U.S. Department of Homeland Security Federal Emergency Management Agency Mass Casualty Medical...

U.S. Department of Homeland Security U.S. Department of Homeland Security Federal Emergency Management AgencyFederal Emergency Management Agency

Mass Casualty Medical Response Mass Casualty Medical Response CapabilitiesCapabilities

Response Division

DHS/FEMA Vision/Concept for Federal DHS/FEMA Vision/Concept for Federal Medical Response to Mass CasualtyMedical Response to Mass Casualty

Build on existing NDMS team capabilities and equipment to serve as the “point of the spear” to begin rapid execution of medical operations

24 Disaster Medical Assistance Teams (Fully Operational/Operational 31 Disaster Medical Assistance Teams (Augmentation/Developmental) 4 National Medical Response Teams / WMD 4 Burn Teams 2 Pediatric Teams 1 Crush Medicine Team 3 Medical/Surgical Response Teams (MSuRT)* 2 Mental Health Teams 1 Family Assistance Core Group 4 Veterinary Medical Assistance Teams11 Disaster Mortuary Operational Response Teams (1 WMD)12 National Pharmacist Response Teams10 National Nurse Response Teams 1 Management Support Team

* Includes 2 under development

NDMS RESPONSE TEAMSNDMS RESPONSE TEAMS

Basic Building Block- DMAT

DMAT Scope of ServicesDMAT Scope of Services

Austere primary andAustere primary and acute careacute care

Triage of mass casualtiesTriage of mass casualties

Initial resuscitation &Initial resuscitation & stabilizationstabilization

Advanced life supportAdvanced life support

Preparation of patients Preparation of patients for evacuationfor evacuation

DMAT Scope of ServicesDMAT Scope of Services (cont.)(cont.)

Acute careAcute care (250 patients / 24-hours)(250 patients / 24-hours)

Acute Care (160), Acute Care (160), stabilize stabilize and hold 6 patients /10 hr and hold 6 patients /10 hr

(2 critical care) (2 critical care)

Community Medical Community Medical OutreachOutreach

Ward care for 30 med/surgWard care for 30 med/surg

Triage and prepare 200 patients at a casualty collection Triage and prepare 200 patients at a casualty collection point (CCP) for evacuation / transportation.point (CCP) for evacuation / transportation.

Alternate Medical Care Facility (150)Alternate Medical Care Facility (150)

Mass drug distribution or immunizationMass drug distribution or immunization

DMAT Scope of ServicesDMAT Scope of Services (cont.)(cont.)

DMAT Medical ServicesDMAT Medical Services

Limited laboratory Limited laboratory

Hb, lites, ABG, Hb, lites, ABG, stool for blood, stool for blood, dipstick urinalysis dipstick urinalysis

Limited Limited pharmaceutical pharmaceutical servicesservices

Storms Alerted Teams Deployed TeamsStorms Alerted Teams Deployed Teams Total PatientsTotal Patients

CharleyCharley 3 3 1212 3,7823,782

FrancesFrances 10 10 8 8 1,4611,461

IvanIvan 11 11 1313 3,4463,446

JeanneJeanne 5 5 2 2 961 961

TotalsTotals 29 29 35 35 9,7409,740

2004 NDMS Hurricane Responses2004 NDMS Hurricane ResponsesDemonstrated CapabilityDemonstrated Capability

(Augmentation personnel: 316 - Total personnel: 800+)

FY04 NDMS ENHANCEMENTS

$ 15.238M above NDMS budget of $34M$ 15.238M above NDMS budget of $34M

NDMS Team Readiness Assessment & Evaluation Criteria & standards developed & applied

Procured organic team transportation assets93 vehicles – 31 teams - $6.44M

Standardized and procured team caches14 full & 17 partial - $7.7M

FEMA/NDMS FEMA/NDMS DMAT Team FY05 planned UPGRADES15 Type I Teams

Diagnostic & Critical Care

Portable Digital X-Ray Portable Sonogram Surgical Scrub Sinks Wheeled Litter Carts Portable Adjustable Beds Surgical Lamps BIPAP machine Crash Cart & Hanging ALS Containers Western Shelter Tent Connectors

Shock Trauma / X-Ray / Lab / Pharmacy

Shock Trauma Unit

Digital X-Ray

CapabilitiesCapabilitiesSingle Team 35 person - D + 1Single Team 35 person - D + 1

Scope of Medical ServicesScope of Medical Services

Outpatient FacilityOutpatient Facility- - 250 pts per day250 pts per day

Treatment with Treatment with Limited HoldingLimited Holding CapacityCapacity

-160+ pts / day160+ pts / day-Observe 8/10 ptsObserve 8/10 pts

Augment StandardAugment Standard Med-Surg WardMed-Surg Ward

- 50 Pts- 50 Pts

Casualty CollectionCasualty Collection Holding CenterHolding Center

-150 Pts 150 Pts (Similar to NDMS (Similar to NDMS Reception Center)Reception Center)

NDMS Medical Care Capabilities(Categories are exclusive, not additive!)

