United States Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response LCDR John Gibbons Regional Emergency Coordinator Dr. Kenneth Sturrock Regional Emergency Coordinator CDR Ron Pinheiro Supervisory Regional Emergency Coordinator HHS/ASPR Region 8 Disaster Response Federal Health and Medical in Support of the Radiation Disaster

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Objective Describe federal health and medical disaster support coordinated through ASPR to assist state, tribal and territorial governments to a Radiological Disaster

ASPR: Resilient People. Healthy Communities. A Nation Prepared. HHS 3 HHS Operating Divisions Administration for Children and Families (ACF) Administration for Community Living (ACL) Agency for Healthcare Research and Quality (AHRQ) Agency for Toxic Substances and Disease Registry (ATSDR) Centers for Disease Control and Prevention (CDC) Centers for Medicare and Medicaid (CMS) Food and Drug Administration (FDA) Health Resources and Services Administration (HRSA) Indian Health Service (IHS) National Institutes of Health (NIH) Assistant Secretary for Preparedness and Response (ASPR) Substance Abuse and Mental Health Services Admin (SAMSHA)

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Lead the nation in preventing, preparing for and responding to the adverse health effects of public health emergencies and disasters ASPR Mission

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Office of Emergency Management (OEM) ─Leads preparedness, response, and recovery activities ─Directs and manages the HHS’ Secretary’s Operation Center (SOC) HHS Emergency Management Group (EMG) ─Staffed by HHS Operating Division and ESF8 Partner representatives ─Provides strategic guidance and operational support to field operations HHS Secretary’s Operations Center (SOC) ─Staffed 24/7 to maintain national situational awareness ─Base of Operations for EMG and OEM during response ASPR Headquarters 5

ASPR: Resilient People. Healthy Communities. A Nation Prepared. HHS Regions 6

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Regional Emergency Coordinators (RECs) HHS/ASPR Regional Representatives Preparedness   Disaster preparedness planning with State and Federal partners Response   Assume leadership and command roles in field operations   Federal Health Official (FHO)   Liaison Officers Recovery   Support regional and national recovery operations

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 8 Capabilities and Resources Federal Response Regional / Mutual Response Systems State Response Increasing magnitude and severity Local Response, Municipal and County All Disasters Are Local MinimalLowMediumHighCatastrophic

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Improvised HEU Device 9 Assumptions Enormous Devastation Local medical infrastructure overwhelmed National casualty distribution required Stafford Act Declaration (Presidential Declaration) Public Health Emergency Declaration

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 10

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Social Security Act, Section1135 Waivers Assists with Medical Surge Activities Professional Licensure Emergency Medical Treatment and Labor Act (EMTALA) Health Insurance Portability and Accountability Act (HIPAA) Emergency Use Authorization (EUA) Permits the FDA to authorize the use of an unapproved medical product or an unapproved use of an approved medical product REGULATORY WAIVERS 11

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Response Flow 12

ASPR: Resilient People. Healthy Communities. A Nation Prepared. US Public Health Service (USPHS) Health and Medical Professionals in all disciplines 6500 active-duty uniformed officers Rapid Deployment Force Teams (RDF) ─Team Capabilities: Low – mid acuity medical care Mental Health Teams (MHT) Applied Public Health Teams (APHT) ─Team Capabilities: Epidemiology, Preventive Med, Environmental Health Service Access Teams (SAT) ─Team Capabilities: Case management and human services (Patient Movement) USPHS Teams 13

ASPR: Resilient People. Healthy Communities. A Nation Prepared. National Disaster Medical System 14 A Nationwide Medical Response System to : Supplement state and local medical resources during disasters or major emergencies Provide backup medical support to the military/ VA medical care systems during an overseas conventional conflict A public / private sector partnership HHS DHS DOD VA NDMS

ASPR: Resilient People. Healthy Communities. A Nation Prepared Major Components of NDMS Medical ResponsePatient MovementDefinitive Care HHS Response Teams DMAT, IMSuRT, DMORT DOD AE Evacuation HHS Patient Return Contract VA / DOD Federal Coordinating Centers Public / Private Participating Hospitals NDMS

