# Presentation: 791383

## Logistics

**Logistics**

***At the end of this session participants will have a working knowledge of the  logistical requirements of a Primary Receiving Center.***

**Notes:**
Managing the supply chain and controlling the flow of goods, information, personnel and other resources between the point of origin and the point of consumption in order to meet customers' requirements. It involves the integration of information, transportation, inventory, warehousing, material handling, and packaging.

## Logistics

***Patient Staging    Logistics***
***Patient Support   Logistics***

**Logistics**

**Overview**

**Notes:**
There are two general areas of logistics that we will be discussing today-Patient Staging Logistics and Patient support Logistics.  Staging logistics discusses the supplies and equipment needed for the staging of the patients, and support logistics refers to the supplies and equipment required for patient care at the patient reception area.

## Logistics

**Logistics**

***Shelter***
***Food***
***Water***
***Clothing***
***Sanitation***
***Waste Management***
***Storage***
***Communication***

**Patient Staging Logistics**

**Notes:**
-You will want to have some type of food available for the DoD patients.  They may have not had any food for several hours, depending on where they are coming from, and the circumstances.

-Water is especially necessary to hydrate if temperatures are warmer, but still needed even on cooler days.
-Coordination of sanitation is needed for hand washing, as well as the fact that there will be spills and/or other messes to clean up.  
-Waste removal of regular, red bag waste, etc will also be needed.

-A location to store medical and other supplies may be necessary if you want to be able to pick up and quickly go to the PRC site.  If  you don’t have ready and stored, all necessary items will need to be gathered, and made ready for transport.

-Various methods of communication should be explored-from Very Small Aperture Terminal (VSAT), which provides broadband, VOIP and virtual private networking; Satellite Phone-the drawback which is you need to have direct line-of-sight access to the open sky, or an outdoor antennae specifically configured for satellite use.

## Logistics

**Logistics**

***VA Team ***
***Control Team members***
***VA Medical Center resources, i.e. staff, pharmaceuticals and medical supplies are available***

***Community Team***
***Community Fire Department resources available***
***Community Fire or Emergency Management Services (EMS) triage daily***
***Community charity groups available to support feeding patients and staff at reception site***

**Patient Support Logistics**

**Notes:**
Many VA medical centers organize their own staff to form a patient reception team.  However, there are some VA medical centers that have been successful in obtaining community resources to conduct the patient reception process.  These community resources may come from the Metropolitan Medical Response System (MMRS), NDMS DMAT or Medical Reserve Corps.   

## Logistics

**Logistics**

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

***Litter bearers***
***Patient Tracking***
***Patient Registration***
***Laborers***
***Psychiatrist***
***Psychologist***
***Housekeepers***
***Hospital police***
***Pharmacist***

**Patient Support Logistics**
***Reception Team depends on number and type of patients.  Team members may include:***

**Notes:**
The listed team members are only a suggestion or a guide.  Again, the make up of the team will depend on the number and type of patients that are being transported to your area of responsibility.  It will also depend on whether or not the team is a VA team or a community team.  A community team may not have all of the positions available.  The concept that I have been taught and believe in is to off load, triage and transport the patients to the appropriate facility as quickly as possible.  Therefore, most of the clinical work should be done at the hospital and not at the patient reception site so many of the specialist may not be needed at the reception site.

## Logistics

**Logistics**

*** ******Automated external defibrillator (AED)***
*** ******Bandages***
*** ******Blankets***
*** ******Blood Pressure devices***
*** ******Bags (body)/tags***
*** ******Catheter***
*** ******Disposable survival blankets***
*** ******Flash/pen lights***
*** ******Gauze***
*** “******Hot & cold" packs***

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

**Notes:**
Your patient reception team will need medical supplies and equipment to support the types of patients you would be expected to receive, such as injuries from blasts, open wounds, fractures, etc.  Here are just some of the supplies needed:
Automated external defibrillator (AED)
Bandages
Blankets
Blood Pressure devices
Catheter
Disposable survival blankets
Flash/pen lights
Gauze
“Hot & cold" packs
Intravenous equipment
Medical Tape
Splints
Syringe
Tourniquet
Tongue depressors 

