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

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Presentation on theme: "U.S. Department of Homeland Security Federal Emergency Management Agency Mass Casualty Medical Response Capabilities Response Division."— 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 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 11Disaster Mortuary Operational Response Teams (1 WMD) 10National Pharmacist Response Teams 10 National Nurse Response Teams 1 Management Support Team * Includes 2 under development NDMS RESPONSE TEAMS

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5 Basic Building Block- DMAT

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

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

8 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 DMAT Scope of Services (cont.)

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

10 Storms Alerted Teams Deployed Teams Total Patients Storms Alerted Teams Deployed Teams Total Patients Charley 3123,782 Charley 3123,782 Frances 10 81,461 Frances 10 81,461 Ivan 11133,446 Ivan 11133,446 Jeanne Jeanne Totals ,740 Totals , NDMS Hurricane Responses Demonstrated Capability (Augmentation personnel: Total personnel: 800+)

11 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 FEMA/NDMS DMAT Team FY05 planned UPGRADES 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

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17 Digital X-Ray

18 Capabilities Single Team 35 person - D + 1 Scope of Medical Services Outpatient Facility Outpatient Facility pts per day Treatment with Treatment with Limited Holding Limited Holding Capacity Capacity pts / day -Observe 8/10 pts Augment Standard Med-Surg Ward Med-Surg Ward - 50 Pts Casualty Collection Holding Center 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 Patients700 Patients1,400 Patients Mass Casualty Incident Holding/Collection Facility (Reception Center) 150 Patients2,100 Patients4,200 Patients

20 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. Federal Medical Contingency Stations

21 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 Federal Medical Contingency Stations

22 FEMA/NDMS Surge Capacity Enhancements FEMAs 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 SMEs 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 MISSION Provide medical augmentation to local medical services Temporary replacement for hospitals destroyed or rendered inoperable Federal Medical Contingency Station Type I

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

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

30 2 DMATs - 84 pts Ward 3 Ward 7 Ward 8 Ward 5 Ward 2 Ward 6 Ward 4 Reg/Waiting Reg/Waiting E.R. E.R. Lab / Supply Lab / Supply X-Ray/Pharm X-Ray/Pharm O.R. O.R. Supply Supply I.C.U. I.C.U. Ward - Step-down Shower Solid Waste Mgmt Federal Medical Contingency Station Type I (Scalable)

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

32 250 BED UNIT Staffing = 6 DMATS (I & II) + 1 MSuRT + addl DMATs (III & IV) to train for personnel augmentation Approx. total personnel : 280 Federal Medical Contingency Station Type I (Scalable) MD/DO- 24 PA/NP- 12 RN - 74 EMT-P- 50 RPh- 16 Mental Health - 6 RT- 5 Medical mgt/support- 51 X-Ray Tech- 6 Lab Tech-10 Dietician- 2 EMT-B-23

33 Medical Officers Total personnel - 24 Surgeons4 Orthopaedic Surgeons1 Emergency Department Physicians8+ Anesthesiologists2 Critical Care Physicians1 Family Practice/Internal Medicine8

34 Nursing Officers Total personnel - 74 Nursing Supervisors4 Emergency Department Nurses8 Operating Room Nurses8 Critical Care Nurses10 Med/Surgical44

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 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 Federal Medical Contingency Station Type I

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

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

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

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

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

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

43 Add Special Teams as needed NMRT, DMORT, etc.

44 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) Federal Medical Contingency Station Type I

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

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

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