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Over 7700 Intermittent Federal Employees (3) - Incident Response Coordination Teams (IRCT) (49) - Disaster Medical Assistance Teams (DMAT) (3) - International Medical/Surgical Response Teams (IMSuRT) (1) - Medical Specialty Enhancement Team (MSET) (3) - National Veterinary Response Teams (NVRT) (10) - Disaster Mortuary Operational Response Teams (DMORT) (1) - Disaster Mortuary Operational Response Team – WMD (1) - Victim Identification Center Team (VIC) (3) - Disaster Portable Morgue Unit Teams (DPMU) 16 NDMS Medical Response

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 17 “Mobile Emergency Room” Disaster Medical Assistance Teams (DMAT) NDMS Medical Response Team Capabilities: Acute/Primary Care Patient Stabilization Casualty Staging and Clearing Equipped and Trained for Austere Operations

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 18 International Medical/Surgical Response Team (IMSuRT) NDMS Medical Response Team Capabilities Provide triage and initial stabilization Provides definitive surgical care Provides critical care and evacuation capacity

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 19 Team Capabilities Assistance in search and recovery Victim identification Victim Identification Center Mortuary services Disaster Portable Morgue Unit (DPMU ) CBRNE decontamination of remains Disaster Mortuary Operational Response Team (DMORT) Victim Identification Center Team (VIC) NDMS Medical Response

ASPR: Resilient People. Healthy Communities. A Nation Prepared. HHS Repository of Medical Countermeasures (MCM) ─Antibiotics, Chemical antidotes, Antitoxins, Vaccines, Antiviral drugs ─Life-saving medical materiel Supplement and re-supply state and local public health agencies in the event of an emergency Unknown Threat  Push Packages ─50-ton caches of pharmaceuticals, antidotes, and medical supplies designed for rapid deployment ─12 hours of the federal decision to deploy Known Threat or Re-supply  Managed Inventory ─Specific Items ─24 to 36 hours of a federal decision to deploy 20 Strategic National Stockpile (SNS)

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Low Acuity Medical Care FMS-250 and FMS-50 Managed by ASPR and CDC SNS Program Requires a building of opportunity and significant “Wrap Around” services Can be used as Medical Shelters 21 Federal Medical Stations (FMS)

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Assets available per zone: Ground Ambulance 300 ground ambulances (ALS & BLS) Air Ambulance 25 air ambulances, helicopter and/or fixed wing Para-transit capability Ability to Transport 3,500 Individuals Medical direction provided by State or Local resources. If unable, a federal medical director can be designated. National Ambulance Contract 22

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Response Flow 23

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 24 Provide Patient Movement from the Disaster Area Utilize All Types of Transportation Primarily Relies on Aeromedical Significant role for State DOH NDMS Patient Movement

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 25 Federal Coordinating Centers (FCCs) 62 Facilities Concentrated in Major Metropolitan Areas Patient Reception and Distribution to NDMS Participating Hospitals NDMS Definitive Care

ASPR: Resilient People. Healthy Communities. A Nation Prepared. 26 NDMS Participating Hospitals Network of approximately 1,800 non-federal hospitals Approximately 80,000 beds Re-imbursement at 110% of Medicare rate Third-party payer NDMS Definitive Care

ASPR: Resilient People. Healthy Communities. A Nation Prepared. RITN Receiving Facility 27

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Catastrophic Event ─Overwhelmed local medical infrastructure and capacity ─Majority of federal assistance into affected and surrounding areas = Scarce Resources RITN Facilities ─Receive ─Treat ─Manage patients Requests for support ─will be routed through the established local  state  federal emergency management systems Expectations 28

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Regulatory Waivers ─1135 ─Emergency Use Authorization Technical Assistance Material and Supply Chain Support Personnel ─USPHS Service Access Teams Federal Support for RITN Facilities

ASPR: Resilient People. Healthy Communities. A Nation Prepared. Uncharted territory ─The views and opinions expressed in this presentation are strictly that of the presenter and are not necessarily the views of ASPR, the Department of Health and Human Services, or the United States Government Catastrophic Event and Scarce Resources HHS Spectrum of Support in Response Operations ─Flow into and out of affected area ─Receiving facility support Strong Link to Local and State Emergency Management Take Home Message 30

ASPR: Resilient People. Healthy Communities. A Nation Prepared. The HHS/ASPR Region 8 Team CDR Ron Pinheiro Supervisory Regional Emergency Coordinator o / c / LCDR John Gibbons Regional Emergency Coordinator o / c / Dr. Kenneth Sturrock Regional Emergency Coordinator o / c / Traci Pole HPP Field Project Officer o / c / HHS Secretary's Operation Center (SOC) / / Questions? 31