# Presentation: 593827

## VA-DoD Primary Receiving Center (PRC) & NDMS Federal Coordinating Center (FCC) Training Course

**VA-DoD Primary Receiving Center (PRC) & NDMS Federal Coordinating Center (FCC) Training Course**

**Military Contingency**

**National Disaster**

## Course Overview

**	**

_***Purpose:***_***  To ensure efficient Patient Reception Program Management and Operations in support of  the VA-DoD Contingency Plan, or, a National Disaster where  Federal Assistance is requested under the National Disaster Medical System (NDMS)***
***Target Audience:***

**Course Overview**

-  ***DoD and VA PRC Coordinators (e.g., EPCs)***
*** ******PRC Reception Team Leaders***
*** ******PRC Directors and Commanders***

-  ***DoD and VA FCC Coordinators ***
*** ******FCC Reception Team Leaders***
*** ******FCC Directors and Commanders***

**Notes:**
  This is an operational course, designed to provide tools and techniques for Patient Reception coordinators and leaders. It is not really designed for upper level leaders. 

## Course Prerequisites

**	**

***TRANSCOM Medical Regulating and Command and Control Evacuation System*** (***TRAC2ES)***
***FEMA IS-100:  Intro to Incident Command System (ICS)***
***FEMA IS-120:  Intro to Exercises***

**Course Prerequisites**

**Notes:**
   Although this course is designed to provide you with many tools you will need to operate a Patient Reception or Federal Coordinating Center, it will not provide in-depth instruction and practice in the TRANSCOM Medical Regulating and Command and Control Evacuation System (TRAC2ES), nor the Incident Command System. It is expected that you have completed these prerequisites before coming to the course.

## Course Outline - Academics

***VA-DoD Contingency System Overview***
***National Disaster Medical System Overview***
***Patient Reception Program Management***
***Patient Regulating***
***TRAC2ES***
***Air Operations Orientation***
_***Tours:***_*** ***
***  ******- 3 75th Aerospace Medicine Squadron’s Air ******	******Staging Facility***
***  ******- AMC Tanker / Airlift Control Center***
***           ******Scott AFB Flightline***

**Course Outline - Academics**

**Notes:**
Here is a brief outline of what will be covered over the next three days. 

## Course Outline - Academics

***Patient Reception Team Operations***
***Joint Patient Assessment and Tracking System***
***Patient Movement Items***
***Logistics***
***Military Patient Management Issues***
***NDMS Patient Management Issues***
***PRC/FCC  Plans Development***
***Facilitated Discussions***
***Services’ and VA Forums***

**Course Outline - Academics**

## VA-DoD Contingency System Overview

**VA-DoD Contingency System Overview**

***At the end of this session participants should be able to describe the VA-DoD Contingency Plan and the functions of PRCs, including the roles and responsibilities of PRC directors and coordinators***

**Notes:**
There are two objectives for this course: 
We want you to be able to describe the VA-DoD Contingency Plan and the functions of PRCs, including the roles and responsibilities of PRC directors and coordinators.

## National Disaster Medical System Overview

**National Disaster Medical System Overview**

***Participants should also be able to describe the NDMS including it’s components, activation, the function of FCCs, and  the roles and responsibilities of FCC directors and coordinators***

**Notes:**
Missouri flood in March 2008. 

And, we want you to be able to describe the NDMS including it’s components, activation, the function of FCCs, and  the roles and responsibilities of FCC directors and coordinators. 

And, of course, we want you to be able to compare and contrast the two types of patient reception activities, to include the mission, scenario, types of patients, destination hospitals, and how the operations are funded.

## VA-DoD Contingency System 

***History***
***Applicable statutes and references***
***Military contingency scenarios***
***PRCs and SSCs roles and responsibilities***
***Command and Control***
***PRC activation and deactivation***
***Funding of PRC operations ***
***Communications systems orientation***

**VA-DoD Contingency System **

**Notes:**
First, we will discuss the VA-DoD Contingency System, by talking about the history of the program, applicable statutes, scenarios, roles and responsibilities and so on.

## History

***Cold War***
***1982 Congressional Hearings***
***65 VA Medical Centers   dubbed “PRCs”***

**History**

**VA-DoD Contingency System **

**Notes:**
In the early 1980s the Senate Subcommittee on Manpower & Personnel met to address the Cold War threat to the medical capabilities of the United States military.  The hearings were highlighted by the realization that military hospitals of the day had only 10% of the critical care beds required to support official casualty estimates.  But Congress recognized that the Department of Veterans Affairs had, “an extensive, comprehensive health-care system that could be used to assist the Department of Defense” in caring for military personnel wounded in combat. 

