PATIENT MOVEMENT

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PATIENT MOVEMENT NDMS Conference Reno, NV 24-26
April 2006 Mr. Mark Mahar USTRANSCOM/GPMRC
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TCSG OVERVIEW

• Serves as DODs single manager for the
  development of policy and standardization of
  procedures and information support systems for
  global patient movement
• Reviews COCOM plans and provides medical
  assessment and input, especially as it relates to
  patient movement and medical logistics
• Plans exercises to train/exercise patient
  movement forces in execution of their wartime
  missions
• Responsible for TRANSCOM Regulating and Command
  and Control Evacuation System (TRAC2ES)
• Oversight for Global Patient Movement System
• Supports inter-theater and CONUS patient
  movement requirements for DOD and as part of the
  National Response Plan
• Maintains a deployable Patient Movement
  Requirements Center Capability

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National Response Plan

• Emergency Support Functions-ESFs
• ESF-8 - Public Health and Medical Services
• ESF-8, when activated is coordinated by Health
  and Human Services (HHS) through the Secretaries
  Operations Center
• During initial activation, HHS convenes a
  conference call with the appropriate ESF-8
  partners and State/local representatives

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National Response Plan

• USTRANSCOM Responsible for
• Coordination with ESF1-Transportation for
  evacuation of ambulatory patients
• Regulating and tracking patients transported on
  DOD assets
• Communicating requirements to Federal
  Coordination Centers (FCCs) and providing
  specific reporting instructions on bed
  availability
• Evacuating/Managing patients from patient
  collection points to NDMS patient reception areas
• Need up-to-date information on State requirements

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In Response to a Contingency

• USTRANSCOM SG GPMRC provides
• Bed availability data in coordination with FCCs
• Validation of patient movement
• Care plan for the patient
• Coordination with USTRANSCOM components
• Joint Patient Movement Team (JPMT)
• Coordination with movement agencies
• In-Transit Visibility

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Hurricane Katrina Timeline
Moved 791 patients
04 Sep 05
Moved 941patients
03 Sep 05
Moved 409 patients
JPMT augmentees arrived
02 Sep 05
Moved 444 patients
EMEDS arrived in New Orleans
AELT arrived in New Orleans
MASF arrived in New Orleans
JPMT arrived at New Orleans requested litter
bearers
01 Sep 05
Moved 142 patients
First official Evac of patients from Hurricane
Katrina
Attempted to contact FCCs in Region IV and VI
Received Tasking via NORTHCOM SG for deployment
of JPMT
FEMA activated NDMS FCCs region IV and VI
31 Aug 05
Moved 52 patients out of Keesler AFMedCen
JPMT put on official alert
30 Aug 05
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Hurricane Katrina Timeline
Last patient moved
20 Sep 05
08 Sep 05
07 Sep 05
Began sustainment operations (regularly scheduled
daily missions)
JPMT returned home to Scott AFB
06 Sep 05
Moved 10 patients
Last MASCAL Evac mission
05 Sep 05
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Hurricane Rita Timeline

Moved 129 patients with 3 AE missions from Texas
Request for forces to NORTHCOM for litter bearer
support
433rd MASF / AELT arrived in Beaumont, Texas
AMC/TACC stands-up glass room
FEMA activated FCCs in Regions IV VI
GPMRC stands up 24/7 contingency operations
TRANSCOM received MA
NORTHCOM/GPMRC provided language for MA to FEMA
22 Sep 05
GPMRC puts 6 member JPMT on alert
NORTHCOM/SG advised of FEMAs verbal request for
DoD assistance for region IV VI
21 Sep 05
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Hurricane Rita Timeline

FCCs stand-down
26 Sep 05
GPMRC stands down 24/7 contingency cell
EOCs state no further patient movement requests

25 Sep 05

Operations suspended while hurricane makes
landfall
24 Sep 05
433rd MASF/AELT departed Beaumont hrs before the
storm surge
Beaumont reported no further requirements and
ceased operations
Lake Charles reported no further requirements and
ceased operations
Ellington Field reported ceasing operations due
to close proximity of the storm
Moved 1075 patients on 19 AE missions
23 Sep 05
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Lessons Learned

• Air National Guard/Coast Guard/Navy Involvement
• There were airframes offered by other than AMC
  that did not have AE crews or equipment. C2 over
  these airframes not always easily identifiable.
• Impact
• TRANSCOM/SG approved movement without AE crew -
  utilized local medical attendants.
• Recommendations
• Airframes have an identified C2 structure for all
  non-AMC responders
• Mechanism for assigning either an AE crew or
  appropriately qualified medical attendants

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Lessons Learned

• JPMT Mission
• The JPMT role is to coordinate patient movement
  requirements. Can be done at GPMRC or deployed.
  If deployed, in order for it to be effective, an
  AELT and Air Staging Facility (ASF) should be
  co-located and in place.
• Impact
• GPMRCs eyes and ears when there are none
• During initial phase JPMT had to perform duties
  outside of their role (i.e.. Litter bearer,
  triage, etc.)
• Recommendation
• Deploy AELT and ASF with JPMT

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Lessons Learned

• TRAC2ES Application
• TRAC2ES is limited in a tactical situation with
  massive on loads and frequent missions. Mass
  casualty PMRs are too cumbersome. Tactical on
  load forms were generated as a result of
  Katrina and were faxed to the FCCs and MASFs
  for Rita and were still only partially used.
  FCCs kept a record of patients received, but
  often without mission numbers.
• Impact
• After the fact PMRs had to be generated when
  information was available
• Solution
• Software is being developed to accommodate large
  number of patient evacuations.

