1. OVERVIEW of the NATIONAL DISASTER MEDICAL SYSTEM

2. NATIONAL RESPONSE FRAMEWORK (NRF) Integrated plan for Federal, State and Local actions during large scale domestic emergencies –Natural (e.g. hurricanes, tornados, earthquakes) –Technological (e.g. industrial spill, nuclear accident) –Terrorism (e.g. chemical, biological, radiation, nuclear, explosive) Activated by Presidential Declaration –May be delegated to Cabinet-level depending on event Divided into functional areas of responsibility –Emergency Support Functions (ESFs)

3. EMERGENCY SUPPORT FUNCTIONS ESF 1Transportation ESF 2Communications ESF 3Public Works and Engineering ESF 4Department of Agriculture/Forest Service ESF 5Emergency Management ESF 6Mass Care, Housing & Human Services ESF 7Resource Support ESF 8Public Health & Medical Services ESF 9Urban Search & Rescue ESF 10Oil & Hazardous Materials Response ESF 11Agriculture & Natural Resources ESF 12Energy ESF 13Public Safety & Security ESF 14Long Term Community Recovery & Mitigation ESF 15External Affairs

4. EMERGENCY SUPPORT FUNCTION 8 PUBLIC HEALTH AND MEDICAL SERVICES DHHS Lead Agency for ESF 8 –Public Health and Medical Services Supporting Agencies –VA, DoD, DHS (FEMA) ESF 8 Representative (on scene) –Performs Medical Needs Assessment of affected areas –Establishes patient reporting activity to facilitate requests for patient movement –Receives Patient Movement Requests (PMR) from State, Local (or DMAT) authorities –Initiates process to move patients out of region

5. NATIONAL DISASTER MEDICAL SYSTEM NDMS –Combines Federal and non-Federal medical resources into a unified response system –Also serves to expand medical support for military casualties that may exceed the capabilities of DoD and VA resources Three Primary Components –Response Teams (DMAT, DMORT, NMRT, NVERT, etc) –Patient Movement and Reception (DoD, TPMRC-A, FCC) –Definitive Medical Care (participating local NDMS hospitals)

6. PATIENT EVACUATION Three categories of patients for evacuation –Patients directly affected by disaster (e.g. orthopedic trauma from building collapse) –Patients in disaster who require care for which resources no longer exist (e.g. dialysis patients when water supply is interrupted) –Patients already in hospitals occupying beds that may be needed for acute casualties (e.g. 3 days post-op hip replacement) Evacuation –NDMS determines which FCCs need to be activated –Theater Patient Movement Requirements Center - Americas (TPMRC-A) regulates patient movement from the affected area to the FCC Patient Reception Areas (PRAs)

7. ENROUTE CARE Attending physician must ensure: –Patient can be transported safely –Appropriate continuing care available at destination –Specific attending physician must be identified at destination, and willing to assume responsibility TPMRC-A is responsible to determine safety and appropriateness of transfer –May approve or disapprove

8. NDMS PATIENT FLOW Disaster Area TPMRC-A NDMS HOSPITAL FCC

9. Puerto Rico Hawaii NDMS Federal Coordinating Center (FCC) Locations Army Navy Air Force VA

15. CONCLUSION The NRF is our nation’s unified approach to mobilizing the country’s emergency response capabilities on a scale necessary to meet a major catastrophe. NDMS is incorporated into this national approach as part of the National Response Plan’s ESF 8. Participating NDMS hospitals function as an asset to the Nation, to complete a comprehensive system of medical care during acute times of need.

16. THE NATIONAL DISASTER MEDICAL SYSTEM