In May of 1982 Congress passed Public Law 97-174, authorizing the VA to, “furnish hospital care, nursing home care, and medical services to members of the Armed Forces on active duty...during and immediately following a period of war, or a period of national emergency”.  Public Law 97-174 was subsequently codified in Title 38 U.S. Code, and mandated that the Department of Defense and VA, “jointly establish guidelines to promote the sharing of health-care resources”.  From these proceedings and from Public Law 97-174 came the VA-DoD Contingency Plan.

##  Public Law 97-174: Defense Health Resource Sharing and Emergency Operations Act (1982)

**Applicable Statutes and References**

*** ******Public Law 97-174: Defense Health Resource Sharing and Emergency Operations Act (1982)***
*** ******MOA between VA and DoD regarding VA furnishing health care services to members of the armed forces during a war or national emergency (2006) ***

**VA-DoD Contingency System**

**Notes:**
This law gave VA a new mission: to serve as the principal health care backup to DoD in the event of war or national emergency that involves armed conflict.  In addition to the contingency mission, this public law amended Title 38, United States Code (U.S.C.), to promote greater peacetime sharing of health care resources between VA and DoD.

In response to Pub. L. 97-174, a Memorandum of Understanding (MOU) was executed between the Secretary of Defense and the Administrator of Veterans Administration (presently the Secretary of Veterans Affairs), specifying each agency's responsibilities under the law.

Veterans Affairs intends to furnish Health Services to Armed Forces on Active Duty; change from Priority #8 Entry Level to Priority #2 Entry Level

5.15.2. Activate and ensure coordination...the two primary medical backup systems for the Department of Defense:  [VA]  and...the NDMS.

##  DoDI 6000.11: Patient Movement (1998)

**Applicable Statutes and References (cont’d)**

*** ******DoDI 6000.11: Patient Movement (1998)***
***  ******DoDD 3020.36: Assignment of National Security Emergency Preparedness (NSEP), Responsibilities to DoD Components (1993)***
*** ******VHA Handbook 0320.04:  VA-DoD Contingency Plan (2007)***

**VA-DoD Contingency System **

**Notes:**
DODI 6000.11 Currently under Revision: Patient Movement implements policy, assigns responsibilities and prescribes procedures for standardizing medical regulating and the implementation of the patient movement mission. Section 5.5 describes the VA responsibilities  under this contingency plan:
The Secretary of VA shall:
Provide medical capability information and assistance to the USTRANSCOM Command Surgeon and respective Patient Movement Requirements Center (PMRC)
Assign a full time liaison officer to USTRANSCOM/SG to assist in regulating and movement of patients to and from the VA MTFs
Ensure sharing of appropriate VA and DOD patient medical information, medical support infrastructure, medical care systems and policies and automated information systems. 

## VA-DoD Joint Strategic Plan

***VA and DoD will collaborate to ensure that plans and readiness capabilities  adequately support DoD combatant command contingency requirements.***
***This collaboration will include the following planning, training, and exercise activities:***
***Joint planning to ensure VA support of DoD contingency requirements;***
***Collaborative training and exercise activities to enhance  joint contingency plans; and,***
***Improvement of joint readiness capabilities.***

**VA-DoD**** Joint Strategic Plan**
**GOAL 6 – Joint Medical **
**Contingency /Readiness Capabilities**

**Notes:**
The VA-DoD Joint Strategic Plan, Goal 6 addresses Joint Medical Contingency and Medical Readiness Capabilities:
Collaborate on plans and readiness capabilities
Plan, Train and exercise

## Service Level  Guidance

***The HEC Contingency Planning Working Group will develop Departmental plans to support the revised VA/DoD MOA and Contingency Plan and ensure that all VA and DoD Primary Receiving Centers (PRCs) complete  local plans to support the VA/DoD MOA and Contingency Plan by April 1, 2009.***
***Publish DoD Instruction, “Department of Defense and Department of Veterans Affairs Responsibilities regarding VA Furnishing Health Care Services to members of the Armed Forces During a War of National Emergency and Joint Contingency Plan/Readiness Programs.”  Estimated Completion Date:  October 31, 2008.***
***Military Departments and VHA provide Service level program implementation guidance to support the VA/DoD Contingency Plan by February 28, 2009.***

**Service ****Level****  Guidance**

**Notes:**
VA-DoD Health Executive Council sent guidance to the Departments to ensure that VA and DoD PRCs complete local plans by April 2009