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1 August 2006 Disaster/Mass Casualty Input
using TMobile

• TMobile - Two basic screens a Patient list and a
  Group Transport list.
• The Patient list is used to enter a large of
  patients prior to having the assets to move them.
  
• The Transport Group List defines how/when/where
  you are moving the patients from to
• There is only one patient list, but you can have
  as many Transport Group lists as you need.
• You can enter new patients to either list, you
  do not have to use the patient list.
• You can move or a group of patients between the
  patient list a Transport Group or between
  Transport Groups.

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1 August 2006 Disaster/Mass Casualty Input
using TMobile (continued)

• Current PMR Fields
• Origin/Dest MTF
• Transport Mode
• Transport Remarks
• Casualty Event
• First Last Name
• ID/ID Type
• Gender
• Patient History
• PMR Remarks

• New PMR Fields
• Transport ID
• Transport Origin/Dest
• Transport Dpt/Arv Time (Also Required for ITR)

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Lessons Learned

• Best Mode to Move Patients
• Use of trains during Rita may have been very
  beneficial in moving large numbers of patients if
  enough lead time is available.
• Impact
• More patients could have been moved in a shorter
  period of time.
• Recommendation
• Evaluate multi-modal patient transport platforms
  for future use.

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Lessons Learned

• Transport to Bed Planner
• The transport to bed planner is an integral part
  of managing mass casualty planning. During the
  relief efforts the transport to bed planner could
  not be utilized.
• Impact
• Missions and patient assignments were manually
  accomplished in TRAC2ES
• Recommendation
• TRAC2ES is being reengineered to simplify the
  input of large numbers of casualties for matching
  against available beds.

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Internal Communications

• USTRANSCOM received a verbal EXORD from the Joint
  Staff
• J-3 alerts USTC Surgeon, GPMRC, and AMC CAT
• 18AF TACC/CC organized staff in Glass Room to
  work requirements

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External Communications

• - Request from state EOCs to FEMA
• - FEMA developed an MA and activated NDMS and
  FCCs
• - FEMA sent the MA to JDOMS to the Joint Staff
  to the Sec of Defense for approval and back to
  the Joint Staff for EXORD
• - Verbal came from Joint Staff to execute
• MA

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Chain of Command
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Patient Tracking Issues

• Military Operations
• JPMT had limited communications while at the New
  Orleans Airport
• Need an effective ITV (In-Transit Visibility)
  mechanism
• FEMA DoD
• Need consistent patient ID system for tracking
• Need standardized tracking forms
• Need joint system training

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Non-USTC Patient Moves

• Loss of visibility when non-Title 10 DOD or other
  assets used
• - Guard assets moved patients
• - Ground transport to civilian facilities
• - Coast Guard assets moved patients to unknown
  locations
• - Limited control of the surge of the patients
  to the New Orleans Airport

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Response Times

• Lead time
• - Activation of FEMA, HHS teleconferences
• - Prepared JPMT to deploy
• - Recalled staff to support Katrina and Rita
  while maintaining OIF/OEF support and peacetime
  mission
• Lag time
• - Notification process from the state
• - Cycling of aircraft, AE Crews, and lay down of
  MASF, EMEDs, CCATT, equipment and litters

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Operational Successes

• 3813 Patients moved in two separate disasters
• Forward deployed first patient movement team in
  CONUS
• Coordinated closely with FCCs
• Interagency Communications with DSH, HHS and VA
• Put the patient first

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ULTIMATE CADUCEUS 2007Scene Setting

• Ultimate Caduceus is USTRANSCOMs biennial
  patient movement exercise
• While supporting a PACOM OPLAN, we are executing
  the activation of medical forces to conduct
  strategic and distribution patient movement (PM),
  patient regulating and tracking, and the
  integration of Canadian and US patient movement
  teams and assets.
• NORTHCOM experiences catastrophic events during
  AS-07 that require support to the homeland and
  the continued care of returning wounded service
  members.

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ULTIMATE CADUCEUS 2007Focus Areas

• Air Mobility Command executes CRAF in support of
  large numbers of wounded service members in a
  West to East route.
• Evaluate the High Speed Vessel as a patient
  movement platform. This would give the COCOM an
  alternative to fixed winged evacuation as the
  only mode of patient movement.
• Test the interoperability of patient tracking
  between the Interagency and DOD.
• Explore our railroad infrastructure as a
  potential patient movement platform.
• Partner with the Canadian Medical Force in
  patient movement.

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ULTIMATE CADUCEUS 2007Patient Movement
Initiatives

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Questions???
Mr Mark Mahar mark.mahar_at_ustranscom.mil 618-229-71
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