1. EMS: On the Radar Screen at OPHEP? Sandy Bogucki, MD, PhD Senior Medical Advisor Office of Public Health Emergency Preparedness Department of Health & Human Services sandy.bogucki@hhs.gov

2. ASPHEP Stewart Simonson Secretary’s principal advisor on matters related to:Secretary’s principal advisor on matters related to: –Bioterrorism –Other public health emergencies –Natural disasters generating medical emergencies Coordinates interagency activities regarding EP and PH emergency responses between HHS andCoordinates interagency activities regarding EP and PH emergency responses between HHS and –Other federal departments, agencies, offices –State, local officials

3. e.g. Project BioShield BioShield was announced by President Bush in his State of the Union address on January 28, 2003. Secretaries Thompson (HHS) and Ridge (DHS) jointly transmitted the “Project BioShield Act of 2003 to Congress on February 26, 2003. Purpose: To accelerate the process of research, development, purchase, and availability of effective countermeasures against agents of bioterror. OPHEP: OPHEP: Office of R&D CoordinationOffice of R&D Coordination Primarily NIHPrimarily NIH

4. OPHEP: OPHEP: Office of R&D CoordinationOffice of R&D Coordination Office of State & Local PreparednessOffice of State & Local Preparedness coordinating and integrating CDC's and HRSA's Cooperative Agreement Programs ($2.5 Billion FY ’02, ’03)coordinating and integrating CDC's and HRSA's Cooperative Agreement Programs ($2.5 Billion FY ’02, ’03) Public Health Cooperative Agreement (CDC)Public Health Cooperative Agreement (CDC) Regional public health preparedness planningRegional public health preparedness planning Increasing lab capacityIncreasing lab capacity Increasing surveillanceIncreasing surveillance Establishing rapid communication systemEstablishing rapid communication system Bioterrorism Hospital Preparedness Cooperative Agreement (HRSA)Bioterrorism Hospital Preparedness Cooperative Agreement (HRSA) Regional surge planning (beds, personnel, and equipment)Regional surge planning (beds, personnel, and equipment) Lab capacityLab capacity Mental health consequences of terrorismMental health consequences of terrorism Training: ICS, PPE, SmallpoxTraining: ICS, PPE, Smallpox

5. OPHEP: OPHEP: Office of R&D CoordinationOffice of R&D Coordination Office of State & Local PreparednessOffice of State & Local Preparedness Office of Planning & Emergency Response Coordination (OPERC)Office of Planning & Emergency Response Coordination (OPERC) –Operates the SOC 24/7, with liaison in HSOC Representatives of Op Div’sRepresentatives of Op Div’s –Some via video link Interagency LiaisonsInteragency Liaisons USPHS (CC)USPHS (CC) Local, regional officesLocal, regional offices –Coordinates ESF #8 (federal response)(federal response)

6. Preventive and Public Health Services Environmental Health Services Medical Services Mental Health Services Provided by DHS, VA, DoD, and HHS assets Supplements state/local resources in response to public health and medical care needs following a major disaster or emergency. ``` ESF #8 Health & Medical Services

7. Let the conference calls begin…  S&R/Recovery, triage, field Rx,  Prolonged Tx times?  Evacuate hospitals?  Augment medical, morgue staffing  Hospital beds (hundreds? thousands?)  Locate burn care capability?  Isolation capability?  FAX ARF’s to DHS  Receive mission assignments  NDMS  Teams  Mass Evac Transport, Destination  SERT, SNS  USPHS, Op Div’s  DoD, VA  ARC Local, mutual aid State FEMAHHS Op Div, VA, DoD HHS Federal aid

8. ``` Speed of mobilizationSpeed of mobilization –To compromised ACF’s, e.g. –For mass casualty care Difficulty preparing for impending threatDifficulty preparing for impending threat Inadequate federal work force of qualified HCWsInadequate federal work force of qualified HCWs DoD capabilities degraded when engaged elsewhereDoD capabilities degraded when engaged elsewhere Cost effectivenessCost effectiveness Medical/Mass transportMedical/Mass transport –DoD assignment as described in NDMS –EMS back-up?? ESF #8 Concerns: Observations & Extrapolations

9. ``` RegionalRegional –All concentric tiers have to become functional (not just conduits) –All must have ongoing operational function (not just planning/preparation) EMS and Hospital Surge Capacity NeighboringState Teams Region Mutual Aid Federal response other than $ Teams State

10. Regional Resource Coordinating Center (RRCC) or Joint Field Office (JFO) HHS REC (chair) SOC DHS MMRS Coordinator MMRS programs in Region EMAC Rep OP Div Regional Reps e.g. FDA, HRSA, IHS, BOP, AOA, CMS, SAMHSA, CDC Individual Agency Headquarters CDC & HRSA Cooperative Agreement Coordinators (State) Regional ECs CDC & NDMS Interagency Regional Reps e.g. VA Regional Manager, USDA, Forest Service, EPA, OSHA SERT 1 rep + 1 alt Response Operations Hospital Surge Function (state) Hospital Surge Function across region (state) Health Dept. (metropolitan) Metropolitan Health Depts. across the region Hospital Surge Function (metropolitan) Hospital Surge Function across region (Metropolitan) Ambulance/ EMS System EMS Consortia 1 rep + 1 alt State Emergency Management State Emergency Management across region 1 rep + 1 alt Metropolitan Emergency Management Metropolitan Emergency Management across the region 1 rep + 1 alt Medical Reserve Corps (MRC) Other MRC units in region 1 rep + 1 alt State Health Dept. State Health Depts. across region 1 rep + 1 alt CDC & HRSA Program Managers (Federal)

11. Conclusion Opportunity to include EMS in Cooperative Agreement GuidanceOpportunity to include EMS in Cooperative Agreement Guidance EMS on Regional TF’sEMS on Regional TF’s –Representative (operational) consortia –Inter-medical direction, Inter-state credentialing issues –Deployable EMS –Multiple, mass transport EMS, including inter-facility