OASD (HA) DODI is in the system to be published

Services and VHA provide program implementation guidance to support the plan

## Objective 6.2

***OBJECTIVE 6.2***
***Collaborate on training and exercise activities that support the VA/DoD Contingency Plan.***
***STRATEGY 6.2(b)***
***The HEC Contingency Planning Working Group/Exercise sub-group will review the Chairman of the Joint Chiefs of Staff Exercise Program to ensure that joint tasks (e.g., patient movement within the continental United States) are included in at least one National Level Exercise annually.***
***STRATEGY 6.2(c)***
***The HEC Contingency Planning Working Group will facilitate one tactical joint patient movement/reception or disaster response exercise at each VA and DoD PRC every three years beginning in October 2009.***

**Objective 6.2**

**Notes:**
More on the VA-DoD Health Executive Council Plan...
Let’s take a look at how DOD regulates Military Patients to the United States MTFs and VA facilities...

## Military Contingency Scenarios: Inter-theater Movements

**Military Contingency Scenarios: Inter-theater Movements**

**VA-DoD Contingency System **

**Notes:**
Department of Defense regulates and transports patients based on bed availability reports that come from hospitals, consistent with medical regulating policy set by the Assistant Secretary of Defense for Health Affairs.  

Patients are initially received in the continental United States at one of several strategic airfields, located in various regions of the country.  For planning purposes, the country is divided into six regions, as shown here.  Within each, generally one strategic airfield is identified.  In the event of a military contingency, this structure might be modified in any number of ways, dependent on the location of the disaster site. 

## Military Contingency Scenarios: Inter-Regional Movements

**Military Contingency Scenarios: ****Inter-Regional Movements**

**VA-DoD Contingency System **

**Notes:**
Currently, the DoD medical regulating policy is to transport patients to a DoD medical treatment facility in the region that is closest to the patient’s home.  If there are no beds available in a military hospital near the patient’s home, the patient may be moved to a VA primary receiving center in the region closest to their home.

## Primary Receiving Center (PRC)

***Primary Receiving Center (PRC)***
***  ***
*** ******Military Treatment Facility (MTF) or VA Medical Center (VAMC) designated for coordinating and/or providing treatment to sick and wounded military personnel returning from armed conflict or national emergency***
*** ******PRCs may be but not necessarily designated as Federal Coordinating Centers of the National Disaster Medical System.  (Review Responsibilities in the Program Implementation Plan for VA-DoD Contingency Plan)***

**VA-DoD Contingency System **

**Notes:**
So, what is a PRC? 

## 84 Primary Receiving Center (PRC)

***84 Primary Receiving Center (PRC)***
***	******	******	******	******5 Air Force***
***	******	******	******	******7 Navy***
***	******	******	******	******15 Army***
***	******	******	******	******57 VA ***

**VA-DoD Contingency System **

**Notes:**
Currently, there are 84 PRCs broken down in the following categories...

## United States Air Force PRCs

_**United States Air Force PRCs**_

*** ******79th Medical Group, Andrews AFB, Maryland***
*** ******81st Medical Group, Keesler AFB, Mississippi ***
*** ******88th Medical Group, Wright-Patterson AFB, Ohio***
*** ******60th Medical Group, Travis AFB, California ***
*** ******3rd Medical Group, Elmendorf AFB, Alaska***
**** In addition, the Michael O'Callahan Federal Hospital is designated as a PRC and is a Joint VA/DoD Facility located on Nellis AFB, Nevada.***

**VA-DoD Contingency System **

## United States Navy PRCs

_**United States Navy PRCs**_

***National Naval Medical Center, Bethesda, MD***
***Naval Medical Center Portsmouth, Norfolk, VA***
***Naval Hospital Jacksonville, Jacksonville, Florida***
***Naval Hospital Pensacola, Pensacola, Florida***
***Naval Hospital Camp Lejeune, Jacksonville, NC***
***Naval Hospital Camp Pendleton, Orange County, CA***
***Naval Medical Center San Diego, San Diego,CA***

