# Presentation: 773626

## NDMS Patient Movement

***After Action Review****** ***
***12-13 Dec 2005***
***Mr. Mark Mahar USTRANSCOM/GPMRC***

## Emergency Support Functions-ESF’s
ESF-8 - Public Health and Medical Services
ESF-8, when activated is coordinated by Health and Human Services (HHS) through the Secretaries Operations Center
During initial activation, HHS convenes a conference call with the appropriate ESF-8 partners and State/local representatives

- ESF-8 - Public Health and Medical Services
- ESF-8, when activated is coordinated by Health and Human Services (HHS) through the Secretaries Operations Center
- During initial activation, HHS convenes a conference call with the appropriate ESF-8 partners and State/local representatives

***National Response Plan***

**Notes:**
The National Response Plan establishes a comprehensive all-hazards approach to enhance the ability of the United States to manage domestic incidents.  The plan incorporates best practices and procedures from incident management disciplines—homeland security, emergency management, law enforcement, firefighting, public works, public health, responder and recovery worker health and safety, emergency medical services, and the private sector—and integrates them into a unified structure. 

It includes 15 Emergency Support Functions (ESFs) that cover everything from Transportation to Firefighting to Public Affairs.  We are specifically interested in ESF8 Public Health and Medical Services and ESF1 Transportation

The Department of Health and Human Serives is the coordinator for ESF8.  ESF8 provides the mechanism for coordinating Federal assistance to supplement State and local resources in response to public health and medical care needs for potential or actual Incidents of National Significance.

## National Response Plan

- USTC/SG Responsible for:
- Coordination with ESF1-Transportation for evacuation of ambulatory patients and Displaced Persons
- Regulating and tracking patients transported on DOD assets
- Communicating requirements to Federal Coordination Centers (FCCs) and providing specific reporting instructions on bed availability
- Evacuating/Managing patients from patient collection points to NDMS patient reception areas

**Notes:**
DOD provides assistance in a number of different areas.  USTRANSCOM/SG is specifically responsible for coordinating with ESF1 Transportation to provide support for the evacuation of patients and potentially Displaced Persons to locations where hospital care or outpatient services are available.  Additionally, we work with the National Disaster Medical System (NDMS) Federal Coordination Centers (FCCs) for ascertaining available hospital beds and capabilities.  Using available transportation resources, we regulate and track patients from the patient collection point in or near the incident site to NDMS patient reception areas.  

## In Response to a Contingency

- USTC SG GPMRC provides:
- Bed availability data in coordination with FCCs
- Validation of patient movement
- Care plan for the patient
- Joint Patient Movement Team (JPMT)
- Coordination with movement agencies
- In-Transit Visibility

**Notes:**
During Hurricane Katrina, we deployed a Joint Patient Movement Team (JPMT) to New Orleans Louis Armstrong International Airport to facilitate the movement of large numbers of patients and Displaced Persons requiring medical care to various FCC NDMS Hospitals around the Southeast United States.  

This team worked with the GPMRC’s Coordination Center’s Duty Officer to ascertain what movement platforms were available, what NDMS beds were available and then make a decision on where the patients would go.  A validating Flight Surgeon deployed to assist the HHS’s Disaster Medical Assistance Teams (DMAT) and other responders to ensure patients were cleared for flight and advise on the effects of physiology of flight 

## Hurricane Katrina Timeline

- 31 Aug 05

- 01 Sep 05

- 02 Sep 05

- 03 Sep 05

- 04 Sep 05

- Received Tasking via NORTHCOM SG for deployment of JPMT

- JPMT put on official alert

- Attempted to contact FCCs in Region IV and VI

- JPMT arrived at New Orleans requested litter bearers

- MASF arrived in New Orleans

- AELT arrived in New Orleans

- JPMT augmentees arrived

- First official Evac of patients from Hurricane Katrina

- FEMA activated NDMS FCCs region IV and VI

- Moved 142 patients

- Moved 444 patients

- Moved 409 patients

- Moved 941patients

- Moved 791 patients

- 30 Aug 05

- EMEDS arrived in New Orleans

***Hurricane Katrina Timeline***

- Moved 52 patients out of Keesler AFMedCen

**Notes:**
Total of 2609 from Katrina

## Hurricane Katrina Timeline

- 05 Sep 05

- 06 Sep 05

- 07 Sep 05

- 08 Sep 05

- 20 Sep 05

- JPMT returned home to Scott AFB

- Last MASCAL Evac mission

- Moved 10 patients

- Began sustainment operations (regularly scheduled daily missions)

***Hurricane Katrina Timeline***

- Last patient moved

**Notes:**
Sustainment operations (regularly scheduled missions) began on 6 Sep.  Last patient moved on 20 Sep

## Hurricane Rita Timeline

- 21 Sep 05

- 22 Sep 05

- NORTHCOM/SG advised of FEMA’s verbal request for  DoD assistance for region IV & VI

- NORTHCOM/GPMRC provided language for MA to FEMA

- TRANSCOM received MA

- FEMA activated FCC’s in Regions IV & VI

- AMC/TACC stands-up glass room

-  433rd MASF / AELT arrived in Beaumont, Texas

- Request for forces to NORTHCOM for litter bearer support

-  Moved 129 patients with 3 AE missions from Texas

- GPMRC puts 6 member JPMT on alert

- GPMRC stands –up 24/7 contingency operations

***Hurricane Rita Timeline***

**Notes:**
Total of 1204 patients moved

## Hurricane Rita Timeline

- 23 Sep 05

- 433rd MASF/AELT departed Beaumont hrs before the storm surge

- FCC’s stand-down

- 25 Sep 05

- GPMRC stands down 24/7 contingency cell

- 26 Sep 05

- Moved 1075 patients on 19 AE  missions

- 24 Sep 05

- Operations suspended while hurricane makes landfall

- EOC’s state no further patient movement requests

- Ellington Field reported ceasing operations due to close proximity
- of the storm

