06 / AFJI 41-315

***Regulating: VA-DoD MOU ’06 / AFJI 41-315***

***Bed Reporting  (Quarterly to Daily)***
***VA-DoD must ensure compliance ***
***Reports updated in TRAC2ES ***
*** ******Closest MTF  (Capability and Capacity)***
***5 “Contingency Med Spec Codes”***
***CC – Critical Care***
***MM/SS – Medical/Surgical***
***SBN – Burn***
***MP – Psychiatric***
***MC - Pediatrics***

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
Bed Reporting  USH/VA and ASD/HA shall determine frequency.

ASD/Health affairs maintains communication/liaison with the Under Secretary of Health/VA.
Under the VA/Dod Contingency Plan, active duty patients into hospitals/medical facilities that meet the following:
Capability to deliver the most appropriate medical care
Nearest to Home/Unit of Record
Seamless transition from Mil to Vet status if required

May establish the Medical Interagency Coordination Group (MIAG)
Determines Medical capability delivery
Identifies “Limiting Factors”
Initiates Plans/Actions to address factors
Refines discharge/transfer plans

## Regulating: DoDD 6000.12, 

***Regulating: DoDD 6000.12, ***
***DoDI 6000.11/AFJI 41-315***

***  ******Deliverables to PRCs:***
***Mission manifest information with times and patient loads***
***PRC will pass information to individual facilities***
***Patient clinical and administrative data***
***Depth of information dependent on availability of data***
***May be limited due to nature of contingency***
***Regulate patients, provide “ITV” for those transported on DoD owned/controlled assets from Aerial Port of Embarkation/Debarkation (APOE/D)***

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
As stated in DoDI 6000.11, Patient Movement

5.6.5.6. In accordance with Chapter 55 of 10 U.S.C., the "National Plan," and the MOU (references (i), (j) and (g)), GPMRC shall coordinate with the VA for treatment of patients in VA Medical Treatment Facilities when required. The GPMRC shall also serve as the patient movement requirements center for the NDMS, in accordance with the NDMS partnership agreement and guidelines provided by the Joint Director of Military Support (JDOMS).

## Regulating: DoDI 6000.11/AFI 11-2AE Series

***Regulating: DoDI 6000.11/AFI 11-2AE Series***

***  ******Non-Medical Attendants (NMAs)***
***One able bodied adult /immediate family ***
***NMAs may be limited due to contingency***
***Critical Patients (Life threatening)***
***Pediatric Patients***
***Burn Patients***
***  ******Authorized Animals on AE Platforms***
***Military Working Dogs***
***Seeing Eye Dogs***

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
Depending upon casualty flow and airframe capability Non-medical attendants may be either limited or curtailed as the situation demands

As demonstrated in a recent exercise, Ultimate Caduceus 08 NMA’s initially reduced airframe capability by two-thirds.

Military Working Dogs may be transported on AE platforms.  The animal should be prepared for flight:
Handler must kennel the animal if available
Muzzle the animal/and provide Lead
Provide all necessary supplies i.e. Food, Water, Medications

## “Throughput” Calculations: (AFJI 41-315)

***“******Throughput” Calculations: (AFJI 41-315)***

*** ******Current Hospital Bed Census/Discharge Plan***
***Supporting Facilities MOU/MOAs ***
***Hospitals (DoD, VA and NGO)***
***APODs (Airports/Airfields)***
***Management and Labor***
*** ******Transportation Assets***
***Organic vs. Contracted***
***Vehicle capability and capacity***
***Crew qualifications***
***Transit time from PRC to VA/DoD MTF***
***Vehicle Maintenance schedules***
**	****	**** **

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
Throughput — 1. In transportation, the average quantity of cargo and passengers that can pass through a port on a daily basis from arrival at the port to loading onto a ship or plane, or from the discharge from a ship or plane to the exit (clearance) from the port complex.  Throughput is usually expressed in measurement tons, short tons, or passengers. Reception and storage limitation may affect final throughput. 2. In patient movement and care, the maximum number of patients (stable or stabilized) by category, that can be received at the airport, staged, transported, and received at the proper hospital within any 24-hour period.
(JP 1-02)

## Summary

***Guidance***
***Alert Notifications***
***Regulating***
***Throughput Calculations***

***Summary***

**Global Patient Movement Requirements **
**Center (GPMRC)**

**Notes:**
Self Explanatory

Mr. Stewarts’ Introduction!!!!!