# Presentation: 017204

## Logistics  

_**Logistics**_**  **
**Block 9**
**February 2009 FCC & PRC Training**

## Little Rock FCC Capabilities

***12 NDMS Hospitals***
***Average 300 available beds***
***30+ Ambulance crews with more available through Mutual Aid***
***Excellent support from Little Rock National Airport and hangar facilities of Central Flying Service***
***Manpower and Flight Crew support from Little Rock Air Force Base***
***Can stand-up for reception activities on short (4 hour) notice***
***Trained Emergency Medical Response Team at VA Medical Center***
***Exercise often***
***Experience with Katrina and Rita ***
***Geography – relatively short flying times from threat zone in Louisiana******   ***

## Patient Reception Activities

***People ***
***Incident Commander, Finance/Administration Logistics, Operations, Planning***
***Triage Teams***
***Medical Teams***
***Patient Movement***
***Equipment Setup and Removal***
***Patient Tracking***
***Public Affairs***
***Communications (VSAT)***
***Food Service***

## Equipment – Medical 
ECG (electrocardiogram)
Digital thermometers
Non invasive blood pressure monitoring equipment
Pulse Oximeters
Suction and infusion pumps
Vital signs monitors
Crash cart
Spine boards
Restraints

***ECG (electrocardiogram)***
***Digital thermometers***
***Non invasive blood pressure monitoring equipment***
***Pulse Oximeters***
***Suction and infusion pumps***
***Vital signs monitors***
***Crash cart***
***Spine boards***
***Restraints***

***Patient Support Equipment***
***Wheelchairs (including bariatric)***
***Litters***
***Litter Stands***
***Walkers***
***Oxygen***
***Suction***
***Ventilators***
***Other***

**Equipment**

## Slide 6

## FCC Operations Statistics

***Operations stood up at Noon, Saturday, August 30, 2008***
***First patients arrive 10:57PM, Saturday, August 30, 2008***
***Last flight received 9:30 PM. Sunday, August 31, 2008***
***225 Acutely ill patients received, triaged and transported***
***197 litter, 28 ambulatory***
***44 non-medical attendants transported***
***13 Aircraft, 9 C-130 & 4 C-17***
***12 NDMS hospitals in Little Rock area used***
***USTRANSCOM manifested less than 100 patients***
***All patients tracked from airport reception to return home***
***6 deaths***
***All patients returned by October 1, 2008.***

## “Rule of Thumb”

**FCCs ****	**
**Coordinate Logistics for PRAs****	****	****(NDMS)**
**Coordinate Logistics for SCCs ****	****	****(NDMS)**
**PRCs **
**Coordinate Logistics for PRAs****	****	****(ICMOP)**
**Coordinate Logistics for facility****	**** ****	****(ICMOP)**
**PRAs**
**“****Space”****	****	****	****	****	****(ICMOP/NDMS)**
**Logistics coordinated through FCC/PRC**
**SCCs ****	****	****	****	****	****(NDMS)**
**Logistics coordinated through FCC****	****(NDMS)**

**Logistics**

**Notes:**
This is meant to help make your logistics requirements clear.  If you are an FCC with an NDMS mission your are designated a PRC for the ICMOP mission and need to develop logistics requirements for both scenarios.  If you are a PRC not designated as an FCC you only have the ICMOP mission and should tailor your logistics plans accordingly.  The most significant difference is:  NDMS will most likely generate patients not common to “war time/contingency medicine.”  Logistics consideration needs to include possible patient events such as bariatric dementia, elderly, and pediatric patients you might even receive pets.  ICMOP patients will almost always be active duty military members.  One thing to note is:   Some VA/DoD centers organize their own staff to form patient reception teams.  However, there are some that have been successful in obtaining community resources to conduct the patient reception process such as the Metropolitan Medical Response System (MMRS), NDMS DMAT or Medical Reserve Corps.  Know your customers and know their requirements to prevent a logistics shortage at the time of alert or activation.   

