# Presentation: 197986

**       **

**Federal Medical Station (FMS)**
**Past, Present and Future**
**COA 2006**
**02 May 2006**

** ****LCDR Gregg Davis, USPHS**
**Office of Mass Casualty Planning**

## The Spectrum of Care & Federal Medical Resources

**Basic First Aid **

**Outpatient**
**Care**

**Hospital**
**Inpatient Care**

**Nursing**** **
**Home Care**

**Pre-hospital **
**Care**

**ICU/Trauma**
**Critical Care**

**Emergency **
**Departments**

- Volunteers

- NDMS Hospitals

- DMAT’s

- VA/DOD

- US Public Health Service

- Medical Reserve Corps

- Federal Medical Stations

## Federal Medical Station (FMS)Deployable Medical Surge Capacity“ Vision”

**Provide surge medical capacity (equipment, materiel, pharmaceuticals) to communities overwhelmed by mass casualties**
**Are standardized, scalable, and adaptable for use across the mass casualty care continuum **
**Can be staffed by approved personnel for any federal, state or local agency or combination of agencies**
**Employ modular configuration and are designed for rapid transportation by land or air and for integration into a range of sites**

**Notes:**
Currently, neither the military, nor the other Federal Health capabilities (Department of Health and Human Services, (DHHS), Department of Defense (DOD), Federal Emergency Management Agency (FEMA) or Veterans Affairs (VA) are currently, organized or equipped to provide mass casualty to more than a few thousand patients.  
The Civil Defense movement of the 1950s and 1960s developed plans to care for hundreds of thousands of individuals displaced by a thermal-nuclear war and the federal government historically maintained federal hospitals in storage but with time the nations priorities and resources were redirected which led to the eliminated of these assets.  
As mentioned before, the Department of Health and Human Services (DHHS) has been given the responsibility under mandates as set forward in the National Response Plan and Homeland Security Presidential Directive (HSPD) 10 to develop a capability to address the nation’s public health challenges in today’s environment.  To address the nation’s potential shortfall in an all-hazard mass casualty care event, DHHS has developed and placed in production at the Strategic National Stockpile, the Federal Medical-Contingency Station (Type III Basic) program. The Type III Basic program will be able to respond quickly and effectively to an overwhelmed public health and medical demand in case of such a national incident.

## Federal Medical StationsStandardized Capabilities Across Agencies

** ****Type I (Advanced)- FMCS: will have the capability to care for severely ill or injured patients, equivalent to conventional operating room, ICU, and basic laboratory – being developed by DHS**
** ****Type II (Specialized): Configured for specific clinical scenarios, such as respiratory isolation. Will have capability of Type III, plus advanced care for specific clinical requirements and populations, e.g., burn patients. Future prototypes to be developed**
**Type III (Basic): Low to mid-level acuity of care to provide platform for PHS teams, quarantine function, alternate care facility to augment community hospital capability**
**Type IV (Medical Needs Shelter) – Care for acute exacerbations of chronic conditions**

## Federal Medical StationsStandardized Capabilities Across Agencies

**HHS has moved away from the approach on the previous slide**
** ****Based on AARs, we have made whole scale revisions to thehe materiel and pharmaceuticals to better care for the patients represented in Anytown, USA – much more all-hazards**
** **
** ****FMS will be the base platform and will be augmented modularly based on the types of patients **

## Federal Medical Station Legal Authority

**HHS has been given the responsibility under mandates in the National Response Plan (NRP) and the Homeland Security Presidential Directive (HSPD) 10 to develop a comprehensive plan to address the challenging health problem of medical surge – both capacity and capability **
**The statutory authority for the Federal Medical Station program pursuant to section 321 of the Federal Medical Act (42 U.S.C. 248) and intra-agency agreements will be executed in accordance with the Economy Act (35 U.S.C 1535).**
**The Stafford Act may provide additional guidance for any events that are declared National Emergencies.**

**Notes:**
Currently, neither the military, nor the other Federal Health capabilities (Department of Health and Human Services, (DHHS), Department of Defense (DOD), Federal Emergency Management Agency (FEMA) or Veterans Affairs (VA) are currently, organized or equipped to provide mass casualty to more than a few thousand patients.  
The Civil Defense movement of the 1950s and 1960s developed plans to care for hundreds of thousands of individuals displaced by a thermal-nuclear war and the federal government historically maintained federal hospitals in storage but with time the nations priorities and resources were redirected which led to the eliminated of these assets.  
As mentioned before, the Department of Health and Human Services (DHHS) has been given the responsibility under mandates as set forward in the National Response Plan and Homeland Security Presidential Directive (HSPD) 10 to develop a capability to address the nation’s public health challenges in today’s environment.  To address the nation’s potential shortfall in an all-hazard mass casualty care event, DHHS has developed and placed in production at the Strategic National Stockpile, the Federal Medical-Contingency Station (Type III Basic) program. The Type III Basic program will be able to respond quickly and effectively to an overwhelmed public health and medical demand in case of such a national incident.

