RDF Overview

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RDF Overview

• CAPT Mike Montello montellom_at_ctep.nci.nih.gov

CDR Laura Pincock LCDR Bill Pierce
vMay 31, 2007
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Presentation Outline

• Overview of PHS Tiered Response System
• Review of RDF mission and objectives
• Detail RDF role in a medical crisis response
• Provide overview of team composition and
  structure
• Describe a pharmacists role on an RDF

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Katrina After Action Findings

• Need to correct inefficiencies and delays
  resulting from ad-hoc staffing
• Logistical hurdles
• On-the-fly organization
• Inconsistent training/experience
• Mixed messages

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Solution

• Multi-tier approach with team emphasis
• Dedicated response assets (HAMR)
• Team-centric training
• Hands-on
• Field exercise
• Funding to support response activities

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PHS Multi-tier Response Plan

• Tier 1
• Rapid Deployment Force (RDF) Multi-disciplinary
  all hazards team (role is subject to training,
  supplies need)
• Incident Response Coordination Teams (IRCT)
  provide command control in coordination with
  Secretarys Operation Center (SOC)
• Tier 2
• Applied Public Health Teams (APHT) preventive
  medicine focus
• Mental Health Teams (MHT) mental health focus

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PHS Multi-tier Response Plan (2)

• Tier 3
• Rest of PHS Corps
• Tier 4
• Medical Reserve Corps (MRC) Community based,
  organized civilian health professional volunteers
• Tier 0
• Health and Medical Response (HAMR) teams PHS
  officers dedicated to crisis response activities.
  Medical Crisis Response Professionals

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Bottom line

• Readiness and Response is a Responsibility of
  every PHS Pharmacist Officer

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How the Tiers/Teams Work Together

• Tier structure intended to provided flexibility
  to tailor PHS response capabilities based on
  unique needs of each event
• Requires collaboration and support between
  tiers/teams
• Each RDF is paired with an IRCT, MHT, APHT and
  tier 3 officers
• All paired assets are on the same 5-month
  rotation schedule
• Hope to maximize co-training between teams to
  re-enforce partnership and build trust/skills
• Teams are designed to work independently but can
  share resources to achieve a specific mission
  objective

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How the Tiers/Teams Work TogetherRDF Focus

• RDF-IRCT interaction
• IRCT
• In collaboration with SOC provides command and
  control for all deployed HHS assets (DMAT, RDF,
  APHT, MHT, etc)
• Interacts with Federal, State, local, tribal
  leadership to identify health resource needs in a
  disaster response
• All mission assignments for an RDF will come
  through the IRCT
• Coordinates delivery of resources to RDF
• RDF
• Develops and implements action plan based on IRCT
  mission assignments
• Provides daily (and PRN) situational reports
  (SitReps) to IRCT evolving mission needs
  resource requirements personnel status

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Mission Response Feedback Loop IRCT-RDF Example
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RDF-Tier 2 IntegrationMHT APHTs

• Potential mechanisms for interaction
• Initial assessment RDF 1st on scene provides
  report to IRCT. MHT /or APHTs activated
• Staffing/skills supplementation (Bidirectional)
  RDF augments MHT/APHT MHT/APHT augments RDF
• RDF provides medical support for MHT/APHT
• MHT/APHT provides expert-consultation services
  to RDF

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RDF Tier 3 4 Integration

• Tier 3 4 provide staffing/skills
  supplementation to RDF
• More Hands - Supplement existing skills on team
  (ex. Outpatient pharmacist)
• Special Hands - Provide skills that arent
  normally included on RDF (ex. Oncology
  pharmacist)
• RDF provides an organized framework (Incident
  Command System) for tier 3 4 personnel

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RDF HAMR Integration (TBD)

• In-quarters (i.e. home, non-deployed)
• Training
• Logistics, administrative and planning support
• Deployments
• HAMR 1st on scene provide assessment for IRCT
  RDF activated
• Staffing/skills supplementation (Bidirectional)
  RDF augments HAMR HAMR augments RDF

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RDF Mission Statement

• To provide quality health care, compassion and
  comfort to the American public, or the global
  community, in the event of a natural or manmade
  public health or medical crisis.
• The 4 Cs
• Care, Compassion, and Comfort in a Crisis

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RDF Objectives

• Assure the safety and security of all team
  members response partners and the affected
  population
• Provide basic medical services and support for
  all team members response partners and the
  affected population
• Assure mental well being of all team members
  response partners and the affected population
• Provide preventive medical assessment,
  recommendations, and support to control disease
  and identify and mitigate health hazards
• Assure the safety and security of all team
  members response partners and the affected
  population

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Three Rules of Response

• In order of precedence
• Take care of yourself
• Take care of your teammates
• Once rule 1 2 are satisfied then (and only
  then) begin work towards accomplishing the
  mission
• Failure to follow Rule 1 2 hurts the team
  twice!! One more patient and one less provider
• People First, Mission Always!!!