Pharmaceuticals (may include controlled substances)
Equipment, such as wheelchairs/litters
You will need to have EMS standing by for those that need ventilator assistance, defib, etc

## Logistics

**Logistics**

***Intravenous equipment***
***Medical Tape***
***Splints***
***Syringe***
***Tourniquet***
***Tongue depressors ***
***Pharmaceuticals (may include controlled substances)***
***Equipment, such as wheelchairs/litters***
***You will need to have EMS standing by for those that need ventilator assistance, defib, etc***

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

## Logistics

***Fixed or portable – Provides a controlled environment for patient reception activities***
***Hangar Space***
***Other fixed airport or airbase building***
***Modular or Hybrid Buildings (Western Shelter type)***
***Tent Sites***
***Trailers***

**Logistics**

**Patient Staging: Shelter**

**Notes:**
-It’s going to be preferable that you have somewhere/someplace to stage the patients, especially if they cannot be immediately put on an ambulance or other mode of transportation right off the aircraft.  There are a variety of means to provide shelter, from airport/base building, hanger, etc.  Meet with the appropriate leaders at the base to determine what building would be feasible to temporarily stage patients.

There are modular or pre-fabricated type buildings that can also be placed at the site in very little time, with the appropriate planning.

A tent is another method of providing shelter.  With proper placement and planning to prevent rotor wash from blowing on the tent.

A trailer is yet another means to explore.  A benefit of a trailer is that there is little preparation time, less manpower needed to set up, and able to be transported with little notice.

## Logistics

**Logistics**

***Portable Kitchen Facilities***
***Volunteer Groups***
***Donated Supplies***
***Trucks, Trailers, Tents***
***Utensils and Sanitation***
***MREs***
***Water-i.e. bottled, bulk***

***Patient Staging: Food & Water***

**Notes:**
-You will want to have some type of food available for the DoD patients.  They may have not had any food for several hours, depending on where they are coming from, and the circumstances they came from.

There are many different options to consider in planning to feed these patients.  Many volunteer and religious groups have portable kitchen facilities, and would be happy to come to feed DoD patients.  There are  also retail establishments that are willing to donate food/groceries for this cause.

In providing food and water, it is beneficial to plan to have an area where they can be fed.  A fixed structure at the airport is ideal, however, if space is limited due to patient operations, look into utilizing a tent, trailer, or other structure as previously discussed.

Plan also to have the appropriate utensils and a way to sanitize them before and after use.
Another food option is to provide MRE’s.  
Water can be provided by a retailer, either in bottles or in bulk-utilizing a “water cooler” type dispenser.

## Work Attire/Uniforms
Foul Weather Gear
Personal Protective Equipment (clothing, gloves, shoes)
Protective Garments
Gowns/Patient Clothing
ICS Vests

***Work Attire/Uniforms***
***Foul Weather Gear***
***Personal Protective Equipment (clothing, gloves, shoes)***
***Protective Garments***
***Gowns/Patient Clothing***
***ICS Vests***

**Logistics**

**Patient Staging: Clothing**

**Notes:**
Having the proper clothing is an important aspect to consider.  PRC workers should wear the proper clothing, such as the uniform, if applicable, that they normally work in at the hospital.

Foul weather clothing, such as rain, winter gear should be brought by the PRC workers, depending on the season and weather forecast.  The PRC organizers should keep PRC workers informed of the forecast. 

Proper protective garments should be provided for PRC workers, such as barrier gowns, gloves, masks, etc.

