# Presentation: 804979

## At the end of this session participants will be familiar with PRC/FCC:
 Organization
 Community Support
 Operations and Training
 Patient Reception Plans
 Bed Availability Reporting
 Communications Requirements
 Financial Management

***At the end of this session participants will be familiar with PRC/FCC:***
*** ******Organization***
*** ******Community Support***
*** ******Operations and Training***
*** ******Patient Reception Plans***
*** ******Bed Availability Reporting***
*** ******Communications Requirements***
*** ******Financial Management***

**PRC/FCC Program Management**

## Represent the Federal Government
Authority to represent the PRC/FCC Director 
Link to Community and all Emergency Response Organizations

***Represent the Federal Government***
***Authority to represent the PRC/FCC Director ***
***Link to Community and all Emergency Response Organizations***

**National Disaster Medical System (NDMS)**

**PRC/FCC Program Management**

## Incident Command System (ICS)

**Incident Command System (ICS)**

**PRC/FCC Program Management**

**Notes:**
Includes logistical support, vehicles, personnel, and both medical & non-medical supplies.
Activation, patient reception activities might continue around-the-clock. Potentially requiring the use of contract service for food ambulance transportation, etc
Ensure comprehensive full-scale exercise is conducted at least once every 3 yrs.
Ensure FCC staff, as well as applicable fed, state & local government and private sector personnel receive appropriate training in operation of the FCC/PRA
Activate local PRA plans as indicated in activation notification If activated under military contingency, DoD plans to provide the FCC w/Liaison personnel, who will require office space, computer access, and other logistical support
Ensure bed availability reporting as well as reception, sorting, staging, transportation and hospitalization or arriving patients occurs efficiently. Included would be computer system access, and at least 2 personnel per 12-hr shift to electronically  enter patients into the patient tracking system. If tracking by paper, 2 additional personnel per 12 hr shift
Provide admin support for patient control and proper patient accounting g. For security, fax on a dedicated fax at the VAMC

## ‘Bread and Butter’
Steering Committee
Numerous Local Emergency Management Working Groups to attend
Volunteer Agencies and Military Reserve Units
Empower agencies that want to Lead and provide resources

***‘******Bread and Butter’***
***Steering Committee***
***Numerous Local Emergency Management Working Groups to attend***
***Volunteer Agencies and Military Reserve Units***
***Empower agencies that want to Lead and provide resources***

**Community Support!**

**PRC/FCC Program Management**

**Notes:**
Establish & maintain active participation & support of local non-Federal and acute care hospitals, involve state & local health associations, EMS, emergency management agencies, hospitals councils, medical societies, public safety, police and fire services.
Ensure EMS agencies, public safety, police & fire services are provided annual orientation to the PRA plan and the actual patient reception site.
Maintain an up-to-date list of local community resources and participants.
Manage PRC communication procedures, processes & equipment to support local patient reception & distribution operations.
Participate in nationwide periodic and ad-hoc local bed reporting exercises.
Collect VAMC bed availability data and report to the DOD GPMRC, as directed.
Ensure open communications, and liaison are established with GPMRC for receipt of regulating decisions, evacuation mission information & patient medical data. Provide GPMRC w/primary/alternate POC to ensure 24 hrs availability.
Alert appropriate VAMC staff when PRA activation is imminent, including notification when PRA activation has occurred.
Ensure PRC director, the PRT, local EMS coordinator's, higher HQ and all other applicable agencies and individuals are notified when patients are regulated to the PRC.
Ensure an accounting method is in place to account for patients regulated but not yet received, in order not to overstate bed availability
Establish and maintain procedures to obtain vehicles & personnel on relatively short notice to transport patients in the PRA. 
Arrange local transportation to move patients from reception sites to the VAMC