**Naval Hospital Pensacola (Pensacola, Florida)**

**VA-DoD Contingency System **

## United States Army PRCs

_**United States Army PRCs**_

*** ******Walter Reed Army Medical Center, Washington, DC***
*** ******Eisenhower Army Medical Center, Augusta, GA***
*** ******Martin Army Hospital, Ft Benning, GA***
*** ******Winn Army Hospital, Ft Stewart, GA***
*** ******Blanchfield Army Hospital, Ft Campbell, KY***
*** ******Womack Army Medical Center, Ft Bragg, NC***
*** ******Moncrief Army Hospital, Ft Jackson, SC***
*** ******Reynolds Army Hospital, Ft Sill, OK***
*** ******Beaumont Army Medical Center, Ft Bliss, TX***
*** ******Brooke Army Medical Center, Ft Sam Houston, TX***
*** ******Darnell Army Hospital, Ft Hood, TX***
*** ******Evans Army Hospital, Ft Carson, CO***
*** ******Tripler Army Medical Center, Honolulu, HI***
*** ******Bassett Army Hospital, Ft Wainwright, AK ***
*** ******Madigan Army Medical Center, Ft Lewis, WA***

**VA-DoD Contingency System **

## Veterans Affairs PRCs

_**Veterans Affairs PRCs**_

***Atlanta VAMC (Decatur, GA)***
***Bay Pines VA HCS (FL)***
***Birmingham VAMC (AL)***
***Boise VAMC (ID)***
***Brooks VAMC (Shreveport, LA)***
***Cincinnati VAMC (OH)***
***DeBakey VAMC (Houston, TX)***
***Dingell VAMC (Detroit, MI)***
***Dole VAM&ROC (Wichita, KS)***
***Durham VAMC (NC)***

**VA-DoD Contingency System**

## Veterans Affairs PRCs (cont’d)

_**Veterans Affairs PRCs (cont’d)**_

***Hayden VAMC (Phoenix, AZ)***
***Hefner VAMC (Salisbury, NC)***
***Hines VAH (IL)***
***Johnson VAMC (Charleston, SC)***
***Kansas City VAMC (MO)***
***Lexington VAMC (KY)***
***Louisville VAMC (KY)***
***McGuire VAMC (Richmond, VA)******Miami VAMC (FL)***
***Minneapolis VAMC (MN)***

**VA-DoD Contingency System **

## Veterans Affairs PRCs (cont’d)

_**Veterans Affairs PRCs (cont’d)**_

***Montgomery VAMC (Jackson, MS)***
***N Texas HCS, Dallas VAMC (TX)***
***New Mexico VA HCS (Albuquerque, NM)***
***North Chicago VAMC/DoD Federal Facility (IL)***
***Northampton VAMC (MA)***
***Oklahoma City VAMC (OK)***
***Philadelphia VAMC (PA)***
***Portland VAMC (OR)***
***Providence VAMC (RI)***
***Roudebush VAMC (Indianapolis, IN)***

**VA-DoD Contingency System Overview**

## Veterans Affairs PRCs (cont’d)

_**Veterans Affairs PRCs (cont’d)**_

***S Arizona VA HCS (Tucson, AZ)***
***San Francisco VAMC (CA)***
***San Juan VAMC (PR)***
***St Louis VAMC (St Louis, MO)***
***Stokes VAMC (Cleveland, OH)***
***Syracuse VAMC (NY)***
***Tenn Valley HCS, Nashville Campus (TN)***
***VA Boston HCS, W Roxbury Campus (MA)***
***VA C Ark HCS, Towbin Center (Little Rock, AR)***
***VA Central Iowa HCS, Des Moines Div (IA)***

**VA-DoD Contingency System **

## Veterans Affairs PRCs (cont’d)

_**Veterans Affairs PRCs (cont’d)**_

***VA Conn HCS, W Haven Campus (CT)***
***VA E Colorado HCS (Denver, CO)***
***VA Greater Los Angeles HCS (CA)***
***VA Hudson Valley HCS, Castle Point (NY)***
***VA Loma Linda HCS (CA)***
***VA Long Beach HCS (CA)***
***VA Maryland HCS, Baltimore VAMC (MD)***
***VA Nebraska / W Iowa HCS, Omaha Div (NE)***
***VA NJ HCS, East Orange Campus (NJ)***
***VA NY Harbor HCS, Brooklyn Campus (NY)***

**VA-DoD Contingency System **

## Veterans Affairs PRCs (cont’d)

_**Veterans Affairs PRCs (cont’d)**_

***VA Pittsburgh HCS, University Dr Div (PA)***
***VA S Nevada HCS – O’Callahan Fed Hosp (Las Vegas)***
***VA Salt lake City HCS (UT)***
***VA West NY HCS (Buffalo, NY)***
***VAMC Memphis (TN)***
***VAMC Stratton (Albany, NY)***
***VAMC & ROC Wilmington (DE)***
***Zablocki VAMC (Milwaukee, WI)***

**VA-DoD Contingency System **

## PRC, SSC and ISC Roles and Responsibilities

**PRC, SSC and ISC Roles and Responsibilities**

***Secondary Support Centers***
***Military Treatment Facility (MTF) or VA Medical Center (VAMC) designated to accept transfers from or sharing resources with a Primary Receiving Center so as to maximize health care services support to DOD.  ***

**VA-DoD Contingency System **

**Notes:**
  In anticipation of receiving significant numbers of military patients, Primary Receiving Centers may elect to transfer some veteran patients to VA secondary support facilities under their management.   

