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U.S. Department of Homeland Security Federal Emergency Management Agency Mass Casualty.

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Presentation on theme: "U.S. Department of Homeland Security Federal Emergency Management Agency Mass Casualty."— Presentation transcript:

1 U.S. Department of Homeland Security Federal Emergency Management Agency Mass Casualty Medical Response Capabilities Response Division

2 DHS/FEMA Vision/Concept for Federal Medical Response to Mass Casualty
Build on existing NDMS team capabilities and equipment to serve as the “point of the spear” to begin rapid execution of medical operations

3 NDMS RESPONSE TEAMS 24 Disaster Medical Assistance Teams (Fully Operational/Operational 31 Disaster Medical Assistance Teams (Augmentation/Developmental) 4 National Medical Response Teams / WMD 4 Burn Teams 2 Pediatric Teams 1 Crush Medicine Team 3 Medical/Surgical Response Teams (MSuRT)* 2 Mental Health Teams 1 Family Assistance Core Group 4 Veterinary Medical Assistance Teams Disaster Mortuary Operational Response Teams (1 WMD) National Pharmacist Response Teams 10 National Nurse Response Teams 1 Management Support Team * Includes 2 under development


5 Basic Building Block- DMAT

6 DMAT Scope of Services Austere primary and acute care
Triage of mass casualties Initial resuscitation & stabilization Advanced life support Preparation of patients for evacuation

7 DMAT Scope of Services (cont.)
Acute care (250 patients / 24-hours) Acute Care (160), stabilize and hold 6 patients /10 hr (2 critical care) Community Medical Outreach

8 DMAT Scope of Services (cont.)
Ward care for 30 med/surg Triage and prepare 200 patients at a casualty collection point (CCP) for evacuation / transportation. Alternate Medical Care Facility (150) Mass drug distribution or immunization

9 DMAT Medical Services Limited laboratory
Hb, lites, ABG, stool for blood, dipstick urinalysis Limited pharmaceutical services

10 2004 NDMS Hurricane Responses Demonstrated Capability
(Augmentation personnel: Total personnel: 800+) Storms Alerted Teams Deployed Teams Total Patients Charley ,782 Frances ,461 Ivan ,446 Jeanne Totals ,740

11 $ 15.238M above NDMS budget of $34M
FY04 NDMS ENHANCEMENTS $ M above NDMS budget of $34M NDMS Team Readiness Assessment & Evaluation Criteria & standards developed & applied Procured organic team transportation assets 93 vehicles – 31 teams - $6.44M Standardized and procured team caches 14 full & 17 partial - $7.7M

12 FEMA/NDMS DMAT Team FY05 planned UPGRADES Diagnostic & Critical Care
15 Type I Teams Diagnostic & Critical Care Portable Digital X-Ray Portable Sonogram Surgical Scrub Sinks Wheeled Litter Carts Portable Adjustable Beds Surgical Lamps BIPAP machine Crash Cart & Hanging ALS Containers Western Shelter Tent Connectors

13 Shock Trauma / X-Ray / Lab / Pharmacy

14 Shock Trauma Unit



17 Digital X-Ray

18 Capabilities Single Team 35 person - D + 1 Scope of Medical Services
Outpatient Facility - 250 pts per day Treatment with Limited Holding Capacity 160+ pts / day Observe 8/10 pts Augment Standard Med-Surg Ward - 50 Pts Casualty Collection Holding Center 150 Pts (Similar to NDMS Reception Center)

19 NDMS Medical Care Capabilities
(Categories are exclusive, not additive!) SCOPE OF MEDICAL SERVICES SINGLE TEAM 35 Pers.(D+0) 14 TEAMS 490 Pers. (D+1) 31 TEAMS 1085 Pers. (D+3) Treat & Release (Outpatient Facility) 250 Patients/day 2,500 Patients/day 5,000 Patients /day Treat & Limited Holding 160 Outpatients/day 8-10 Inpatients 2,250 Outpatients/day 112 Inpatients 4,500 Outpatients/day 224 Inpatients Hospital Ward 50 Patients 700 Patients 1,400 Patients Mass Casualty Incident Holding/Collection Facility (Reception Center) 150 Patients 2,100 Patients 4,200 Patients

20 Federal Medical Contingency Stations
Initiative developed jointly by DHS and HHS to create a deployable infrastructure to help close the U.S. surge capacity gap, that could, by 2010 create 31,000 beds.