## Federal Medical StationAttributes

**Scalable to the incident**
**Modular configuration**
**Mobile for maximum geographic distribution**
**Quickly integrated to the site**
**Predictable resources**
**Modeled for all age populations**

**Notes:**
Currently, neither the military, nor the other Federal Health capabilities (Department of Health and Human Services, (DHHS), Department of Defense (DOD), Federal Emergency Management Agency (FEMA) or Veterans Affairs (VA) are currently, organized or equipped to provide mass casualty to more than a few thousand patients.  
The Civil Defense movement of the 1950s and 1960s developed plans to care for hundreds of thousands of individuals displaced by a thermal-nuclear war and the federal government historically maintained federal hospitals in storage but with time the nations priorities and resources were redirected which led to the eliminated of these assets.  
As mentioned before, the Department of Health and Human Services (DHHS) has been given the responsibility under mandates as set forward in the National Response Plan and Homeland Security Presidential Directive (HSPD) 10 to develop a capability to address the nation’s public health challenges in today’s environment.  To address the nation’s potential shortfall in an all-hazard mass casualty care event, DHHS has developed and placed in production at the Strategic National Stockpile, the Federal Medical-Contingency Station (Type III Basic) program. The Type III Basic program will be able to respond quickly and effectively to an overwhelmed public health and medical demand in case of such a national incident.

## Federal Medical StationMission Statement 

**An FMS will provide scalable (in size), modular and rapidly deployable health and medical care to those patients who have non-acute medical, mental health, or other health-related needs that cannot be accommodated or provided for in a general shelter population.**
**An FMS is designed to provide health and medical care for patients with needs such as:**
**Conditions that require observation, assessment or maintenance**
**Chronic conditions which require assistance with the activities of daily living and do not require hospitalization**
**Need for medications and vital sign monitoring and who are unable to do so at home**
**Conditions that require the level of care provided by an FMS**
**An FMS is not an acute care hospital, nursing home or emergency department**

**Notes:**
Currently, neither the military, nor the other Federal Health capabilities (Department of Health and Human Services, (DHHS), Department of Defense (DOD), Federal Emergency Management Agency (FEMA) or Veterans Affairs (VA) are currently, organized or equipped to provide mass casualty to more than a few thousand patients.  
The Civil Defense movement of the 1950s and 1960s developed plans to care for hundreds of thousands of individuals displaced by a thermal-nuclear war and the federal government historically maintained federal hospitals in storage but with time the nations priorities and resources were redirected which led to the eliminated of these assets.  
As mentioned before, the Department of Health and Human Services (DHHS) has been given the responsibility under mandates as set forward in the National Response Plan and Homeland Security Presidential Directive (HSPD) 10 to develop a capability to address the nation’s public health challenges in today’s environment.  To address the nation’s potential shortfall in an all-hazard mass casualty care event, DHHS has developed and placed in production at the Strategic National Stockpile, the Federal Medical-Contingency Station (Type III Basic) program. The Type III Basic program will be able to respond quickly and effectively to an overwhelmed public health and medical demand in case of such a national incident.

## Basic Concept: HHS Federal Medical 

**Basic Concept: HHS Federal Medical **
**                  ****Station**

## Host requirements

- The following are FMS requirements for the hosting facility to provide:
- -40,000 square feet of enclosed space
- - perimeter security
- - waste removal
- - electrical power source and distribution
- - potable water
- - ice
- - fork lift for off loading/set-up
- - local transportation
- - billeting for 150 personnel per FMS
- - latrine/showers for patients
- - access to civilian medical personnel and contractors employed in patient care, patient transportation, and other supportive services
- Ideally each installation should be able to provide:
- communications support
- food service for staff and patients
- access to airstrip or helipad for air evacuations
- medical oxygen
- laundry services
- mortuary support
- refrigeration

## FMS Units in Hurricane Katrina Relief Effort

- Note: The PMAC/LSU and Alexandria SNS facilities were state-run medical shelters
- that were augmented with FMS equipment and supplies, and USPHS personnel.