## Logistics

***Is it on a PROGRAM OBJECTIVE MEMORANDUM?***
***Is it on a DESIGNED OPERATIONAL CAPABILTIY STATEMENT?***
***Is it on a UNIT TYPE CODE?***
***Is it WAR RESERVE MATERIEL?***
***...******.is it FUNDED?***
***Pre-Plan to record costs***
***Pre-Plan to recover costs***

**Logistics**

**Notes:**
Logistics can be costly.  NDMS logistics requirements can present requirements not normally inherent to the facility whereas ICMOP requirements will most likely be requirements inherent to the facility.  The logistics challenge will be identifying proper requirements and stocking the requirements at a level that enables the facility to meet the mission with little notice while remaining fiscally responsible. Time frames to consider are: Initial Notification, to include the PRAs and SCCs, Surge, and Quiescent Operations.  Logistics demands could be significantly different during these time frames

## FCC Director/FCC Coordinator	(NDMS)
PRAs
Air Field, Port, Dock, Railhead  Managers
DoD Base/Post Commander
Community Fire Department 
Community Emergency Management Services (EMS)
Contracted Transportation
Community Charity
Nationwide Network (Non-Federal Acute Care Hospitals)
Secondary Support Centers

PRC Director/PRC Coordinator	 (ICMOP)
DoD Base/Post Commander
PRAs
Installation Logistics Functions
Air Field, Port, Dock, Railhead Managers
Medical Facility 
DoD/VA Casualty Receiving Hospitals

***FCC Director/FCC Coordinator******	******(NDMS)***
***PRAs***
***Air Field, Port, Dock, Railhead  Managers***
***DoD Base/Post Commander***
***Community Fire Department ***
***Community Emergency Management Services (EMS)***
***Contracted Transportation***
***Community Charity***
***Nationwide Network (Non-Federal Acute Care Hospitals)***
***Secondary Support Centers***
***PRC Director/PRC Coordinator******	****** (ICMOP)***
***DoD Base/Post Commander***
***PRAs***
***Installation Logistics Functions***
***Air Field, Port, Dock, Railhead Managers***
***Medical Facility ***
***DoD/VA Casualty Receiving Hospitals***

**Logistics**

**Customers**

**Notes:**
As you can see the FCC and PRC has some similarities and some differences.  Take all these into consideration when analyzing the effectiveness of your logistics support plan 

## Logistics

**Logistics**

**Team Coordinators**
**Medical Triage Officer**
**Trauma Physician**
**Surgeon**
**Nursing Staff**
**Respiratory Therapist**
**Chaplain**
**Public Affairs Officer**

**Litter Bearers**
**Patient Tracking**
**Patient Registration**
**Laborers**
**Psychiatrist**
**Psychologist**
**Housekeepers**
**Security Police**
**Pharmacist**

**Logistics Customers**

**Notes:**
Here is a list of others that might come to you for logistics support. It would be wise to plan with all persons involved and make sure all logistics requirements are met for all persons prior to alert or activation.

## Logistics

_***Patient Staging    Logistics***_*** ***
***Supplies and Equipment Required for Patient Staging***
_***Patient Support Logistics ***_
***Supplies and Equipment Required for Patient Care***

**Logistics**

**Notes:**
There are two general areas of logistics: Patient Staging Logistics and Patient Support Logistics.  Patient Staging Logistics are the supplies and equipment needed for staging the patients.  Patient Support Logistics refers to the supplies and equipment required for patient care at the patient reception area.  Remember to integrate the NDMS/ICMOP planning requirements into the logistics requirements the facilities will experience if activated; especially an ICMOP activation.