21 Federal Medical Contingency
Stations Three types of FMCS deployable caches are envisioned: Type I - Medically robust facility comprehensive capability (field hospital) to care for severely ill or injured patients Type II- Specialized versions of the FMCS Type I configured for specific needs , such as respiratory isolation and/or burns Type III – Low to mid-level acuity of care that may be used for special needs shelters, quarantine function, alternate care or step-down facility to augment community hospital capability in a shelter-of-opportunity

22 FEMA/NDMS Surge Capacity Enhancements
FEMA’s 2005 budget includes $20 million for: Medical surge capability planning Developing two (2) prototype federal medical contingency stations- type I (fixed & mobile) Exercise and evaluation

23 Federal Medical Contingency Station - Type I
FEMA Subject Matter Expert Group Eighteen SME’s represent: 7 Level 1 Trauma Centers DoD present and past Medical Corps NDMS – 15 yrs min (8 DMATs, MsURT, NMRT, Burn, & Pediatric teams) Medical specialties represented include: Emergency Medicine, Family Practice, Pediatrics, General Surgery, Trauma Surgery, Orthopedic Surgery, Critical Care Medicine, Critical Care Nursing (ER, trauma, ICU), Lab & X-Ray Specialists

24 Federal Medical Contingency Station
Type I DEVELOPMENT Review available military and civilian resources for: Requirements for storage, assembly, and staffing Logistical support requirements for maintenance, movement, and setup Logistical, management and medical teams Exercise and evaluate for future development

25 Federal Medical Contingency Station
Type I CAPABILITIES From request to full operational capability – 2 days Travel - 24 hr Set-up - 48 hrs

26 Federal Medical Contingency Station
Type I MISSION Provide medical augmentation to local medical services Temporary replacement for hospitals destroyed or rendered inoperable

27 Federal Medical Contingency Station
Type I CAPABILITIES Triage, immediate life saving intervention & limited surgery Scalable in-patient care for up to 250 patients (both acute and sub-acute illness) ICU beds for up to 12 patients

28 Federal Medical Contingency Station
Type I (Scalable) 1 DMAT 250 out pt’s / day 8-10 observation beds Reg/Waiting E.R. Solid Waste Mgmt Pharm./Supply X-Ray/Lab

29 Federal Medical Contingency Station
Type I (Scalable) 1 MSuRT - 12 ICU pt’s 1 OR 1 Ward – 12 pt’s Reg/Waiting E.R. Solid Waste Mgmt Lab / Supply X-Ray/Pharm O.R. Supply Ward - Step-down I.C.U. I.C.U.

30 Federal Medical Contingency Station
Type I (Scalable) Reg/Waiting 2 DMAT’s pt’s E.R. Solid Waste Mgmt Lab / Supply X-Ray/Pharm O.R. Supply Ward - Step-down I.C.U. I.C.U. Ward 2 Ward 5 Ward 7 Ward 3 Shower Ward 6 Ward 8 Ward 4

31 Federal Medical Contingency Station - I (Scalable)
Reg/Waiting 3 DMAT’s patient’s E.R. Solid Waste Mgmt Lab / Supply X-Ray/Pharm O.R. Supply Ward - Step-down I.C.U. I.C.U. Ward 2 Ward 9 Ward 15 Shower Ward 3 Ward 10 Ward 16 Ward 4 Ward 11 Ward 17 Ward 5 Ward 7 Ward 12 Ward 18 Ward 6 Ward 8 Ward 13 Ward 19 Ward 14 Ward 20

