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NDMS Operational Readiness: A Proposed OWG Sail Plan CAPT Arthur J. French MD FACEP Operations Workgroup NDMS Conference 2006.

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Presentation on theme: "NDMS Operational Readiness: A Proposed OWG Sail Plan CAPT Arthur J. French MD FACEP Operations Workgroup NDMS Conference 2006."— Presentation transcript:

1 NDMS Operational Readiness: A Proposed OWG Sail Plan CAPT Arthur J. French MD FACEP Operations Workgroup NDMS Conference 2006

2 Vision vs. Policy CAVEAT! NDMS Section sets policy- we assist in development and implementation OWG vision is where we hope to sail together based upon what we see as current capability gaps

3 NDMS OWG 2006 Goals Develop Concept of Operations (CONOPS) –Aligned with NDMS Capstone documents i.e. nesting Address Report on the NDMS 2005 Hurricane Response (Malcolm Pernie) Develop recommendations for logistics, training, and C4I aligned with CONOPS defined operational capabilities

4 CONOPS Concept of Operations - (DOD) A verbal or graphic statement, in broad outline, of a commander's assumptions or intent in regard to an operation or series of operations. The concept of operations frequently is embodied in operation plans; The concept is designed to give an overall picture of the operation.

5 CONOPS vs FOG vs SOP Level 1 CONOPS: Overview, a brief concept summary of a disaster-related function, team, or capability. Level 2 Standard Operating Procedure or Operations Manual: A complete reference document, with procedures for performing a single function (SOP), or a number of interdependent functions (Ops Manual). Level 3 Field Operations Guide (FOG): A durable pocket or desk guide, containing essential nuts-and- bolts information needed to perform specific assignments or functions. Level 4Job Aid/Task Books: A checklist or other aid for job performance or job training.

6 Nesting of NDMS CONOPS & SOPs National Homeland Security Strategy –HSPDs/PDDs Department of Homeland Security –National Response Plan & NIMS –DHS & HSC Capstone documents Department of Health and Human Services –Agency for Healthcare Research and Quality –CDC & NIOSH DoD/SBCCOM Improved Response Program

7 HLS Capstone Documents National Planning Scenarios DHS Universal Task List 2.1 (Dec 2004) DHS Target Capabilities List: Version 2.0 (Jan 2005) HSPD-8 National Preparedness Goal (Dec 2005) DHS National Preparedness Guidance? Found at

8 National Planning Scenarios: The NDMS World of Work Nuclear Detonation Radiation Device Biological- Anthrax Biological-Influenza Biological- Plague Chemical- Nerve Agent Chemical- Industrial Chemical- Blister Chemical- Chlorine Explosion- IED Earthquake Hurricane Food contamination Foreign Animal Disease

9 DHS Universal Task List 2.1 NDMS-related Tasks –Incident Management –Command and Control Do we need an NDMS Response Team Task List? –NDMS Mission Essential Tasks Lists? –Team & position specific? –Scope of practice for clinical providers?

10 DHS Target Capabilities List: Version 2.0 How do we define capabilities of NDMS Response Teams and type teams per NIMS typing scheme? Does/ should one size fit all missions? –Currently only one type of DMAT/VMAT Should NDMS team typing be based on predesignated team capabilities versus operational readiness metrics?

11 HSPD-8 National Preparedness Goal Standards for preparedness assessments and strategies Critical Tasks –Associated Conditions –Performance Standards Competency-based training Performance assessment standards Preparedness scorecards

12 How Do We Incorporate HSPD-8 Capability Elements Into NDMS? Personnel Planning Organization & Leadership Equipment & Systems Training Exercises, Evaluations, and Corrections Personnel Facilities

13 Team Capabilities & Typing: Whats Important & Why? NIMS aligned capability-based team typing to manage resources efficiently Type 1 not better than Type 2/ Type 3 Clinical operational capabilities (DMATs) Non-clinical operational capabilities Response capability building blocks –Unit –Individual

14 Proposed Clinical Capability Parameters (DMAT) Defined Echelons/Levels of Care –Critical care vs acute care vs outpatient care Staff mix – physicians, nurses, allied health Biomedical equipment (EKG) Medical supplies Pharmacy operations Laboratory capabilities (I-Stat, POC) Diagnostic Imaging (US, X-ray, Doppler)