## Hospital Enrollment and Support

**Hospital Enrollment and Support**

**PRC/FCC Program Management**

***State Office of Emergency Management (OEM)***
***Colorado Springs OEM***
***El Paso County OEM***
***Pueblo OEM***
***Grand Junction OEM***
***Colorado Department of Public Health and ***
***     ******Environment (CDPHE)***
***Jefferson County Incident Management Team ***
***     ******(IMT)***
***National Medical Response Team***
***  ******	******(NMRT)***
***American Medical Response (AMR)***
***Defense Coordinating Element (DCE) ***
***     ******FEMA Region VIII***
***NDMS FEMA Region VIII***
***HHS Region VIII***
***Colorado National Guard***

***USNORTHCOM***
***Evans Army Community Hospital (EACH)***
***USA MEDDAC EOC***
***Denver NDMS Hospitals***
***Colorado Springs NDMS Hospitals***
***Pueblo NDMS Hospitals***
***Grand Junction NDMS Hospital***
***Butts Army Airfield***
***Colorado Salvation Army***
***American Red Cross (Pikes Peak)***
***Fort Carson Warrior Transition Battalion***
***Fort Carson Transportation Motor Pool (TMP)***
***Colorado Amateur Radio Emergency Services (ARES)***
***Civil Air Patrol (CAP)***
***Colorado Behavioral Health***

## Activation Notice – Full or Partial
Ensure all Essential Personnel are Alerted
Local ESF #8 HHS will assist
Utilize current PRC/FCC OPLAN Concept
Deploy Patient Reception Team 

***Activation Notice – Full or Partial***
***Ensure all Essential Personnel are Alerted***
***Local ESF #8 HHS will assist***
***Utilize current PRC/FCC OPLAN Concept***
***Deploy Patient Reception Team ***

**Coordinate Patient Reception Operations**

**PRC/FCC Program Management**

## PRC/FCC Program Management

**PRC/FCC Program Management**

**Patient Reception and Movement Concept**

_**Patient**_** **_**Reception**_** - *****Notification***

**Air – Coordinator**
**Ground - Coordinator**

_**Bulk**_** **_**Movement**_

_**Hospital**_** **_**Status**_** – *****Bed Availability***

_**Triage**_

**IMT-IC**

_**Situational**_** **_**Report**_

**Federal – Representative**
**State – Representative (CO OEM) **

_**Status**_** **_**Report**_** **_**from**_** **
_**Hospitals**_

**PRC/FCCNDMS **
**HOSP Reps**

_***Re***_***-***_***Evaluate***_*** ***_***Capabilities***_*** (continue mission)***

**PRC/FCC PRT**
**Compile Cumulative Patient Report **

***‘******Sixty Minutes’***

## Practice and Develop Operations Plan - OPLAN
Practice and Develop Operations Orders – OPORD
Annual Requirement
Utilize local airfields, hangars and support facilities
On-Line Education and Schoolhouse Courses

***Practice and Develop Operations Plan - OPLAN***
***Practice and Develop Operations Orders – OPORD***
***Annual Requirement***
***Utilize local airfields, hangars and support facilities***
***On-Line Education and Schoolhouse Courses***

**Training and Exercise Opportunities**

**PRC/FCC Program Management**

## Exercise Sketch - Sample

***(UNCLASSIFIED) – ***_***Exercise***_*** ***_***Purposes***_*** ***_***Only***_

**Exercise Sketch - **_***Sample***_

## Exercise Hangar Sketch - Sample

**Exercise Hangar Sketch - **_***Sample***_

## PRC/FCC Program Management

**PRC/FCC Program Management**

***Each PRA plan should address:***
***Concept of Operations***
***System Activation***
***Alerting of Participating***
***	******Hospitals***
***Patient Reception***
***Patient Administration***
***Communications***