PRCs and SSCs prepare to expand their internal operations to the degree possible.  Outpatient services might be reduced and elective surgeries may be cancelled in order to ensure capabilities are available.  A small percentage of VA patients may be transferred to local civilian facilities or discharged, and ward spaces may be expanded.  Additional supplies, pharmaceuticals and equipment may be procured in anticipation of increased need.  Additional staffing may be made available by canceling or curtailing leave or by temporary hiring actions.

## United States Air Force SSCs

_**United States Air Force SSCs**_

***	******Wilford Hall Medical Center (59******th****** Medical Wing) supporting Brooke Army Medical Center (Ft. Sam Houston)***

***Wilford Hall Medical Center***
***(59th Medical Wing) ***

***Brooke Army Medical Center***
***(Ft. Sam Houston)***

**Supporting****Role**

**VA-DoD Contingency System **

**Notes:**
Relationships between DoD PRCs and SSCs

## United States Navy SSCs

_**United States Navy SSCs**_

***	******Naval Hospital Bremerton supporting Madigan Army Medical Center (Ft. Lewis)***

***Naval Hospital Bremerton***

***Madigan Army Medical Center***
***(Ft. Lewis)***

**Supporting****Role**

**VA-DoD Contingency System **

## United States Army SSCs

_**United States Army SSCs**_

***There are no United States Army Secondary Center Designations ***

**VA-DoD Contingency System **

## PRC, SSC and ISC Roles and Responsibilities

**PRC, SSC and ISC Roles and Responsibilities**

***Installation Support Center***
***VA Medical Center proximal to a military installation designated to provide health care services and other health care resource support to military forces in the event of armed conflict or national emergency.***

**VA-DoD Contingency System **

**Notes:**
Installation Support Centers

## Activation

**	**

***Secretary of Defense requests priority treatment of  active duty personnel***
***Secretary of VA sets priorities of treatment***
***VA-DoD Liaison enhanced***
***VA Primary Receiving Centers implement local plans***
*** ******USTC / GPMRC regulates patients***

**Activation**

**VA-DoD Contingency System **

**Notes:**
Upon Declaration of a national emergency, if the Secretary of Defense projects that patient loads exceed DoD capabilities, he requests that the Secretary of Veterans Affairs authorize the admission and/or treatment on a priority basis of active duty military personnel at VA medical facilities.  Upon receipt of DoD’s request, the Secretary of Veterans Affairs will prescribe the priorities for the treatment of active duty military personnel in VA medical facilities.  These prescribed priorities are communicated to DoD and VA medical facilities, and daily VA-DoD liaison is established in order to coordinate DoD patient load projections.  Subsequently, a few, many or all VA medical centers may be directed to implement local plans in preparation to receive military patients.

Priority Group 1 Veterans with service-connected disabilities rated 50% or more disabling 
Priority Group 2 Veterans with service-connected disabilities rated 30% or 40% disabling
Priority Group 3 Veterans who are former POWs, awarded the Purple Heart, whose discharge was for a disability that was incurred or aggravated in the line of duty, with service-connected disabilities rated 10% or 20% disabling, or veterans awarded special eligibility classification under Title 38, U.S.C., Section 1151, "benefits for individuals disabled by treatment or vocational rehabilitation“
Priority Group 4 Veterans who are receiving aid and attendance or housebound benefits, or who have been determined by VA to be catastrophically disabled
Priority Group 5 Nonservice-connected veterans and noncompensable service-connected veterans rated 0% disabled whose annual income and net worth are below the established VA Means Test thresholds, receiving VA pension benefits, or eligible for Medicaid benefits
Priority Group 6 Compensable 0% service-connected veterans, World War I veterans, Mexican Border War veterans, Veterans solely seeking care for disorders associated with: exposure to herbicides while serving in Vietnam; or exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; or for disorders associated with service in the Gulf War; or for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998.
Priority Group 7 Veterans who agree to pay specified copayments with income and/or net worth above the VA Means Test threshold and income below the HUD geographic index, Subpriority a: Noncompensable 0% service-connected veterans who were enrolled in the VA Health Care System on a specified date and who have remained enrolled since that date. Subpriority c: Nonservice-connected veterans who were enrolled in the VA Health Care System on a specified date and who have remained enrolled since that date. Subpriority e: Noncompensable 0% service-connected veterans not included in Subpriority a above. Subpriority g: Nonservice-connected veterans not included in Subpriority c above.
Priority Group 8 Veterans who agree to pay specified copayments with income and/or net worth above the VA Means Test threshold and the HUD geographic index. Subpriority a: Noncompensable 0% service-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date. Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date. Subpriority e: Noncompensable 0% service-connected veterans applying for enrollment after January 16, 2003. Subpriority g: Nonservice-connected veterans applying for enrollment after January 16, 2003