Incident command (IC) vests should be worn by IC staff when working at the PRC site

## Hand washing
Hand Sanitizer 
Patient Care Items (soiled clothing, linens)

***Hand washing***
***Hand Sanitizer ***
***Patient Care Items (soiled clothing, linens)***

**Logistics**

**Patient Staging: Sanitation**

**Notes:**
Coordination of sanitation is needed for hand washing.  Ideally, the PRC site will have hand washing facilities there for patient care and non/patient care workers to utilize to wash their hands.  However, if there are none available, there are various commercial means to provide portable hand washing facilities.

Hand sanitizer is also an effective alternative to regular hand washing in urgent situations, when hand washing is not feasible.  Ensure sufficient quantities of hand sanitizer is available at the site.

Ensure that there are proper laundry bags/containers for contaminated or soiled patient care clothing or linen items, such as bloody or soiled clothing, linens, etc.  These should be tagged or bagged as appropriate and placed in the proper bags or receptacles to be laundered.

## Medical Waste 
Blood and Blood Products
Sharps 
Isolation Waste
Pathologicals
Soiled Dressings
Regular Waste
Radiological Waste

***Medical Waste ***
***Blood and Blood Products***
***Sharps ***
***Isolation Waste***
***Pathologicals***
***Soiled Dressings***
***Regular Waste***
***Radiological Waste***

**Logistics**

**Patient Staging: Waste Management**

**Notes:**
Ensure that medical waste, such as blood and blood products or items contaminated by blood and blood products, such as isolation waste, pathological, soiled dressings, etc  are properly disposed in red bags and that these bags are properly disposed of as is medical waste at your hospital. Sharps containers should be brought to the PRC site, and ensure that sharps devices are properly disposed in the containers.

It is possible that there would be radiological contaminated items would need proper disposal.  Therefore, plan to bring the proper receptacles that provide appropriate shielding, to have these items disposed of. 

Ensure that regular waste receptacles are available and that planning is done ahead of time to properly dispose of this waste.

## Blood and Blood Products (refrigeration required)
Litters (folding/backrest with straps)
Medical Supplies 
Pharmaceuticals (may include controlled substances)
Trailers
Wheelchairs

***Blood and Blood Products (refrigeration required)***
***Litters (folding/backrest with straps)***
***Medical Supplies ***
***Pharmaceuticals (may include controlled substances)***
***Trailers***
***Wheelchairs***

**Logistics**

**Patient Staging: Storage**

**Notes:**
-A location to store medical and other supplies may be necessary if you want to be able to pick up and quickly go to the PRC site.  If  you don’t have ready and stored, all necessary items will need to be gathered, and made ready for transportation.

Most PRC’s have trailers that are utilized to transport items such as wheelchairs, patient litters (both wheeled and standard), and  various medical supplies (as discussed earlier).

Refrigeration may be required to store blood and blood products for those patients who cannot wait to be transported to the hospital to be administered such medical care.

**Logistics**

**Storage (cont’d)**

**Notes:**
These are picture of items to consider storing until they are required to be brought to the PRC site.
Starting from upper left, and going clockwise
-Triage mats-these are used by spreading them out on the ground and placing the appropriate categorized patient on the mats, utilizing the TRIAGE method.
Standard military type litter can be folded lengthwise for storage purposes
-Triage flags-utilized similar to triage mats; patients would be placed near the flags for proper triage classification.
-NATO litter roller.  Place litter on wheels so it can be used by one person, can also roll over rough terrain 
-IC vests, tape-job action sheets, patient tags
-Rolling litter-useful especially if patients require to be brought a long distance from aircraft to triage location.