## Logistics

**Logistics**

***Shelter***
***Food***
***Water***
***Clothing***
***Sanitation***
***Waste Management***
***Storage***
***Communication***
***Contracting***
***Air Field Support***
***Base/Post Support ***

**Patient Staging Logistics**

**Notes:**
- Here is an example of Patient Staging Logistics.  Some points for SHELTER is making sure to procure through an MOA or a contract, space large enough and environmentally controlled enough.  Remember in the MOA or Contract all Power, Lighting, Fuel and other utility costs.  Alternates to buildings of opportunity is tents, trailers, portable shelters etc.  Remember to plan in all the space and BOS procurement requirements associated with this option.  FOOD AND WATER:   Remember ICE!  If possible plan to cater to the culture of patients; especially with NDMS missions (elderly, children, religious, etc)  Explore Volunteer Groups, Donated Supplies, Charities, etc especially for NDMS scenarios.  CLOTHING:  Be cognizant of the climate the patients are being transported from.  This might drive a requirement for coats, blankets, or the reverse: a heavy clothing swap-out for lighter clothes and clothing storage requirement.  Remember all possible Patient Gown requirements.  Another part of clothing is team work attire and uniforms such as foul weather gear, Personnel Protection Equipment, and ICS vests. SANITATION:  First consider the logistics requirements for personnel hygiene and toilets.  Second, consider waste management, - medical waste, sharps, pathologicals and radiological as well as regular waste to include HAZMAT. STORAGE: Plan logistically for Blood and Blood Products. Litters and Litter Straps, Wheelchairs, Patient Valuables (will differ significantly from NDMS and ICMOP) Weapons, Narcotics, and Controlled Substances.

## Logistics

**Logistics**

***Medical Materiel***
***Medical Equipment***
***Medical Supplies***
***Pharmaceuticals***
***Blood***
***PMI***

**Patient Support Logistics**

## 
Administrative and General
Clipboards				Paper Clips
Printers Paper and Cartridges	Pencils/Pens
Felt Tip Pens				Rubber Bands
File Boxes				Staplers/Staples
File Folders				Tape
Forms				Writing Pads
Maps				Guidelines
Checklists				Plans
Regulations

**DO NOT OVER LOOK IT, COMM, POWER GENERATION and SIGNAGE

***Administrative and General***
***Clipboards******	******	******	******	******Paper Clips***
***Printers Paper and Cartridges******	******Pencils/Pens***
***Felt Tip Pens******	******	******	******	******Rubber Bands***
***File Boxes******	******	******	******	******Staplers/Staples***
***File Folders******	******	******	******	******Tape***
***Forms******	******	******	******	******Writing Pads***
***Maps******	******	******	******	******Guidelines***
***Checklists******	******	******	******	******Plans***
***Regulations***
_*****DO NOT OVER LOOK IT, COMM, POWER GENERATION and SIGNAGE***_