- Lake Charles reported no further requirements and ceased operations

- Beaumont reported no further requirements and ceased operations

***Hurricane Rita Timeline***

## Lessons Learned

- Air National Guard/Coast Guard/Navy Involvement
- There were plenty of airframes offered by other than AMC that did not have AE crews or equipment.  There was no identified C2 over these airframes.
- Impact
- TRANSCOM/SG approved movement without AE crew - utilized local medical attendants.
- Recommendations
- Airframes have an identified C2 structure for all non-AF responders
- Mechanism for assigning either an AE crew or appropriately qualified medical attendants

**Notes:**
In addition to AMC assets, other responders operating under state or local agreements moved patients outside of ESF8.  This resulted in persons being moved with little or no accountability or visibility.   The impact of that was they were moved as Displaced Persons versus patients and bypassed the Patient Reception Areas.  Thus when they arrived at a shelter, they required medical care that had to be obtained locally.

## Lessons Learned

- JPMT Mission
- The JPMT role is to regulate and coordinate patient movement. In order for it to be effective, an AELT and Air Staging Facility (ASF) should be co-located and in place.
- Impact
- During initial phase JPMT had to perform duties outside of their role (i.e.. Litter bearer, triage, etc.)
- Recommendation
- Deploy AELT and ASF with JPMT

**Notes:**
The AELT and ASF should already be in place prior to JPMT arrival.  

## Lessons Learned

- TRAC2ES Application
- TRAC2ES is limited in a tactical situation with massive on loads and frequent missions. Mass casualty PMRs are too cumbersome.   Tactical on load forms were generated as a result of ‘Katrina’ and were faxed to the FCCs and MASFs for ‘Rita’ and were still only partially used.  FCCs kept a record of patients received, but often without mission numbers.
- Impact
- After the fact PMRs must be generated.
- Recommendation
- Change software to accommodate large number of patient evacuations.

**Notes:**
TRAC2ES was designed to operate from fixed facility to fixed facility not necessarily from a battlefield or disaster mass casualty environment.  We are working on a process that potentially could involve local officials with the ability to provide patient information directly into our system.  This would streamline the process and provide for better accountability of patients moved.

## Lessons Learned

- Best Mode to Move Patients
- Use of trains during ‘Rita’ may have been very beneficial in moving large numbers of patients.
- Impact
- More patients could have been moved in a shorter period of time.
- Recommendation
- Evaluate multi-modal patient transport platforms for future use.

## Lessons Learned

- Transport to Bed Planner
- The transport to bed planner is an integral part of managing mass casualty planning. During the relief efforts the transport to bed planner could not be utilized.
- Impact
- Missions and patient assignments were manually accomplished in TRAC2ES
- Recommendation
- Reengineer TRAC2ES to simplify the input of large numbers of casualties for matching against available beds.

## Internal Communications

- USTRANSCOM received a verbal EXORD from the Joint Staff
- J-3 alerts USTC Surgeon, GPMRC, and AMC CAT
- 18AF TACC/CC organized staff in Glass Room to work requirements

##      External Communications

-    - Request from state EOCs to FEMA
-    - FEMA developed an MA and activated NDMS and FCCs
-    - FEMA sent the MA to JDOMS to the Joint Staff to the Sec of Defense for approval and back to the Joint Staff for EXORD
-     - Verbal came from Joint Staff to execute
-     MA

## Chain of Command

**Notes:**
Joint Department of the Military Support

NORTHCOM is supported TRANSCOM would be supporting

## Chain of Command

**Notes:**
Joint Department of the Military Support

## Patient Tracking Issues

- Military Operations
- JPMT had limited communications while at the New Orleans Airport
- Need an effective ITV (In-Transit Visibility) mechanism
- FEMA – DoD
- Need consistent patient ID system for tracking
- Need standardized tracking forms
- Need joint system training

## Non-USTC Patient Moves

- Loss of visibility
-  - Guard assets moved patients
-  - Ground transport to civilian facilities
-  - Coast Guard assets moved patients to unknown locations
-  - Limited control of the surge of the patients to the New Orleans Airport

## Response Times

- Lead time
-    - Activation of FEMA, HHS teleconferences
-    - Pre-planning with JPMT
-    - Team dedicated to Katrina and Rita
- Lag time
-  - Notification process from the state
-  - Cycling of aircraft, AE Crews, and lay down of  MASF, EMEDs, and CCATT

**Notes:**
Responded to the largest federal response to a regional civilian disaster while continuing to support Operation Iraqi Freedom and Operation Enduring Freedom

##      Other Modes of Patient Movement

- Capability existed to move patients through various means
-    - Ground
-    - Naval Vessels
-    - Rotary Wing
-    - Fixed Wing

## Operational Successes

- 3813 Patients moved in two separate disasters
- Deployed first ever JPMT
- Coordinated closely with FCCs for bed availability
- Participated in multiple teleconferences to provide updates
- Put the patient first

## Questions???

***Questions???***