## Logistics

***Hand held radios***
***Bullhorns***
***White board/chalk board***
***Cell phones***
***Wireless laptop computer ******	******(air cards)***

**Logistics**

**Communication**

**Notes:**
Communication is always a critical component in field operations. Up to date information regarding the patient reception activity will be needed by triage teams, dispatchers, transportation assets, receiving facilities, medical control components and airfield personnel.  Tracking data on marker boards is critical for team management and patient tracking. Hand held walkie-talkie radios are the standard for group communication and offer ease of use, familiarity and ease of training for team members.  Bullhorns may be necessary for working in a large area or areas with high levels of ambient noise.  Wireless internet and e-mail could be crucial in accessing data base information such as TRAC2ES and EMSytems.  Land line availability is the most reliable but limits mobility and fax capability may be necessary for information exchange.  Satellite phones may be necessary when working in damaged or very remote areas.  Satellite phones may also be necessary if cell phone systems become inoperable.  The VSAT system allows for maximum flexibility with telephone and computer capability.  The VSAT allows access to the Computerized Patient Records System.  Amateur radios and operators can be extremely valuable assets to the PRC when other means of communication are unavailable or as an adjunct to other communication.     

## Logistics

**Logistics**

*** ******E-mail/Internet***
*** ******Land lines (including fax)***
*** ******Satellite phones***
*** ******VSAT (Very Small Aperture Terminal)***
*** ******Amateur Radio***
*** ******Communication Go-Kits***

**Communication**

**Notes:**
Go-KitTM from Sprint’s Emergency Response Team, public safety agencies can keep a cache of devices and Mobile Broadband Cards on-hand for emergencies, preparedness drills or pre-planned events. Simply purchase phones, cards and accessories and pay for service only when you use the equipment. 

## Logistics

***Triage supplies and mats***
***Incident Command vests***
***Job Action Sheets***
***Tags and bags***
***Office supplies and equipment***
***Sanitation supplies and equipment***
***Toilets (portable or fixed)***
***Tents***
***Trailers***
***Lighting***
***Other***

**Logistics**

**Non Medical Supplies and Equipment**

**Notes:**
Triage supplies will be used by the reception team to keep an orderly flow of patient movement from the aircraft to ground transportation.  The mats help to clearly identify triage stations for holding patients waiting for ground transportation.  
Incident Command System vests clearly identify critical staff in the reception area.
Job Action Sheets are tools for defining and performing a specific emergency response functional roles.
Triage Tags may be needed to assist with sorting and routing patients.  Bags such as large, zip-top bags can be helpful in transferring personal effects and other loose items.
Office supplies will be necessary to assist with patient triage, tagging, tracking, etc.
Sanitation supplies: trash bags, trash cans, red bags, medical waste containers and sharps containers.
Access to airfield toilets will be necessary for reception team members.  Portable toilets could be used if available.
Tents can be used to help protect patients and team members from the elements during reception activities.  They are also helpful for storing supplies and for team rest if necessary.
Trailers will be used to transport and store logistical supplies to and from the airfield.  Airfield operations may not allow trailers to remain in the reception area while not in use.  
Either fixed or portable lighting will be critical for night operations. 

## Logistics

***Base/Airport security coordination***
***EMS/Ambulances/Air Ambulance/Ambus (civilian or military)***
***Contracted Transport***
***Buses***
***Shuttles***
***Passenger vans***

**Logistics**

**Ground Transport Management**

**Notes:**
Security clearances should must be completed well in advance of reception activities.  Military bases and civilian airports may have very strict access protocols to follow for reception team members as well as ground transportation crews including local EMS personnel.  Drivers for contracted buses or vans may also need clearances.
Communication with and among ground forces like triage stations, ambulance crews and local hospitals can greatly expedite reception activities.
Patient tracking may require marker boards, office supplies, bar code readers, computers, telephones, radios, other.
Signage may be necessary for a variety of locations including, triage stations, restrooms, storage caches, tents and directionals.        

## Logistics

***Ambulance crews***
***Communication (with ambulance crews, treatment facilities, triage stations)***
***Patient tracking equipment***
***Signage***

**Logistics**

**Ground Transport Management**

**Notes:**
Communication with and among ground forces like triage stations, ambulance crews and local hospitals can greatly expedite reception activities.
Patient tracking may require marker boards, office supplies, bar code readers, computers, telephones, radios, other.
Signage may be necessary for a variety of locations including, triage stations, restrooms, storage caches, tents and directionals.        