32 Federal Medical Contingency Station
Type I (Scalable) 250 BED UNIT Staffing = 6 DMATS (I & II) + 1 MSuRT + add’l DMAT’s (III & IV) to train for personnel augmentation Approx. total personnel : 280 MD/DO PA/NP RN EMT-P RPh Mental Health RT Medical mgt/support - 51 X-Ray Tech - 6 Lab Tech -10 Dietician - 2 EMT-B -23

33 Medical Officers Total personnel - 24 Surgeons 4
Orthopaedic Surgeons 1 Emergency Department Physicians 8+ Anesthesiologists 2 Critical Care Physicians 1 Family Practice/Internal Medicine 8

34 Nursing Officers Total personnel - 74 Nursing Supervisors 4
Emergency Department Nurses 8 Operating Room Nurses 8 Critical Care Nurses 10 Med/Surgical

35 Federal Medical Contingency Station
Type I CAPABILITIES Not State-of-the Art Medical Care compared to routine daily care in US Triage/out-comes lower than in non disaster mass casualty scenario

36 Federal Medical Contingency Station
Type I Types of Medical Care Limited number of high acuity non-surgical patients (12 bed ICU) Wound management Primary fracture care and amputations Hydration/GI disease

37 Federal Medical Contingency Station Types of Medical Care (cont.)
Type I Types of Medical Care (cont.) Ventilator support – Short term (hours) & limited numbers (max 12) Supportive/special needs

38 Federal Medical Contingency Station
Type I Trauma Surgery Initiate fluid & ventilator support Bleeding control “Stabilize” Rapid evacuation to higher level care

39 Federal Medical Contingency Station
Type I OR Procedures High end wound care Exploratory laparotomy Amputations C-Section Bronchoscopy Tracheostomy Burr hole K-wires Fasciotomy

40 Federal Medical Contingency Station Laboratory Capability
Type I Laboratory Capability Lites Hb/Hct Bun U/A WBC Tropins Gram’s stain Stool & gastric blood Type & cross match PT/Pro Pregnancy ABG’s CO oximetery

41 Federal Medical Contingency Station Diagnostic Capability
Type I Diagnostic Capability Portable digital X- Ray & C- Arm Ultra sound 12 lead EKG Expired tidal volume/min. vent Intra ocular pressure

42 Federal Medical Contingency Station Monitoring Capability
Type I Monitoring Capability Continuous EKG monitoring Pulse oximetery Expired CO2 Blood pressure Doppler Weight Core body temperature Compartment pressure

43 Add Special Teams as needed

44 Federal Medical Contingency Station Required Services NOT Provided
Type I Required Services NOT Provided Food Potable water Generator fuel Fork lifts Organic transportation Armed security Solid waste Bio-hazard waste Sanitation services Intra-agency communication Medical evacuation (ground & air)

45 FEMA/NDMS Surge Capacity Enhancements
Electronic Medical Records (EMR) Initiative Evaluate existing electronic records systems for applicability to NDMS Acquire electronic medical records software appropriate to integrate into existing platforms Training and Exercises for all NDMS team members

46 FEMA/NDMS Surge Capacity Enhancements
Support National Patient Accountability, Movement & Regulating Initiative with DOD and DOT

47 Medical Surge Bed Capacity
DHS/FEMA Capability (Staffed by NDMS Teams) 500 FY05 1000 add’l by FY08 pending support for funding Private Sector DoD HHS VA USG Medical Surge Bed Capacity Target By FY 2010 : 31,000+ (pending funding)

48 GAPS Sufficient medical surge capacity in the US to respond to a naturally occurring catastrophic disaster or terrorist event WMD - including CBRN agents Hospital Beds & facilities Healthcare personnel Equipment & supplies Interoperable electronic medical records Patient movement capability Expertise ADEQUATE funding & staffing to address gaps


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