15 Can We Align Team Types With Mission Scenarios? Type 1- Level 1/2 emergency department with ICU (without surgery) Type 2- Level 2/3 community hospital emergency department without ICU Type 3- Outpatient clinic/ urgent care center Type 4- Forward needs assessment/ advance BOO C4I-coordinating team

16 Team Typing Versus Team Readiness: A Difference? Should all teams have same operational readiness requirements? –Ability to deploy within specified time with full team –Training & qualifications current –Passed team performance assessment Team typing team readiness Team type = groups of designed operational- clinical capabilities Team readiness = ability to meet their type- defined operational-clinical capabilities

17 Individual Target Capabilities Front End Analysis: What is the NDMS responders world of work? –Human performance technology approach –Operational work –Clinical work Defined Competency-Based Training Requirements –Equipment skills checklist Deployment Checklists (job aids/ tasks books)

18 Beyond CONOPS: Other Potential Areas of OWG Focus Patient safety and quality improvement –Standardization of procedures –Defined privileges & qualifications Triage doctrine Surge operations models Patient movement doctrine (PRT) Clinical practice guidelines

19 Clinical Privileging Privileging vs credentialing vs qualifications –Privileging applies to scope of patient care –Qualifications applies to skills All physicians should be resuscitationists –Require ACLS-EP, PALS,ATLS, FCCM? Establish core NDMS acute care privileges? –Define minimum competencies e.g. GMO Non-intensivist critical care providers? –ED/ICU RNs

20 Which Triage System is Best? Need ESF-8 standardization –NDMS –VA –DoD –HHS Primary triage – situationally dependent –START? –Sacco Triage Method ? Secondary triage - disease vs. injury? –AHRQ Emergency Severity Index

21 Patient Movement Issues Patient Reception Team SOPs Patient transport equipment (litters-gurneys) Joint medical operations –NDMS-DoD-VA interoperability –State-local- EMS aeromedical interoperability DoD medical regulating procedures/policies NDMS-DoD common patient movement items –Integrated critical care modules (SMEED, LSTAT)

22 How Can We Leverage Existing Federal Models? AHRQ & CDC –Alternate Care Site Selection Tool –Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness –Smallpox Response Plan and Guidelines –Pandemic Influenza: A Planning Guide for State and Local Officials SBCCOM Improved Response Program –Acute Care Center: A Mass Casualty Care Strategy for Biological Terrorism Incidents

23 Surge Capacity Protocols HHS-DoD Improved Response Program HHS Agency for Healthcare Research and Quality (AHRQ) –Surge operations models & protocols Centers for Disease Control and Prevention (CDC) – Bioterrorism/ pandemic protocols

24 Possible Clinical Guidelines? Infectious disease Rx (SARS, influenza) Critical care surge triage –Physician-nurse staff ratios –Indications for mechanical ventilation CBRNE triage-treatment Palliative Rx Dialysis criteria & priority of patients

25 C4I – Situational Awareness Command, Control, Communications, Computers, and Intelligence Battlefield information dominance elements –Team comms, wireless LANs, telemedicine –Electronic Patient Tracking –PDAs (BMIS-T) performance support systems –Electronic Medical Records – decision support Use of patient simulators for NDMS FTXs? Tabletop computer modeling and simulation for NDMS command & control exercises

26 C4I Interoperability DHS SAFECOM Project –Statement of Requirements for Public Safety Wireless Communications & Interoperability Integrated Wireless Network (IWN) Integrated Patient Tracking Initiative –COMCARE Alliance

27 Tiered IMT (MST) Deployment? Do we need Type 1, 2, & 3 IMTs? –Group Supervisors? Group/ Task Force IMT C4I teams scaled & aligned with missions & geography to maintain span of control in AOR How should IMT be staffed? –External - FT/PT NDMS, NDMS-1 –Internal - recruit from on-scene team staffs IMT position qualifications-designations?

28 NDMS Is a System of Systems The OWG Cant Do This Alone! Intra-NDMS collaboration –NDMS staff –Senior Medical Policy Group –MWG, DPWG, TWG, & LWG External collaboration –ACEP Disaster Section Electronic collaboration- Disaster Help


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