## Mr. Randy Rodgers – AMC/SGXL 

**Mr. Randy Rodgers – AMC/SGXL**

## Patient Movement Items

***Medical equipment and supplies required to support the patient during evacuation***
***The purpose of the PMI system is to support patients in-transit, to exchange in-kind PMIs without degrading medical capabilities, and to provide prompt recycling of PMIs***
***The handling and return of equipment to the originating theater through the evacuation system is the responsibility of the logistics function***
***The originating Medical Treatment Facility is responsible for notifying the Patient Movement Requirements Center if the patient needs any special medical equipment for transport***

**Patient Movement Items**

**Notes:**
Specialized patient equipment will be used while the patient is in transit.  Once the patient is at the Medical Treatment Facility for definitive care, this equipment should be returned to the original departure site.
The mission of the PMI system is to support patients in-transit, to exchange in-kind PMI without degrading medical capabilities and to provide prompt recycling of PMI.

## Documented Lessons Learned From Operation Desert Shield/ Storm
Supplement to AE System Assets
Global Tracking – Asset Visibility

**Supplement to AE System Assets**
**Global Tracking – Asset Visibility**

**Patient Movement Items**

## Program focuses on 16 standardized items
Medical supplies and equipment required to support a patient during evacuation
Key elements: 
Inventory
Tracking 
Recycle Assets
Biomedical Maintenance

**Medical supplies and equipment required to support a patient during evacuation**
**Key elements: **
**Inventory**
**Tracking **
**Recycle Assets**
**Biomedical Maintenance**

**Patient Movement Items**

**Notes:**
While all the items to support a patient during AE are considered as PMI, this program focuses on 16 critical items which are fundamental to sustaining the AE system and to supporting forward capabilities.

## EQUIPMENT
Defibrillator/Monitor Zoll 
IV Controller- Alaris Medsytem III 
Oxygen Analyzer- MINIOX 3000
Pulse Oximeter- BCI 3303
Stryker Frame- 965MO
Suction Impact- 326M
Ventilator- 754M 
Vital Sign Monitor-Propaq 206EL

***Defibrillator/Monitor Zoll ***
***IV Controller- Alaris Medsytem III ***
***Oxygen Analyzer- MINIOX 3000***
***Pulse Oximeter- BCI 3303***
***Stryker Frame- 965MO***
***Suction Impact- 326M***
***Ventilator- 754M ***
***Vital Sign Monitor-Propaq 206EL***

***DURABLE SUPPLIES***
***Blankets***
***Litters***
***Over Sized Litter***
***Litter Mattresses***
***Litter Straps***
***Litter Backrest***
***Spine Boards***
***IV Pole***

**Patient Movement Items**

## 
Pulmonetics LTV 1000 Ventilator
KCI Freedom Wound Vac Pump
Patient Controlled Analgesic Pump (AmBit)
MOST-2B
Critical Care Platform (SMEEDS)
Power Infuser
SMEED

***Pulmonetics LTV 1000 Ventilator***
***KCI Freedom Wound Vac Pump***
***Patient Controlled Analgesic Pump (AmBit)***
***MOST-2B***
***Critical Care Platform (SMEEDS)***
***Power Infuser***
***SMEED***

**Patient Movement Items**

## Where?

***Program operates throughout U.S., Pacific, Europe, and in support of GWOT  ***
***Over 70 PMI tracking sites, 5 redundant data exchange hubs, and a web server***

**Patient Movement Items**

## Scott AFB, IL, AMC

Travis AFB, CA, AMC

Andrews AFB, MD, AMC

Yokota AB, JP, PACAF

Ramstein AB, GE, US

***Travis AFB, CA, AMC***
***Andrews AFB, MD, AMC***
***Yokota AB, JP, PACAF***
***Ramstein AB, GE, US***

**Patient Movement Items**

**PMI Centers**

## Patient Movement Items

***PMI Joint Service Tracking Nodes***
***Army Sites:***
***Baghdad – Mosul – Tikrit – Tallil - Al Asad***
***Air Force Sites: ***
***Balad – Biap – Kirkuk - Al Udeid – Bagram ***
***Navy Sites:***
***Djibouti - Arifjan***

