1. Emergency Coordinator
National Ambulance Contract
CDR Amy O. Taylor
DHHS/ASPR R6
Emergency Coordinator
Cole Bricker
DHS/FEMA Region 6
Operations

2. Federal National Ambulance Service: PURPOSE
The purpose of the Federal National Ambulance and Para-transit Support Services contract is to provide a full array of licensed ground and air ambulance services and para-transit services that may be ordered as needed to supplement the Federal and Military response to a disaster, act of terrorism or other public health emergency in any of the 48 contiguous states.

3. Background Why a National Ambulance Contract? Multi-Agency Effort Cost
Complexity
Credentials
Coordination
Multi-Agency Effort
GSA
HHS
FEMA

4. Mission
The Department of Health and Human Services provides technical assistance to FEMA in support of contracted ground + air ambulances, and para-transit vehicles to support State, tribal and local governments ability to prepare for and respond to the effects of a major disaster.

5. Centrally managed, regionally coordinated contract
Provide a full array of licensed ground, air ambulance and para-transit services to assist states in accomplishing patient evacuation
May be ordered as needed to supplement response to a disaster, act of terrorism or other public health emergency.
State public health authorities determine there are unmet requirements to rapidly and safely evacuate patients with complex and ongoing medical needs;
Initiate request for Federal assistance.

6. Authorities FEMA contract executed through HHS operational support
Can only be utilized within a Stafford Act Activation/Declaration

7. Contract Zones

8. Performance Requirements Per Zone
GROUND AMBULANCE
300 ground ambulances (ALS & BLS)
Typically a 70%/30% ALS/BLS split
AIR AMBULANCE
25 air ambulances, helicopter and/or fixed wing
PARA-TRANSIT
Ability to Transport 3,500 individuals
Not 3,500 vehicles
BOTTOM LINE: LIMITED NUMBER OF RESOURCES

9. Resources

10. Ground Ambulance Services

11. Types of Ground Ambulances
Type II – Advanced Life Support, Non-HazMat
Type IV – Basic Life Support, Non-HazMat
Type V – Bariatric Ambulance, ALS
Type VI – Med-Evac Bus, ALS
> 4 stretcher patients

12. EMS Roles Patient triage, treatment & transport Hazard recognition
Symptom surveillance & reporting
On-scene medical standby
Redistribution of pts. to free up hosp. beds
Distributing immunizations
Staffing shelters
Staffing emergency departments
Setting up mobile medical units

13. Para-Transit Services

14. 6 Types of Para-Transit Vehicles

15. Para-transit Restrictions
Sending facility responsible for determining host facilities/destinations
One-way distance < 200 miles or 6 hrs.
Multiple trips expected
No medical staff on vehicles
Caregiver must accompany patient if medical care is required
Order by patient type, not by vehicle type
Non-ambulatory, wheelchair bound
Ambulatory with assistance
Ambulatory & no assistance needed

16. AIR AMBULANCE SERVICES

17. Types of Fixed-Wing Aircraft
Type I – critical care ALS 2+ pts.
Type II – critical care ALS 1 pt.
Type III – ALS 2+ pts.
Type IV – BLS 1 pt.
Type V - Neonatal

18. Types of Rotary-Wing Aircraft
Type II – ALS 2+ pts., night ops.
Type III – ALS 1 pt., non-night ops.
Type IV – ALS 1 pt., night ops. VFR
Type V - Neonatal Specific

19. Performance Requirements Per Zone
2 Zones
3 Zones
4 Zones
300 ground amb.
600 ground amb.
900 ground amb.
1,200 ground amb.
25 air ambulances
50 air ambulances
75 air ambulances
100 air ambulances
3,500 bus seats
7,000 bus seats
10,500 bus seats
14,000 bus seats

20. State Considerations Medical Evacuation Planning (State ESF-8 lead)
Activation Request to FEMA Region (Governor)
Coordination with HHS /ESF-8 regional office

21. Medical Evacuation Planning Considerations
Planning must be performed whether it be deliberate or crisis-action and is a state ESF-8 responsibility. It should include:
Number of patients to evacuate
Patient locations (Pick up Points)
Hospitals
Nursing Homes
Residences
Where will patients go?
Intrastate or Interstate evacuation
Shelter/Hospital Agreements

22. Medical Evacuation Planning Considerations (cont)
Staging area (Check-In site) locations
Security
Repatriation
Medical Assets
Can this be handled through EMAC?
Will this require Federal augmentation

23. Activation Request to Region
If activating the Federal Ambulance Contract, the state must prepare an ARF identifying the following information (at the very least):
No. of patients to evacuate & condition:
Critical/Intensive Care
Advanced Life Support
Basic Life Support
Check-in site
How they will be used
Local augmentation of 911 dispatch
Transportation/Evacuation of Patients

24. Needs Identification
State/local identify numbers needing specific type of support during planning.
State incorporates EMAC assets in planning (follow GAP analysis concept).
State works with HHS Region to identify Federal piece.
NOTE: The national contract is NOT a panacea- it is intended to augment State and local resources.