SCOPE OF MEDICALSERVICES

SINGLE TEAM

35 Pers.(D+0)

14 TEAMS490 Pers. (D+1)

31 TEAMS1085 Pers.

(D+3)

Treat & Release(Outpatient

Facility)

250 Patients/day

2,500 Patients/day

5,000 Patients /day

Treat & LimitedHolding

160 Outpatients/da

y8-10 Inpatients

2,250 Outpatients/day112 Inpatients

4,500 Outpatients/day224 Inpatients

HospitalWard

50 Patients 700 Patients 1,400 Patients

Mass Casualty Incident

Holding/CollectionFacility

(Reception Center)

150 Patients 2,100 Patients 4,200 Patients

Initiative developed jointly by DHS and Initiative developed jointly by DHS and HHS to create a deployable infrastructure HHS to create a deployable infrastructure to help close the U.S. surge capacity gap, to help close the U.S. surge capacity gap, that could, by 2010 create 31,000 beds.that could, by 2010 create 31,000 beds.

Federal Medical Contingency Stations

Three types of FMCS deployable caches are Three types of FMCS deployable caches are envisioned:envisioned:

Type I - Medically robust facility comprehensive capability Type I - Medically robust facility comprehensive capability (field hospital) to care for severely ill or injured patients(field hospital) to care for severely ill or injured patients

Type II- Specialized versions of the FMCS Type I configured Type II- Specialized versions of the FMCS Type I configured for specific needs , such as respiratory isolation and/or burnsfor specific needs , such as respiratory isolation and/or burns

Type III – Low to mid-level acuity of care that may be used for Type III – Low to mid-level acuity of care that may be used for special needs shelters, quarantine function, alternate care or special needs shelters, quarantine function, alternate care or step-down facility to augment community hospital capability in step-down facility to augment community hospital capability in a shelter-of-opportunitya shelter-of-opportunity

Federal Medical Contingency Stations

FEMA/NDMS Surge Capacity FEMA/NDMS Surge Capacity EnhancementsEnhancements

FEMA’s 2005 budget includes $20 million for:

Medical surge capability planning

Developing two (2) prototype federal medical contingency stations- type I (fixed & mobile)

Exercise and evaluation

Federal Medical Contingency Station - Type IFEMA Subject Matter Expert Group

Eighteen SME’s represent:

7 Level 1 Trauma Centers

DoD present and past Medical Corps

NDMS – 15 yrs min (8 DMATs, MsURT, NMRT, Burn, & Pediatric teams)

Medical specialties represented include: Emergency Medicine, Family Practice, Pediatrics, General Surgery, Trauma Surgery, Orthopedic Surgery, Critical Care Medicine, Critical Care Nursing (ER, trauma, ICU), Lab & X-Ray Specialists

Federal Medical Contingency StationType I

DEVELOPMENT

Review available military and civilian resources for:

Requirements for storage, assembly, and staffing

Logistical support requirements for maintenance, movement, and setup

Logistical, management and medical teams

Exercise and evaluate for future development


CAPABILITIES

From request to full operational capability – 2 days

Travel - 24 hrSet-up - 48 hrs

MISSION

Provide medical augmentation to local medical services

Temporary replacement for hospitals destroyed or rendered inoperable



CAPABILITIES

Triage, immediate life saving intervention & limited surgery

Scalable in-patient care for up to 250 patients (both acute and sub-acute illness)

ICU beds for up to 12 patients

Reg/WaitingReg/Waiting

E.R.E.R.

Pharm./SupplyPharm./Supply

X-Ray/LabX-Ray/Lab

1 DMAT 250 out pt’s / day

8-10 observation beds

Solid Waste MgmtSolid Waste Mgmt

Federal Medical Contingency StationType I (Scalable)


E.R.E.R.

Lab / SupplyLab / Supply X-Ray/PharmX-Ray/Pharm O.R.O.R. SupplySupply

I.C.U.I.C.U. I.C.U.I.C.U.Ward - Step-downWard - Step-down

1 MSuRT - 12 ICU pt’s

1 OR

1 Ward – 12 pt’s



2 DMAT’s - 84 pt’s2 DMAT’s - 84 pt’s

Ward 3 Ward 3

Ward 7Ward 7

Ward 8Ward 8

Ward 5Ward 5Ward 2Ward 2

Ward 6Ward 6Ward 4 Ward 4


E.R.E.R.



