Federal Medical Station FMS

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Federal Medical Station (FMS) Past, Present and
Future COA 2006 02 May 2006

LCDR Gregg Davis, USPHS Office of Mass Casualty
Planning
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The Spectrum of Care Federal Medical Resources
Volunteers
NDMS Hospitals
DMATs
VA/DOD
US Public Health Service
Medical Reserve Corps
Federal Medical Stations
Basic First Aid
Outpatient Care
ICU/Trauma Critical Care
Emergency Departments
Hospital Inpatient Care
Nursing Home Care
Pre-hospital Care
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Federal Medical Station (FMS)Deployable Medical
Surge Capacity Vision

• Provide surge medical capacity (equipment,
  materiel, pharmaceuticals) to communities
  overwhelmed by mass casualties
• Are standardized, scalable, and adaptable for use
  across the mass casualty care continuum
• Can be staffed by approved personnel for any
  federal, state or local agency or combination of
  agencies
• Employ modular configuration and are designed for
  rapid transportation by land or air and for
  integration into a range of sites

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Federal Medical StationsStandardized
Capabilities Across Agencies

• Type I (Advanced)- FMCS will have the
  capability to care for severely ill or injured
  patients, equivalent to conventional operating
  room, ICU, and basic laboratory being developed
  by DHS
• Type II (Specialized) Configured for specific
  clinical scenarios, such as respiratory
  isolation. Will have capability of Type III, plus
  advanced care for specific clinical requirements
  and populations, e.g., burn patients. Future
  prototypes to be developed
• Type III (Basic) Low to mid-level acuity of care
  to provide platform for PHS teams, quarantine
  function, alternate care facility to augment
  community hospital capability
• Type IV (Medical Needs Shelter) Care for acute
  exacerbations of chronic conditions

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Federal Medical StationsStandardized
Capabilities Across Agencies

• HHS has moved away from the approach on the
  previous slide
• Based on AARs, we have made whole scale
  revisions to thehe materiel and pharmaceuticals
  to better care for the patients represented in
  Anytown, USA much more all-hazards
• FMS will be the base platform and will be
  augmented modularly based on the types of
  patients

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Federal Medical Station Legal Authority

• HHS has been given the responsibility under
  mandates in the National Response Plan (NRP) and
  the Homeland Security Presidential Directive
  (HSPD) 10 to develop a comprehensive plan to
  address the challenging health problem of medical
  surge both capacity and capability
• The statutory authority for the Federal Medical
  Station program pursuant to section 321 of the
  Federal Medical Act (42 U.S.C. 248) and
  intra-agency agreements will be executed in
  accordance with the Economy Act (35 U.S.C 1535).
• The Stafford Act may provide additional guidance
  for any events that are declared National
  Emergencies.

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Federal Medical StationAttributes

• Scalable to the incident
• Modular configuration
• Mobile for maximum geographic distribution
• Quickly integrated to the site
• Predictable resources
• Modeled for all age populations

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Federal Medical StationMission Statement

• An FMS will provide scalable (in size), modular
  and rapidly deployable health and medical care to
  those patients who have non-acute medical, mental
  health, or other health-related needs that cannot
  be accommodated or provided for in a general
  shelter population.
• An FMS is designed to provide health and medical
  care for patients with needs such as
• Conditions that require observation, assessment
  or maintenance
• Chronic conditions which require assistance with
  the activities of daily living and do not require
  hospitalization
• Need for medications and vital sign monitoring
  and who are unable to do so at home
• Conditions that require the level of care
  provided by an FMS
• An FMS is not an acute care hospital, nursing
  home or emergency department

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Basic Concept HHS Federal Medical
Station

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Host requirements

• The following are FMS requirements for the
  hosting facility to provide
• -40,000 square feet of enclosed space
• - perimeter security
• - waste removal
• - electrical power source and distribution
• - potable water
• - ice
• - fork lift for off loading/set-up
• - local transportation
• - billeting for 150 personnel per FMS
• - latrine/showers for patients
• - access to civilian medical personnel and
  contractors employed in patient care, patient
  transportation, and other supportive services
• Ideally each installation should be able to
  provide
• communications support
• food service for staff and patients
• access to airstrip or helipad for air evacuations
• medical oxygen
• laundry services
• mortuary support

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FMS Units in Hurricane Katrina Relief Effort
Note The PMAC/LSU and Alexandria SNS facilities
were state-run medical shelters that were
augmented with FMS equipment and supplies, and
USPHS personnel.
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FMS Units in Hurricane Katrina Relief Effort
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FMS Units in Hurricane Katrina Relief Effort
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FMS Units in Hurricane Katrina Relief Effort
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FMS Units in Hurricane Katrina Relief Effort
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FMS Units in Hurricane Katrina Relief Effort
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FMS Units in Hurricane Rita Relief Effort
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FMS Units in Hurricane Rita Relief Effort
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FMS Units in Hurricane Rita Relief Effort
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Common medical conditions among FMS patients
Waco, Marlin, and Meridian NAS
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Common behavioral health conditions
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Prevalence of medical and behavioral health
conditions
Waco, Marlin, and Meridian NAS (n380)
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Prevalence of multiple medical conditions per
patient
Waco, Marlin, and Meridian NAS (n325)
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Prevalence of multiple behavioral health
conditions per patient
Waco, Marlin, and Meridian NAS (n120)
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Prevalence of mobility issues among FMS residents
Needs assistance (walker, etc) 20
Wheelchair dependent 20
Ambulatory 60
Waco, Marlin, and Meridian NAS
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Length of Stay for patients/family
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Discharge destinations
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Future/Present Initiatives

• Public Relations
• Training Program and a Training FMS
• IT/Communications Package
• Structures, generators, logistical burden on host
• National food service contract
• Electronic Medical Records and standard forms
• Regionalization of equipment caches
• ICS structure for FMS
• PT Committee Meeting
• Go-bags for outreach missions

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PT Committee - General

• CV dropped IV, changed to most commonly
  prescribed, change quant.
• Anticoagulants - 2 strengths of warfarin,
  Coagucheck monitors
• Diagnostics incr. of glucometers to 10
• GI - proton pump inhibitor, docusate
• Abx dropped most of the IV, changed quantities,
  levofloxacin
• HIV/AIDS - CDC post-exposure prophylaxis drugs
• Respiratory Incr. and quantity of inhalers,
  Singulair, Serevent
• TB - all TB maintenance drugs (Ethamb, INH,
  Pyr, Rif)
• Mental Health - longer acting antidepressants,
  atypical anitpsychotics, ADHD
• Pain - Percocet and Oxycodone SR for chronic
  pain
• Misc - migraine, Parkinsons, Gout, incontinence

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PT Actions Diabetes

• Before
• Glyburide tabs 1x100
• Insulin 70/30 1 vial
• Insulin Lente 12 vials
• Insulin NPH 2 vials
• Insulin Regular 1 vial

• After
• Glyburide tabs incr. to 5 bottles
• Insulin 70/30 incr. to 2 vials
• Insulin Lente dropped
• Insulin NPH incr. to 12 vials
• Insulin Regular incr. to 10 vials
• Insulin Glargine 5 vials
• Glipizide tabs 1x100
• Metformin tabs 5x100
• Pioglitazone tabs 2x90
• Glucose tabs 75x12

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Contact Info

• Gregg Davis
• HHS/OPHEP/OMCP
• 200 Independence Ave., S.W.,
• Room 403B
• Washington, DC 20201
• Gregory.Davis_at_hhs.gov
• 202-205-9317