## Command and Control

**Command and Control**

*** ******Services***
*** ******Veterans Health Administration***
*** ******USNORTHCOM***
*** ******USTRANSCOM/GPMRC***
*** ******PRCs***
*** ******SSCs***

**VA-DoD Contingency System **

**Notes:**
DoD PRCs fall under the command of their services. MTF Commanders are the PRC Directors

Other commands that play a role include USNORTHCOM, USTRANSCOM

## Funding for patient care  

**Funding of PRC Operations**

***Peacetime / steady state funding to train, equip, exercise***
***Funding for operations***
***Funding for patient care******  ***

**VA-DoD Contingency System **

**Notes:**
Peacetime / steady state funding to train, equip, exercise  = VHA and the Services’ responsibility
Funding for operations = DoD responsibility under Economy Act
Funding for patient care = DoD responsibility under the MOA, which says:  
“Unless a local or TRICARE Network agreement provides for an alternate reimbursement rate. the reimbursement for all health care services shall be at the rates established by the SecDef and SecVA Title 38 USC, section 8111.  The inpatient reimbursement methodology was implemented in guidance signed on August 29, 2006. bills shall be forwarded to the fiscal intermediary for supplemental care or to the local military medical treatment facility, if referred under a direct sharing agreement.”

## Communications

**Communications**

***Services’ HF radio and INMARSAT networks***
***Conventional phones and E-mails***
***TRANSCOM Medical Regulating and Command and Control Evacuation System (TRA2CES)***

**VA-DoD Contingency System **

## Summary

***Applicable statutes and references***
***Military contingency scenarios***
***PRCs and SSCs roles and responsibilities***
***Command and Control***
***PRC activation and deactivation***
***Funding of PRC operations ***
***Communications systems orientation***

**Summary**

**VA-DoD Contingency System **

## VA-DoD Contingency System 

**VA-DoD Contingency System **
**and NDMS Overview**

|  | DoD-VA PRC | NDMS FCC |
| --- | --- | --- |
| Scenarios |  |  |
| Patients |  |  |
| Funding |  |  |
| PRTs |  |  |
| Regulating |  |  |
| Destination Hospital (s) |  |  |

**Notes:**
Let’s take a few moments to summarize the PRC Scenario, type of patient, funding, patient reception team, patient regulating, and destination hospital in comparison and contrast to those of the Federal Coordinating Centers under the National Disaster Medical System. 

## NDMS Overview

- National Response Framework (NRF)
- NRF Tiered Response
- NDMS Partnership, Activation and Components
- Federal Coordinating Centers
- Roles and Responsibilities

**Notes:**
This is Yorba Linda, CA, December 12, 2008 -- This home in Hidden Hills is one of 180 homes that were destroyed in Orange County by the November wildfires. More then 30,000 acres burned during these wildfires. FEMA/Michael Mancino 

Let’s switch our focus to Federal Coordinating Centers under the NDMS. We will discuss the NRF, the tiered response to emergencies, the NDMS partnership, how it is activated, it’s components, the Federal Coordinating Centers and the roles and responsibilities of the directors and coordinators.

## National Response Framework (NRF) 2008

- The National Response Framework provides structures for implementing national-level policy and operational coordination for ***domestic incident response.***
- The term _*“*__***response***__*”*_ includes:
- c

**Notes:**
Emergencies and disasters are generally handled locally. However, when the emergency goes beyond the local and state authorities, a national response may be required. The 2008 National Response Framework (formerly the National Response Plan) provides policy and operational coordination for a domestic incident response.  

The term response includes: 
Immediate actions to save lives, protect property and the environment, and meet basic human needs. 
The execution of emergency plans and actions to support short-term recovery. 

## Tiered Nature of Disaster/Emergency Response (Domestic)

**Notes:**
This slide is a bit messy, but it depicts how our nation provides the national response. The NRF provides for a Tiered Response:

Incidents begin and end locally, and most are managed at the local level 
Many incidents require unified response from local agencies, the private sector, and nongovernmental organizations.