## FMS Units in Hurricane Katrina Relief Effort

## FMS Units in Hurricane Katrina Relief Effort

## FMS Units in Hurricane Katrina Relief Effort

## FMS Units in Hurricane Katrina Relief Effort

## FMS Units in Hurricane Katrina Relief Effort

## FMS Units in Hurricane Rita Relief Effort

**FMS Units in Hurricane Rita Relief Effort**

## FMS Units in Hurricane Rita Relief Effort

**FMS Units in Hurricane Rita Relief Effort**

## FMS Units in Hurricane Rita Relief Effort

**FMS Units in Hurricane Rita Relief Effort**

## Common medical conditions among FMS patients

| Condition | % affected (n=325) |
| --- | --- |
| Hypertension | 40.9 |
| Behavioral health issues | 36.9 |
| Diabetes | 24.3 |
| Heart disease | 16.0 |
| Asthma | 15.1 |
| Epilepsy | 6.8 |
| Blind/partially blind | 6.2 |
| O2 dependent | 4.9 |
| Morbid obesity | 4.9 |

- Waco, Marlin, and Meridian NAS

## Common behavioral health conditions

| Condition | % affected (n=120) |
| --- | --- |
| Depression | 27.1 |
| Schizophrenia/Psychosis | 20.2 |
| Anxiety | 14.7 |
| Bipolar  | 11.6 |
| Alzheimer’s/dementia | 9.3 |

## Prevalence of medical and behavioral health conditions

- Waco, Marlin, and Meridian NAS (n=380)

## Prevalence of multiple medical conditions per patient

- Waco, Marlin, and Meridian NAS (n=325)

## Prevalence of multiple behavioral health conditions per patient

**Prevalence of multiple behavioral health conditions per patient**

- Waco, Marlin, and Meridian NAS (n=120)

## Prevalence of mobility issues among FMS residents

**Ambulatory 60%**

**Needs assistance (walker, etc)  20%**

**Wheelchair dependent 20%**

- Waco, Marlin, and Meridian NAS

## Length of Stay for patients/family

## Discharge destinations

| Destination | Meridian NAS | Marlin | Waco |
| --- | --- | --- | --- |
| Home | 6% | 67% | 63% |
| Family/friends | 30% | 22% | 23% |
| Assisted living | 19% | 4.5% | 9% |
| New/semi-perm housing | 19% | 4.5% | 3% |
| Hospital | 26% | 1% | 1% |
| Federal institution | 0 | 1% | 1% |

## Future/Present Initiatives

**Public Relations**
**Training Program and a Training FMS**
**IT/Communications Package**
**Structures, generators, logistical burden on host**
**National food service contract**
**Electronic Medical Records and standard forms**
**Regionalization of equipment caches**
**ICS structure for FMS**
**P&T Committee Meeting**
**Go-bags for outreach missions**

## P&T Committee - General

**CV – dropped IV, changed to most commonly prescribed, change quant.**
**Anticoagulants - +2 strengths of warfarin, + Coagucheck monitors**
**Diagnostics – incr. of glucometers to 10**
**GI - +proton pump inhibitor, docusate**
**Abx – dropped most of the IV, changed quantities, + levofloxacin**
**HIV/AIDS - +CDC post-exposure prophylaxis drugs**
**Respiratory – Incr. # and quantity of inhalers, +Singulair, +Serevent**
**TB - + all TB maintenance drugs (Ethamb, INH, Pyr, Rif)**
**Mental Health - + longer acting antidepressants, +atypical anitpsychotics, +ADHD **
**Pain - +Percocet and Oxycodone SR for chronic pain**
**Misc - +migraine, Parkinsons, Gout, incontinence**

## P&T Actions – Diabetes

**Before**
**Glyburide tabs – 1x100**
**Insulin 70/30 – 1 vial**
**Insulin Lente – 12 vials**
**Insulin NPH – 2 vials**
**Insulin Regular – 1 vial****	****	**

**After**
**Glyburide tabs – incr. to 5 bottles**
**Insulin 70/30 – incr. to 2 vials**
**Insulin Lente – dropped**
**Insulin NPH – incr. to 12 vials**
**Insulin Regular – incr. to 10 vials**
**Insulin Glargine – 5 vials**
**Glipizide tabs – 1x100**
**Metformin tabs – 5x100**
**Pioglitazone tabs – 2x90**
**Glucose tabs – 75x12**

## Contact Info

**Gregg Davis**
**HHS/OPHEP/OMCP**
**200 Independence Ave., S.W., **
**Room 403B**
**Washington, DC 20201****	**
**Gregory.Davis@hhs.gov**
**202-205-9317**