ShowerShower



Federal Medical Contingency Station - I (Scalable)

Ward 3 Ward 3

Ward 15Ward 15

Ward 16Ward 16


Ward 10Ward 10

Ward 4 Ward 4


E.R.E.R.



ShowerShower

Ward 11Ward 11

Ward 12Ward 12

Ward 13Ward 13

Ward 14Ward 14

3 DMAT’s - 134 patient’s3 DMAT’s - 134 patient’s

Ward 17Ward 17

Ward 18Ward 18

Ward 19Ward 19

Ward 20Ward 20

Ward 5Ward 5 Ward 7Ward 7



250 BED UNIT Staffing = 6 DMATS (I & II) + 1 MSuRT250 BED UNIT Staffing = 6 DMATS (I & II) + 1 MSuRT

+ add’l DMAT’s (III & IV) to train for personnel augmentation+ add’l DMAT’s (III & IV) to train for personnel augmentation

Approx. total personnel : 280Approx. total personnel : 280


MD/DOMD/DO - 24- 24

PA/NPPA/NP - 12- 12

RN RN - 74- 74

EMT-PEMT-P - 50- 50

RPhRPh - 16- 16

Mental Health Mental Health - 6- 6

RTRT - 5- 5

Medical mgt/supportMedical mgt/support - 51 - 51

X-Ray TechX-Ray Tech - 6- 6

Lab TechLab Tech -10-10

DieticianDietician - 2- 2

EMT-BEMT-B -23-23

Medical OfficersMedical Officers

Total personnel - 24

• Surgeons 4• Orthopaedic Surgeons 1• Emergency Department Physicians 8+• Anesthesiologists 2• Critical Care Physicians 1 • Family Practice/Internal Medicine 8

Nursing OfficersNursing Officers

Total personnel - 74

Nursing Supervisors 4Emergency Department Nurses 8Operating Room Nurses 8Critical Care Nurses 10 Med/Surgical 44


CAPABILITIES

Not State-of-the Art Medical Care compared to routine daily care in US

Triage/out-comes lower than in non disaster mass casualty scenario

Types of Medical Care

Limited number of high acuity non-surgical patients (12 bed ICU)

Wound management

Primary fracture care and amputations

Hydration/GI disease


Types of Medical Care (cont.)

Ventilator support – Short term (hours) & limited numbers (max 12)

Supportive/special needs


Trauma Surgery

Initiate fluid & ventilator support

Bleeding control

“Stabilize”

Rapid evacuation to higher level care


OR Procedures


High end wound care

Exploratory laparotomy

Amputations

C-Section

Bronchoscopy

Tracheostomy

Burr hole

K-wires

Fasciotomy

Laboratory Capability

Lites

Hb/Hct

Bun

U/A

WBC

Tropins

Gram’s stain

Stool & gastric blood

Type & cross match

PT/Pro

Pregnancy

ABG’s

CO oximetery


Diagnostic CapabilityDiagnostic Capability

Portable digital X- Ray & C- Arm

Ultra sound

12 lead EKG

Expired tidal volume/min. vent

Intra ocular pressure



Continuous EKG monitoring

Pulse oximetery

Expired CO2

Blood pressure

Doppler

Weight

Core body temperature

Compartment pressure

Monitoring Capability

Add Special Teams as needed

NMRT, DMORT, etc.

Required Services NOT Provided

Food

Potable water

Generator fuel

Fork lifts

Organic transportation

Armed security

Solid waste

Bio-hazard waste

Sanitation services

Intra-agency communication

Medical evacuation (ground & air)



Electronic Medical Records (EMR) Initiative

Evaluate existing electronic records systems for applicability to NDMS

Acquire electronic medical records software appropriate to integrate into existing platforms

Training and Exercises for all NDMS team members


Support National Patient Accountability, Movement & Regulating Initiative with DOD and DOT

USG Medical Surge Bed Capacity Target By FY 2010 : 31,000+ (pending funding)

DHS/FEMA Capability(Staffed by NDMS Teams)• 500 FY05•1000 add’l by FY08 pending

support for funding

Medical Surge Bed Capacity

Private S

ector

HH

S

VA DoD

GAPSGAPS

Hospital Beds & facilitiesHospital Beds & facilitiesHealthcare personnelHealthcare personnelEquipment & suppliesEquipment & suppliesInteroperable electronic medical recordsInteroperable electronic medical recordsPatient movement capabilityPatient movement capabilityExpertiseExpertiseADEQUATE funding & staffing to address gapsADEQUATE funding & staffing to address gaps

Sufficient medical surge capacity in the US to Sufficient medical surge capacity in the US to respond to a naturally occurring catastrophic respond to a naturally occurring catastrophic disaster or terrorist event WMD - including disaster or terrorist event WMD - including CBRN agentsCBRN agents

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