Other incidents may require additional support from neighboring jurisdictions or the State. In some cases the Emergency Management Assistance Compact between States provides support. 
A small number require Federal support, which may involve the NDMS.

National response protocols recognize this and are structured to provide additional, tiered levels of support.

## The NRF and NDMS

- The NRF utilizes the **National Disaster Medical System (NDMS)**, as part of the Department of Health and Human Services, Office of Preparedness and Response, under Emergency Support Function #8 (ESF #8), Health and Medical Services, to support Federal agencies in the management and coordination of the Federal medical response to major emergencies and federally declared disasters including:
- Natural Disasters
- Major Transportation Accidents
- Technological Disasters
- Acts of Terrorism including Weapons of Mass Destruction Events

**Notes:**
When this national response includes a medical response, the Department of Health and Human Services, Office of Preparedness and Response, under Emergency Support Function #8 (ESF #8), Health and Medical Services, might activate the National Disaster Medical System. The NDMS might be activated in major emergencies and federally declared disasters including:
-Natural Disasters 
-Major Transportation Accidents 
-Technological Disasters 
-Acts of Terrorism including Weapons of Mass Destruction Events

## NDMS Partnership

**DHS: FEMA **Provides Funding

**DOD**: Provides Patient Movement and Definitive Care

**VA:** Provides Definitive Care

**HHS**: Provides Response Teams

**Notes:**
The National Disaster Medical System is a partnership between four Federal Partners:
The Department of Health an Human Services
The Department of Defense
The Department of Veterans Affairs 
The Department of Homeland Security Federal Emergency Management Agency

## NDMS Activation

- Governor requests federal assistance under the Robert T. Stafford Disaster Relief and Emergency Assistance Act
- State Health Officer requests activation under Public Health Emergency
- ASD (HA) requests activation when number of Military patients exceed the capability of the Military Healthcare System and VA Medical Systems

**Notes:**
As stated, the NDMS may be activated when the local and state authorities determine that the emergency is beyond their capabilities. NDMS can be activated one of three ways:
-Governor requests federal assistance under the Robert T. Stafford Disaster Relief and Emergency Assistance Act
-State Health Officer requests activation under Public Health Emergency
-ASD (HA) requests activation when number of Military patients exceed the capability of the Military Healthcare System and VA Medical Systems

## NDMS Three Components

**‘****Seamless Medical Continuum of Care’**

**NDMS Three Components**

**Notes:**
There are three Components of the National Disaster Medical System:
Medical response to a disaster area in the form of personnel, teams and individuals, supplies, and equipment. 
Patient movement from a disaster site to unaffected areas of the nation. 
Definitive medical care at participating hospitals in unaffected areas.
Activation of NDMS does not necessarily mean that all three components are activated. Often the Disaster Medical Assistance Teams are activated to provide medical response, but the patient movement and definitive care portions of NDMS are not activated. 

## NDMS Definitive Care

- Federal Coordinating Center (FCC)                          A facility located in a metropolitan area of the United States responsible for day to day coordination of planning and operations in one or more assigned geographic NDMS Patient Reception Areas

**Notes:**
When it is determined that patients located in hospitals in the affected area need to be evacuated, the Patient Movement and Definitive Care portions of NDMS are activated. At this time, a number of FCCs will be activated to receive and distribute patients to NDMS hospitals. 

## FCC Function in a Disaster

- Patients evacuated from a disaster area arrive at the FCC patient reception area
- Patients are off-loaded, triaged and staged pending further regulating to a local NDMS hospital
- FCCs monitor status of NDMS patients treated in NDMS hospitals

**Notes:**
Upon alert, FCCS ensure their personnel recall rosters are current and they make contact with everyone on the roster. They may initiate bed counts and monitor TRAC2ES. Upon activation, FCCs will activate their patient reception plans and begin bed reporting and monitor TRAC2ES for patient manifests. 