**Patient Support Logistics:**
**Non-Medical Supplies**

- *Example from David Grant USAF Medical Center, FCC, Travis AFB CA

**Logistics**

**Notes:**
There are also Non-Medial Supplies.  Here is an example from David Grant Medical Center 

## Logistics

**Logistics**

***        ******2x2s - 4 boxes ******	******	******	******	******IV Trays******	***
***	******Airways, Disposable - 10 medium ******	******	******	******KCL 20 Megs - 4 Ampoules***
***	******Alcohol swabs - 2 boxes ******	******	******	******Life pack - 1***
***	******Ammonia inhalants - 4 boxes ******	******	******	******Masks 02 - 20***
***	******Bacitracin ointment - 1 box ******	******	******	******Nylon tape - 1 box ea. (1⁄2", 1", 2")***
***	******Band-Aids - 4 boxes ******	******	******	******	******Otoscopes/Ophthalmoscopes w/3 batteries ***
***	******Betadine swabs - 4 boxes ******	******	******	******Penlights - 6***
***	******Blood pressure cuffs - 6 ******	******	******	******Portable 02 - 20***
***	******Cold packs - 6 boxes ******	******	******	******	******Portable suction - 5***
***	******Cotton tip applicators - 4 pkgs ******	******	******	******Reflex hammers - 3***
***	******Dressings  ******	******	******	******	******Restraints - 5***
***	******ABDs - 50 ******	******	******	******	******Scissors - 6***
***	******Ace bandages - 3"x12" ******	******	******	******Splints ***
***	******Ace bandages - 4"x12"******	******	******	******	******Arm - Air - 1***
***	******Cravats - 50******	******	******	******	******Baalsa Wood - 6***
***	******Kling 3" - 20******	******	******	******	******Hand traction - 1***
***	******Kling 4" - 20******	******	******	******	******Leg - Air - 1***
***	*******Drug Kit ******	******	******	******	******Stethoscopes - 6***
***	******Emergency Crash Cart - 1 ******	******	******	******Tongue Blades - 4 boxes***
***	******Eye dressing/Eye pads - 2 boxes ******	******	******	******Tourniquets - 4***
***	******Intercaths - 10 ea. (18, 20, and 22 ga.) ******	******	******Volutrol - 20 ea.***
***	******IV fluids - 2 boxes***
***	******	******1000cc RL - 10***
***	******	******1000cc D5W - 10***
***	******	******1000cc D5NS - 10***
***	******	******1000cc D5RL – 10***
**** Drug kits will be assembled by the Pharmacy Team upon activation.***

**Patient Support Logistics: Medical Supplies**

*******Example from David Grant USAF Medical Center, FCC, Travis AFB CA**

**Notes:**
Here is an example of medical supplies planned for patient support logistics.

## Logistics

**Logistics**

***	******IV Trays***
***	***
***	******Life pack – 1***
***	******Otoscopes/Ophthalmoscopes w/3 batteries ***
***	******Blood pressure cuffs - 6 ***
***	******	******	***
***     ******Portable 02 – 20***
***	******Portable suction – 5***
***	******Stethoscopes – 6***
***	******Emergency Crash Cart - 1 ******	******	******	******	***

**Patient Support Logistics: Medical Equipment**

- *Example from David Grant USAF Medical Center, FCC, Travis AFB CA

**Notes:**
And a continuation of the patient  support logistics.

## Logistics

**Logistics**

**Notes:**
Here is an example of the patient support logistics for PRA activities provided by the Army.  Note: They have captured unit and total costs.

## Logistics

***Security ***
***EMS/Ambulances/Air Ambulance/Ambus (civilian or military)***
***Contracted Transport***
***Buses***
***Shuttles***
***Passenger Vans***
***Comm***
***Pest Control***
***Fuel***
***Food/Billeting***

**Logistics**

**Contracted Services**

**Notes:**
Here are some examples of items that could be contracted out in the event of the actual need.  It is important to effectively integrate contracting into your logistics plans and requirements.  One big consideration is FLIGHTLINE ACCESS and SECURITY CLEARNACES.  Consider your mission and contract accordingly. 

## Logistics

***Body Tags and Bags***
***Patient Movement Item Management***
***Communications***
***Signage***
***Lighting***
***Adverse Weather***
***Ice, Snow Removal***
***Wind, Rain, Dust, Pest Mitigation***
***Heating and Cooling***
***Pets***
***Your Team!!***

**Logistics**

**REMEMBER!**

## Logistics

***Base your Logistics Plans on:***
***Activation***
***Patients per 24 Hour Period (Quiescent)***
***Maximum Surge from Planned Patients***

**Logistics**

**PLANNING FACTOR**

## Logistics

***AFI 41-209***
***AR 40-61***
***Navy Operational Medical Logistics***
***Navy Health Services Strategies***
***Ft Dietrich ***

**Logistics**

**IMPORTANT DOD NOTES**

## Questions?

**Major Gregory J. Ready**
**Chief, Homeland Security Operations**
**Headquarters Air Force, SG3XO**
**DSN: 222-7683   COMM: 703-692-7683**
**gregory.ready@pentagon.af.mil**
**703-692-7683**

**J. Rex Oxner**
**Area Emergency Manager**
**Central Arkansas Veterans Healthcare System**
**j.oxner@med.va.gov**
**501-257-1015**