**Patient Reception Plans**

**Notes:**
3.  Plan Development.  The development of local plans is critical to the viability of the PRC/FCC program.  The key to success is the thoroughness and effectiveness of local planning.  Each local community is unique.  The degree of sophistication of current community disaster planning and the availability of resources that can be incorporated into the PRA Plan will vary widely.  Each PRA Plan must be tailored to its community.  Local planning cannot be accomplished without the support, involvement, and coordination of the local medical and emergency planning communities.  Most communities have an Airport Disaster Plan or a similar Mass Casualty Incident (MCI) Plan.  In many instances, this can be used as a basis for the PRA Plan.  In fact, it is advisable that the PRA Plan be based on existing plans when possible.  At a minimum, the same people and organizations involved in the development of existing emergency response plans should help develop, test, and manage the PRA Plan.  Each PRA Plan should address the following areas:
4.  Concept of Operations.
Provide a concise mission statement
Define the Patient Reception Area of responsibility
Briefly describe the roles and responsibilities of principle agencies, teams, and individuals
Identify any applicable references, including the National Response Framework as well as any applicable state and local disaster plans
Identify applicable state and local governmental and non-governmental bodies, including local Emergency Medical System agencies
Identify primary and alternate airfields, rail and bus terminals
Identify local resources for transporting patients
Identify local resources for definitive medical treatment
5.  PRA Activation.
Describe the processes for activation of the PRA
Describe the processes for alerting and augmenting the PRC/FCC staff
Describe the processes for notifying local agencies of activation
6.  PRC/FCC Operations.
Describe PRC/FCC staff roles, responsibilities and shift schedules
Describe PRC/FCC internal communications, logs, reports, etc.
Describe control of access to the PRC/FCC
7.  Bed Availability Reporting.
Provide definitions of terms, including a list of medical categories 
Describe the processes for collecting initial and recurring bed reports, including “throughput”
8.  Medical Regulating and Patient Evacuation to the PRA.
Describe the role of the DOD Global Patient Movement Requirements Center (GPMRC)
Describe the processes and procedures for coordinating patient movement missions between GPMRC and the PRC/FCC
9.  Patient Reception and Staging.
    a.  Describe the patient reception site(s).  Patients arriving from distant disaster sites or from military contingencies will generally be received at a single reception site in the PRA (e.g., an airfield, rail or bus terminal).  The site should facilitate the off-loading of patients, the immediate evaluation and triage of patients, and the staging of litter and ambulatory patients prior to transport to local medical facilities.  Close coordination is required with DOD, civil airport authorities, EMS providers, city emergency planners and other agencies and organizations as appropriate to ensure access to the site, adequate staffing, security, environmental control (heat, water, light), provision of food and drink, and communications.
    b.  Describe the roles and responsibilities of a Patient Reception Team (PRT).  The PRT is a multi-function group and consists mainly of clinical staff, but should also include appropriate support from medical administration and communications personnel, logistics personnel, and people acting as litter bearers and drivers.  The team leader can be a physician or other person with appropriate medical background.  This team can be based out of a federal facility (VA or DOD) or comprised of volunteers from community organizations.  Disaster Medical Assistance Team (DMAT) members and U.S. Public Health Service Officers may make exceptional PRT members if they are available.  Local Emergency Medical Service (EMS) volunteers who perform dispatch and ambulance transportation can also be helpful.

## PRC/FCC Program Management

**PRC/FCC Program Management**

***Each PRA plan should address:***
***Transportation***
***Personnel Administration***
***Test (Exercise) and***
***	******Evaluation***
***Public Relations and***
***	******Media Information***