25. Coordination Pre-Event During the Event Post-Execution
HHS Regional Emergency Coordinators work with States to determine if medical evacuation assistance may be necessary and identify potential check-in sites for assets.
Finalize State coordination of requirements.
State ID’s potential types and numbers.
During the Event
Monitor usage
State ID’s types and numbers
Post-Execution
Forward draw-down and demobilization plan

26. Caveats Regions work through HQs
No individual direct contact with contractor prior to activation
ESF #8 manages, FEMA pays
Joint decision-coordination process
Under utilization= demobilization
State/ local exhaust available support
Own contracts/assets
Mutual aid and EMAC

27. How does it work?

29. Check In Ground Ambulance - verify quantity at Check-in
ALS (usually 70%)
BLS (usually (30%)
Para-transit (seats)
Verify quantity at check in
25% of seats must have working wheelchair lifts
Air – Verify quantity at check in. This may occur at a separate check in site from the ground assets.
COTR must validate check-in times for each asset 29

30. AMR/FEMA Vehicle Placard
A=ALS ground ambulance
B=BLS ground ambulance
C=ALS bariatric grnd amb
D=ALS Med-Evac bus
G=Type I sedan/minivan
H=Type II minibus
J=Type III coach transit bus
K=Type IV wheelchair van
L=Type V ADA minibus
M=Type VI ADA coach bus
X=Support vehicle

31. Check-In Form

32. Inspection COTR Inspections (Random)
“Contractor is responsible for maintaining all provisioning necessary to resupply all ambulances provided pursuant to any task order for extended periods” – SOO Section C-4
COTR Inspections (Random)
Medical Supply Inspections
Expiration Date
Type of supplies required are adequate for tasks assigned
Personnel Credentials
State DOT may perform vehicle inspections as well

33. Equipment Issuance
Transportation Management Services (TMS) contractor support staff will be at the check in site to tag each ground asset with a GPS transponder
Used for deployed evacuation assets across the evacuation transportation enterprise
Plots and tracks assets in real time using Sprint i365 GPS enabled phone
Provides long-term historical tracking information
Provides online (web-based) real-time reporting through Telenav
Enables quick setup and management – anytime from anywhere

34. Corrugated Container Box
BESS Kit Contents
Adhesive Placard
12V Y-Adapter
120V AC Charger
Laminate Placard
Corrugated Container Box
Portable 12V DC
Power Pack
Sprint i365
12V DC Charger

35. Reporting / Tracking The COTR must
Provide regular status reports – frequency will be set by the National COTR. These reports will capture information on mobilization, missions being performed, asset utilization, inspections, demobilization, etc
Coordinate with state representatives at staging areas and issue work orders to the contractor for missions (which will assign certain assets to a specific purpose for a duration of time)
Adjust work orders as mission requirements demand
Maintain a spreadsheet that tracks work order progress

36. Asset Utilization How many assets are redlined and why?
Maintenance Issues
Assets should never be down due to driver rest requirements
COTRs must identify how many assets are on missions out of total available (percent utilization)?
Asset Utilization is the key metric used to lead demobilization coordination calls with the states.

37. Patient Encounter Form

38. ICS 220 Operational Status Reports (measures asset utilization)
Ground
ambulance
Para-transit
Air Ambulance

39. Demobilization COTR is responsible for demobilization coordination
ESF-8 liaison at state EOC
RRCC
JFO
OHA
FEMA National COTR

40. Demobilization, Check-Out Form

41. Lessons Learned

42. Deployments Hurricane Dean Aug 08 $15M
Hurricane Gustav/Ike Aug 08 $120M
Presidential Inauguration Jan 09 $8M

43. Successes Met performance requirement Deployed safely
Logistical support
Mission Ready
Accomplished assigned missions

44. Challenges Check in process Direct resource communication & tracking
Resource utilization
Inter-agency coordination
Logistics leveraging
Costs

45. Summary Planning Activation Deployment Demobilization
State and HHS region coordinate
Project assets needed/ staging
Activation
Deploy assets to staging area
FEMA placards for vehicle ID
State/local briefing; credentialing (if necessary)
Deployment
Resources deploy from sating area to site(s)
Once assets leave staging area, assigned to state
State/ local gov’t provide medical direction; patient distribution and tracking
Demobilization
Once task(s) or assignments complete, or asset no longer needed

46. QUESTIONS ?