## Directors’ Responsibilities

***Appoints and/or identifies the FCC or PRC Coordinator responsible for the day-to-day operation and readiness***
*** ***
*** ******Establish and maintain the support of area hospitals, government agencies, volunteer organizations and others within the immediate area***
*** ***
*** ******Ensure the development, exercise and evaluation of local Patient Reception Area plans***

***Directors’ Responsibilities***

**Notes:**
Here is a list of responsibilities for the directors and coordinators...

## Directors’ Responsibilities

***Conduct a full-scale exercise at least once every three years***
*** ***
***Ensure that FCC or PRC staff, as well as applicable federal, state and local government and private sector personnel receive appropriate orientation or training in operations***
*** ***
***Activate local PRA plans as indicated in activation notifications***

***Directors’ Responsibilities***

## Directors’ Responsibilities

***Ensure that bed availability reporting, as well as reception, sorting, staging, transportation and hospitalization of arriving patients occurs efficiently.***
*** ***
*** ******Provide administrative support for patient control and proper patient accounting.***

***Directors’ Responsibilities***

## Coordinators’ Principal 

*** ******Establish and maintain active participation and support of local hospitals, health associations, EMS, emergency management agencies, police and fire services***
*** ******Ensure that representatives of NDMS member hospitals, as well as representatives of local emergency management agencies, EMS agencies, public safety, police and fire services are provided annual orientation to the PRA plan***

***Coordinators’ Principal ***
***Responsibilities***

## Coordinators’ Principal 

***Ensure that FCC staff and other individuals designated to augment the FCC staff annually receive detailed education and training ***
***Ensure that a PRT is developed for each PRA***
*** ******Collect bed availability data from each participating non-Federal hospital and report to the DoD’s GPMRC as directed***

***Coordinators’ Principal ***
***Responsibilities***

## Coordinators’ Principal 

*** ******Ensure 24/7 communications are established with GPMRC for the receipt of regulating decisions, evacuation mission information and patient medical data. ***
***Ensure an accounting method is in place to account for patients regulated but not yet received, and for patients in the PRA. ***
***Coordinate fiscal information to support the processing of financial claims reimbursement. ***

***Coordinators’ Principal ***
***Responsibilities***

## NDMS Overview Summary

- National Response Framework (NRF)
- NRF Tiered Response
- NDMS Partnership, Activation and Components
- Federal Coordinating Centers
- Roles and Responsibilities

**Notes:**
Bolivar Peninsula, TX, December 6, 2008 -- Specially trained cadaver locating dog "Cooper" (upper left) works a pile of debris while his trainer and flanker look on. Months after Hurricane Ike left the area a disaster, final sweeps are being made to determine that no human remains are still in the piles; clearing the way for cleanup crews to move in and start removing the mess. FEMA supports this mission, along with many others, as a community recovers after a disaster. Mike Moore/FEMA 

## VA-DoD Contingency System 

**VA-DoD Contingency System **
**and NDMS Overview**

|  | DoD-VA PRC | NDMS FCC |
| --- | --- | --- |
| Scenarios |  |  |
| Patients |  |  |
| Funding |  |  |
| PRTs |  |  |
| Regulating |  |  |
| Destination Hospital (s) |  |  |

**Notes:**
Let’s review the comparison and contrast between a PRC and an FCC.

## Questions?

**VA-DoD Primary Receiving Center (PRC) & NDMS Federal Coordinating Center (FCC) Training Course**

**Military Contingency**

**National Disaster**

## NDMS References

- National Response Framework, 2008 http://www.fema.gov/emergency/nrf/
- DoD Directive 6010.22: "National Disaster Medical System," January 21, 2003 (Currently under revision)
- NDMS Memorandum of Agreement among the Departments of Homeland Security, Health and Human Services, Veterans Affairs and Defense (NDMS Federal Partners MOA),     24 October 2005 http://fhp.osd.mil/ndms/docs/NDMS_Partners_MOA_24_Oct05.pdf
- DoD Directive 3025.1, "Military Support to Civil Authorities (MSCA)", January 15, 1993  http://www.dtic.mil/whs/directives/corres/html/302501.htm
- DoD Instruction 6000.11 "Patient Movement," September 9, 1998. (Currently under revision)

## Federal Coordinating Centers

*As of April 2009*
- All VA PRCs are also FCCs
- Air Force FCCs:
- Andrews Air Force Base, MD
- Keesler Air Force Base, MS
- Travis Air Force Base, CA
- Wright Patterson Air Force Base, OH

## Federal Coordinating Centers

*As of April 2009*
- Army FCCs
- Beaumont Army Medical Center, TX
- Fort Jackson, SC
- Dwight D. Eisenhower Medical Center, GA
- Madigan Army Medical Center, WA
- Brooke Army Medical Center, TX
- Tripler Army Medical Center, HI

## Federal Coordinating Centers

*As of April 2009*
- Navy FCCs
- Walter Reed National Military Medical Center, MD
- Naval Hospital Jacksonville, FL
- Naval Medical Center Portsmouth, VA
- Naval Medical Center San Diego, CA
- Naval Hospital Camp Pendleton, CA