**Patient Reception Plans (cont)**

**Notes:**
10.  Transportation.
    a.  Describe resources, procedures and contact information to obtain vehicles, drivers and other personnel to transport patients from the reception site(s) to the PRC or local NDMS member hospitals.  It is important that all vehicles be assessed for their patient carrying capability, inventoried, and tabulated in the patient transportation plan.  Additionally, advance coordination should be effected with the authorities that will make these vehicles and personnel available.  Military vehicles that are scheduled to move to an overseas theater of operations early in mobilization, or are committed to a potential military mobilization effort, should not be included as patient transportation assets during military contingencies.  Resources might include:
Ambulances, other vehicles and personnel from local Emergency Medical Services (EMS)
Military, VA, and/or local hospital ambulances and ambulance buses
Commercial, governmental or other vehicles available that are wheelchair accessible or otherwise configured to accommodate litter patients
Other commercial vehicles (e.g., airport limousines or buses)
Military and other governmental general use trucks, vans, school buses, etc.
    b.  Describe the roles, processes and procedures for managing and tracking the use of local transport resources.
    c.  Identify primary and alternate routes from the patient reception site(s) to local medical facilities.  Ensure advance coordination with local law enforcement agencies is made in the event that traffic control and additional security are needed.
11.  Patient Administration.
    a.  Describe the roles and responsibilities of the PRC/FCC Coordinator.  Under the NDMS, the FCC Coordinator assumes administrative responsibility for patients.  This responsibility begins upon a patient's arrival and continues until the patient is either returned home or, in the case of military patients, returned to the responsible Service personnel system for processing and assignment to a military unit or discharge from active duty, as appropriate.
    b.  Describe the roles and responsibilities of Global Patient Movement Requirements Center (GPMRC) Liaisons, if available, and Military Patient Administration Team (MPAT), if available.
    c.  Identify contact information for each participating NDMS hospital for normal operating hours as well as for after regular working hours.
    d.  Describe the roles and responsibilities of each participating NDMS hospital.  The patients’ day-to-day medical management and care will be accomplished by the medical staff of that hospital.  The hospital will provide medical care using its own procedures and forms.  NDMS member hospitals should provide information to the FCC Coordinator, to include a daily admission and disposition list (indicating the expected length of stay) and a narrative summary upon discharge of the patient.
    e.  Describe the roles, processes and procedures for tracking patients in the PRA.  Ensure that the following information is included in the tracking system adopted by the FCC:
Patient name
Social security or other identification number
FEMA registration number
Date of birth
Medical regulating/diagnostic category
Type of patient (i.e., directly injured/victimized by disaster or relocated/displaced by the disaster)
Home address (if available)
Next of kin, address and telephone number (if available)
Admitting hospital, admission date, address, point of contact and telephone number for inpatients
Local domicile (e.g., hotel or shelter), address, point of contact and telephone number for outpatients
Military status and unit of assignment, as applicable  
    f.  Describe policies and procedures for disposition of records.  The FCC Coordinator generally retains patient data for the minimum period required by statutory law.  The FCC Director will determine, in conjunction with legal advice from an attorney, the final disposition of this information.  All appropriate patient confidentiality procedures, including protection of social security numbers, must be followed.  All protected health information should be safeguarded in accordance with the Health Insurance Portability and Accountability Act of 1996.
    g.  Generally, the Department of Veterans Affairs confidentiality statutes and the Privacy Act permit disclosure of medical records to the Federal Coordinating Centers, to treating hospitals and to third party payers for medical care, e.g., insurance carriers, Medicaid and Medicare, without the consent of the patients.  However, as to drug, alcohol, HIV, and sickle cell anemia treatment records, this information cannot be disclosed about deceased patients without following special procedures.  See section 7332 (b) (3) of title 38, United States Code, or section 1.465 (b) of Title 38, Code of Federal Regulations.  As to living patients, disclosure of this information is not permitted without prior written consent unless disclosure is made to medical personnel to the extent necessary to meet a bona fide medical emergency.  However, the medical records of any patient, living or deceased, treated pursuant to NDMS, may be disclosed without consent after the drug, alcohol, HIV and sickle anemia treatment information has been blanked out.
12.  Patient Movement Items Management.  Describe the general provisions of a PMI system and identify points of contact at the nearest DOD military medical treatment facility.
13.  Patient Discharge and Return.
Describe roles and responsibilities for individual patient discharge planning
Describe the processes and procedures for transporting patients who require continuing medical treatment
Describe the processes and procedures for transporting patients who do not require continuing medical treatment 
14.  Financial Claims Processing.
Describe basic procedures for data collection, claims processing and reimbursement
Describe roles and responsibilities of the FCC Coordinator and NDMS participating hospitals
15.  Training and Exercises.
Identify the requirements and objectives for annual training of individuals
Identify the requirements and objectives for annual training of teams
Identify the requirements and objectives of triennial (or more frequent) comprehensive PRA exercises
16.  Public Relations and Media Information.
Identify local media resources
Describe rules, limitations and processes for preparing information for release 
Identify local agencies and individuals authorized to release information
17.  Communications.
    a.  Identify primary and alternate means of communication among, and provide a detailed contact list for the following (for normal operating hours as well as for after regular working hours):
The PRC/FCC
Appropriate headquarters elements or agencies
GPMRC
Local authorities and agencies
Patient reception site authorities
Patient reception teams
Patient transport agencies
All participating NDMS hospitals
Others as required
    b.  Provide an inventory of primary and alternate communications equipment and supplies. 