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RDF Response Scenarios

• Federal Medical Station (FMS) Provide primary
  medical care and mental health services for a
  sheltered population of up to 250 special needs
  patients. Including supportive care for family
  members (and pets?).
• Mass Casualty Care Provide pre-hospital triage
  or mass causality care and support for up to 250
  individuals/day.

These scenarios are not exclusive to RDFs
Other tiers may be involved as well.
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RDF Response Scenarios (cont)

• Mass Dispensing Provide mass medication
  distribution for up to 12,000 individuals/day
• Mass Immunization Provide mass immunization for
  up to 6,000 individuals/day
• Community Outreach Provide localized community
  assessment and care to an affected population

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RDF Response Scenarios (cont)

• Quarantine Provide isolation and quarantine
  care and support for 250 patients
• Humanitarian Assistance Provide international
  humanitarian assistance to displaced populations
  (up to 5,000 individuals)
• Provide Public Health and Ancillary Services
  (dental, laboratory, occupational health)
• Note Emergent care is NOT a primary role of an
  RDF,
• but the team must be prepared to provide emergent
  care when needed

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Pharmacists in Action
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RDF Highlights

• Multi-disciplinary team with 105 officers
• 5 Teams (2) DC-metro Atlanta OK/TX NM/AZ
• Rotate on-call schedule every 5 months
• Response requirements
• Leadership within 6 hrs of activation
• General staff within 12 hours of activation
• Organized using Incident Command System (ICS)

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RDF Command Structure using ICS Principles
Ops is Tops!
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Generic RDF Team Composition

• Command Staff
• Team Commander (1) Deputy Team Commander (2)
  Safety Officer (2) Public Information
  Officer/Liaison (2)
• Administration/Finance Section
• Administrative Section Chief (1) Administrative
  Staff (4) (includes 1 home support) Medical
  Records (4)
• Logistics Section
• Logistics Section Chief (1) Communications (2)
  Information Technology (2) Logistics Staff (3)
• Planning Section
• Planning Section Chief (1) Planning Staff (4)
  (includes 1 home support)
• Operations Section
• Operations Chief (1) Physicians (8) NP/PA (8)
  Dentists (4) Nurses (24) Pharmacists (8)
  Mental Health Providers (4) Occupational
  Health/Therapists (4) Veterinarians (2)
  Laboratorians (2).

Total team 105 Officers
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Pharmacy Branch

• Each RDF has an 8-member Pharmacy Branch within
  the Operations Section
• Pharmacy Branch Role
• Clinical pharmacy services including therapeutic
  selection, dose monitoring and adjustment
  adverse event assessment patient counseling etc
• Drug storage and security
• Disease surveillance
• Preparation and dispensing of pharmaceuticals
• Administration of vaccines (certified
  pharmacists)
• Formulary development and management

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RDF Go-bags

• Provided by ASPR
• Formulary developed by RDF, OFRD and ASPR
  pharmacists clinicians
• Purpose
• Assure well being of RDF team members
• Supplies for strike teams
• Kick-start a mission until primary supplies are
  available
• Two variants
• Medical/Surgical supplies
• Pharmacy go-bag
• RDFs responsible for storage
• Re-supply process has been developed
• Whenever the RDF deploys the Go-bags deploy with
  them
• Formulary In handouts
• Kudos to LCDR Gregg Davis

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Med-Surg Go-bag
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Other RDF Roles for Pharmacists

• Command staff
• Team commander (1) Deputy Team Commander (2)
• Liaison officer (1) Safety officer (0)
• Logistics Section
• Chief/Deputy (2) IT/Commo (2) Other staff (4)
• Admin/Finance Section
• Chief/Deputy (1) Other staff (1)
• Planning Section
• Chief/Deputy (1) Other staff (6)
• Operations Section
• Pharmacy Branch (40) Medical Records (2)
  Ancillary health (1) other (13)
• 75 Pharmacists have leaned forward to
  participate on RDFs!!

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PHS2 Pharmacists
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Selected RDF Pharmacy Activities

• ICS principles training
• Ford Funeral Strike Teams
• ASPR PT Committee
• RDF SOP development working groups
• Medical Effects of Ionizing Radiation Training
• Hurricane Earthquake response (Camp Bullis)
• Standardization of pharmacy forms

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Team Spirit
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RDF Summary

• RDFs are part of an integrated multi-tiered
  response plan
• Multi-disciplinary aspect of RDF allows
  flexibility to adapt to a variety of missions
• RDFs provide a variety of opportunities for
  pharmacy officers, including traditional
  pharmacy billets and a wide range of leadership
  and support roles

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If you are interested in joining an RDF contact

• PHS1 (DC Metro) LCDR Bill Pierce
• William.pierce_at_fda.hhs.gov
• PHS2 (DC Metro) CDR Laura Pincock
• Laura.pincock_at_fda.hhs.gov
• PHS3 (Atlanta Metro) CAPT Walter Holt
• wholt_at_cdc.gov
• PHS4 (OK/TX) CAPT Travis Watts
• Travis.watts_at_ihs.gov
• PHS5 (AZ/NM) CDR Randall Haigh
• Randy.haigh_at_ihs.gov