NDMS Patient Movement

1
NDMS Patient Movement After Action Review 12-13
Dec 2005 Mr. Mark Mahar USTRANSCOM/GPMRC
2
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

3
National Response Plan

• USTC/SG Responsible for
• Coordination with ESF1-Transportation for
  evacuation of ambulatory patients and Displaced
  Persons
• 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

4
In Response to a Contingency

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

5
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
6
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
7
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
8
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
9
Lessons Learned

• Air National Guard/Coast Guard/Navy Involvement
• There were plenty of airframes offered by other
  than AMC that did not have AE crews or equipment.
  There was no identified C2 over these airframes.
• Impact
• TRANSCOM/SG approved movement without AE crew -
  utilized local medical attendants.
• Recommendations
• Airframes have an identified C2 structure for all
  non-AF responders
• Mechanism for assigning either an AE crew or
  appropriately qualified medical attendants

10
Lessons Learned

• JPMT Mission
• The JPMT role is to regulate and coordinate
  patient movement. In order for it to be
  effective, an AELT and Air Staging Facility (ASF)
  should be co-located and in place.
• Impact
• 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

11
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 must be generated.
• Recommendation
• Change software to accommodate large number of
  patient evacuations.

12
Lessons Learned

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

13
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
• Reengineer TRAC2ES to simplify the input of large
  numbers of casualties for matching against
  available beds.

14
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

15
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
17
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
• - 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
• - Pre-planning with JPMT
• - Team dedicated to Katrina and Rita
• Lag time
• - Notification process from the state
• - Cycling of aircraft, AE Crews, and lay down of
  MASF, EMEDs, and CCATT

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Other Modes of Patient Movement

• Capability existed to move patients through
  various means
• - Ground
• - Naval Vessels
• - Rotary Wing
• - Fixed Wing

22
Operational Successes

• 3813 Patients moved in two separate disasters
• Deployed first ever JPMT
• Coordinated closely with FCCs for bed
  availability
• Participated in multiple teleconferences to
  provide updates
• Put the patient first

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Questions???