## PRC/FCC Program Management

**PRC/FCC Program Management**

***PRC/FCC Coordinator responsibilities:***
***Provide training to PRC/NDMS member hospitals***
***Standard definitions:  available beds,***
***    ******categories, throughput, etc.***
***Local bed reporting system***
***Provide the GPMRC with primary/***
***	******alternate points of contact***
***Participate in planned and ad-hoc local bed reporting exercises***

**Bed Availability Reporting**

## PRC/FCC Program Management

**PRC/FCC Program Management**

***PRC/FCC Coordinator responsibilities (cont.):***
***Alert PRC/NDMS member hospitals when PRA activation is imminent or has occurred***
***Receive bed-reporting instructions from GPMRC through Service or VA channels, as appropriate***
***Report PRA bed availability totals to the GPMRC in accordance with instructions***

**Bed Availability Reporting**

## PRC/FCC Program Management

**PRC/FCC Program Management**

**Facilitating Communications**

*"****What we've got here is a failure to communicate.****"*
-                                                                                         Cool Hand Luke, 1967

## Obstacles

The lack of interoperable systems
Inadequate or outdated equipment
Poorly trained personnel and staff                   retention
The absence of effective command
     and control procedures
Variance in PRC/FCC capacity
Poor collaboration and coordination within and across response organizations

***Obstacles***
***The lack of interoperable systems***
***Inadequate or outdated equipment***
***Poorly trained personnel and staff                   retention***
***The absence of effective command***
***     ******and control procedures***
***Variance in PRC/FCC capacity***
***Poor collaboration and coordination within and across response organizations***

**PRC/FCC Program Management**

**Facilitating Communications**

## The PRC/FCC Coordinator is responsible for:

***The PRC/FCC Coordinator is responsible for:***

***Planning,***
***Testing, and ***
***Coordinating                                           communications***
***Procedures,***
***Processes, and***
***Equipment***

**PRC/FCC Program Management**

**Facilitating Communications**

## Planning

***Planning***

***Identify primary/alternate means of communication***
***Detailed contact list***
***Normal operating hours***
***After regular working hours***

**PRC/FCC**** ****Program Management**

**Facilitating Communications**

## Contact list should include:

***Contact list should include:***

***Internal PRC/FCC contacts***
***Appropriate headquarters elements/agencies***
***GPMRC***
***Local authorities and agencies***
***Patient reception site authorities***
***Patient reception teams***
***Patient transport agencies***
***All participating NDMS hospitals***
***Others as required***

**PRC/FCC Program Management**

**Facilitating Communications**

## PRC/FCC Coordinators assist in developing budgets and coordinating fiscal information to support:
 Training
 Equipment
 Exercises
 Operations 
Pre-Activation Expenses
Activation Expenses

***PRC/FCC Coordinators assist in developing budgets and coordinating fiscal information to support:***
*** ******Training***
*** ******Equipment***
*** ******Exercises***
*** ******Operations**** *
***Pre-Activation Expenses***
***Activation Expenses***

**PRC/FCC Program Management**

**Financial Management**

## Today, we have discussed PRC/FCC:

 Organization
 Community Support
 Operations and Training
 Patient Reception Plans
 Bed Availability Reporting
 Communications Requirements
 Financial Management

***Today, we have discussed PRC/FCC:***
*** ******Organization***
*** ******Community Support***
*** ******Operations and Training***
*** ******Patient Reception Plans***
*** ******Bed Availability Reporting***
*** ******Communications Requirements***
*** ******Financial Management***

**PRC/FCC Program Management**

## Questions?

**Questions?**

**PRC/FCC Program Management**

## PRC/FCC Program Management

**PRC/FCC Program Management**