1. Joint Regional Medical Plans & Operations
USNORTHCOM
Command Surgeon
Joint Regional Medical Plans & Operations
NDMS Patient Movement
Lt Col Tony Voirin
USNORTHCOM JRMP – NW Branch

2. Federal Patient Movement Capabilities
National Ambulance Contract
300 Amb/3000 para-transit seats/life-flight
Military Ground Ambulance – Humvee
Military Helicopters – MEDEVAC/CASEVAC
National Guard and Active Duty
Civilian Contract Airlines
Low acuity/Ambulatory/Chronic patients
NDMS Fixed Wing Patient Evacuation

3. A public/private sector partnership DHS DHHS DOD DVA
National Disaster Medical System
A public/private sector partnership DHS DHHS DOD DVA

4. Major Components of the NDMS System
Three functions that provide a comprehensive, supplemental health care delivery system during events of national significance. Within the partnership the MEDICAL RESPONSE leg is coordinated & managed by NDMS Headquarters. The Operations Support Center (OSC) coordinates personnel/team movement from home base to the mobilization site/staging area. NDMS response operations are also closely coordinated with the NRCC.
MEDICAL RESPONSE consist of the “out the door” teams that hit the affected area.
PATIENT EVACUATION is coordinated and managed by DoD. TRANSCOM supported lift out of pre-designated APOEs within or near the disaster area. Patients are received at Patient Reception Areas (PRAs) and regulated to local participating treat facilities by the Federal Coordinating Center (FCC).
DEFINITIVE CARE is that care delivered once evacuated patients are admitted to the participating hospitals.

5. NDMS Patient Evacuation
DoD has primary responsibility
Movement from point of origin to receiving Federal Coordinating Center (FCC) Patient Reception Area (PRA)
Primarily relies on air
AE = Aeromedical Evacuation
System Components
Movement Requests
Staging
Regulating
Lift
Reception & Distribution
Tracking (HHS JPATs)

6. System Capability Patient Evacuation can begin 36 hrs from notice
System can move 500 patients per day (up to 20% critical)
Up to four Airfields
Limited capability for patients
Suggest the following patients be evacuated by other modes
High-acuity burn
NICU and PICU
Psychiatric (if requires medical supervision)

7. Reception Sites (FCC)

8. What we need to know How many patients over what period (approx)
What airfields (coordinated approval)
Rate of delivery to the Airfield
Acuity of Patients (higher Acuity, less patients)
Litter/Amb – Space, number of patients/plane
Critical – CCATT and Equipment
Vented – CCATT, Equipment and O2
How will Patient Movement Requests flow
Will need to know but make best guess

9. Other factors Notice vs No Notice
Hurricane vs Earthquake/CBRNE
Catastrophic or Not (Potential or Just Bad)
7.8 Earthquake/Nuke or Prestorm/Wildfire
State Request Submitted or On Fence
Mission Assignment Driven Process
Single or Multi-State Event

10. Regional Hospital Coordinator Ambulances dispatched
AE System Overview
PT MAN
GPMRC
State EOC
JPMT (GPMRC)
PMR
LOCAL HOSP
Situational
Awareness
Mission
Built
PMR
Crews
Alerted
PT MAN
LOCAL HOSP
PMR
LOCAL HOSP
AMC
(TACC)
PMR
Regional Hospital Coordinator
PMR
Mission Specifics
(MSN #, Times, Etc.)
Ambulances dispatched
to hospitals
APOE/AMP
MASF/AELT
Ambulance
Control
CRE/CRT
State/Local IC
Pts moved
to APOE
and loaded
JPRT/QRC
NDMS HOSP
NDMS DMAT/CCT
NDMS HOSP
AE movement
to APOD
NDMS HOSP
APOD/FCC

11. Challenges Patient Movement Requests
Number of patients; over period of time (approximately)
FEMA Mission Assignment (MA) to DoD
Identification and allocation of space on Airfields
Rate of delivery to the Airfield(s)
right patient
right airhead
right order/time
Acuity of patients (higher acuity = less patients)
Litter/Ambulatory – space, number of patients/plane
Critical – CCATT, Equipment, O2 (20% max)
Vented – CCATT, Equipment, O2
# Non-medical attendants (i.e. pediatric patients - 20% max)

12. Questions?