**Patient Movement Items**

**AOR Sites**

## Slide 29

**CONUS**
**PMI**
**CENTER**

**CSH**
**CASF**
**EMDS**
**MASF**

**Disconnect**
**Clean**
**Ship to Center**

**Repair**
**Inspect **
**Ship**

**Calibrate**
**Prepare**
**Ship**

**On patient**

**CONUS MTF**

**OCONUS PMI Center**
** ****or PMI Cell**

**Patient Movement Items**

**Notes:**
With the transport picture in mind, the flow of USAF PMI begins with a regulated patient at the ASF/MASF interface.  As the materiel moves through the system, the goal is timely recycling.

The loop from ASF/MASF to CONUS MTF to CONUS PMI Center  and back to the OCONUS PMI Center is 8 days.  This has been blessed by AMC transporters as long as the proper priority is noted for the shipments.  Recycling longer than 8 days dramatically increases the USAF PMI requirement.

## 
Added 1-800 number to PMI barcode label
Added oversized litters to PMI program inventory

***Added 1-800 number to PMI barcode label***
***Added oversized litters to PMI program inventory***

**Patient Movement Items**

## 
PMITS web site for Global PMI asset visibility
https://199.122.5.70
Secure system CAC card required 
DOD DMLSS sponsored technical system support 
Toll Free: 1-800-994-5655
Com:  801-599-9379 
 PMI Medical Asset Tracking Course
http://jko.jfcom.mil    	

***PMITS web site for Global PMI asset visibility***
***https://199.122.5.70***
***Secure system CAC card required****** ***
***DOD DMLSS sponsored technical system support ***
***Toll Free: 1-800-994-5655***
***Com:  801-599-9379****** ***
*** ******PMI Medical Asset Tracking Course***
***http://jko.jfcom.mil***

**Patient Movement Items**

**PMI Support Resources**

## Patient Movement Items

| Ventilator, Portable (Impact 754) | 4 |
| --- | --- |
| IV Controller (IVAC MS III) | 4 |
| Suction Machine (CISU) | 8 |
| Defibrillator Zoll CCT | 4 |
| Oxygen Analyzer (Miniox 3000) | 4 |
| Vital Signs Monitor (Propaq 206EL) | 4 |
| Pulse Oximeter (BCI 3303) | 4 |
| Litter, NATO, Standard | 40 |
| Litter mattress pads | 40 |
| Litter Straps | 80 |
| Blanket, Cotton (or wool) | 40 |
| IV Poles | 40 |
| Restraint Set | 4 |
| Litter Folding Oversized | 2 |
| Litter Backrest | 40 |

**PMI Push Package**

**Patient Movement Items**

**Notes:**
 Basic items sent out by DoD to initially support patient movement and airlift of 40 patients. Planners should anticipate their individual patient population and make adjustments.

## Patient Movement Items

**Patient Movement Items**

**Notes:**
 Additional logistical items for DoD Standard Support Package for Air Evacuation of 500 patients.  

## PMI PROGRAM MANAGEMENT TEAM

***HQ AMC/SGXL***
***Lt Col Kurt Faubion – Chief, Readiness Logistics Branch***
***Mr. Randy Rodgers – MEFPAK Readiness Logistics Manager***
***Mr.  Randy Gonsalves -  Program Manager***
***Mr.  Daniel Zarazua -  Asst. Program Manager***
***Toll Free:  800-851-7542, then 229-6952***
***DSN: 779-6952***
***COM: (618) 229-6952***
***E-mail: hqamcpmi@scott.af.mil***

**Patient Movement Items**

## Patient Movement Items

**Questions or Comments?**

**Patient Movement Items**