Emergency Coordinator National Ambulance Contract CDR Amy O. Taylor DHHS/ASPR R6 Emergency Coordinator Cole Bricker DHS/FEMA Region 6 Operations

Federal National Ambulance Service: PURPOSE The purpose of the Federal National Ambulance and Para-transit Support Services contract is to provide a full array of licensed ground and air ambulance services and para-transit services that may be ordered as needed to supplement the Federal and Military response to a disaster, act of terrorism or other public health emergency in any of the 48 contiguous states.

Background Why a National Ambulance Contract? Multi-Agency Effort Cost Complexity Credentials Coordination Multi-Agency Effort GSA HHS FEMA

Mission The Department of Health and Human Services provides technical assistance to FEMA in support of contracted ground + air ambulances, and para-transit vehicles to support State, tribal and local governments ability to prepare for and respond to the effects of a major disaster.

Centrally managed, regionally coordinated contract Provide a full array of licensed ground, air ambulance and para-transit services to assist states in accomplishing patient evacuation May be ordered as needed to supplement response to a disaster, act of terrorism or other public health emergency. State public health authorities determine there are unmet requirements to rapidly and safely evacuate patients with complex and ongoing medical needs; Initiate request for Federal assistance.

Authorities FEMA contract executed through HHS operational support Can only be utilized within a Stafford Act Activation/Declaration

Contract Zones

Performance Requirements Per Zone GROUND AMBULANCE 300 ground ambulances (ALS & BLS) Typically a 70%/30% ALS/BLS split AIR AMBULANCE 25 air ambulances, helicopter and/or fixed wing PARA-TRANSIT Ability to Transport 3,500 individuals Not 3,500 vehicles BOTTOM LINE: LIMITED NUMBER OF RESOURCES

Resources

Ground Ambulance Services

Types of Ground Ambulances Type II – Advanced Life Support, Non-HazMat Type IV – Basic Life Support, Non-HazMat Type V – Bariatric Ambulance, ALS Type VI – Med-Evac Bus, ALS > 4 stretcher patients

EMS Roles Patient triage, treatment & transport Hazard recognition Symptom surveillance & reporting On-scene medical standby Redistribution of pts. to free up hosp. beds Distributing immunizations Staffing shelters Staffing emergency departments Setting up mobile medical units

Para-Transit Services

6 Types of Para-Transit Vehicles

Para-transit Restrictions Sending facility responsible for determining host facilities/destinations One-way distance < 200 miles or 6 hrs. Multiple trips expected No medical staff on vehicles Caregiver must accompany patient if medical care is required Order by patient type, not by vehicle type Non-ambulatory, wheelchair bound Ambulatory with assistance Ambulatory & no assistance needed

AIR AMBULANCE SERVICES

Types of Fixed-Wing Aircraft Type I – critical care ALS 2+ pts. Type II – critical care ALS 1 pt. Type III – ALS 2+ pts. Type IV – BLS 1 pt. Type V - Neonatal

Types of Rotary-Wing Aircraft Type II – ALS 2+ pts., night ops. Type III – ALS 1 pt., non-night ops. Type IV – ALS 1 pt., night ops. VFR Type V - Neonatal Specific

Performance Requirements Per Zone 2 Zones 3 Zones 4 Zones 300 ground amb. 600 ground amb. 900 ground amb. 1,200 ground amb. 25 air ambulances 50 air ambulances 75 air ambulances 100 air ambulances 3,500 bus seats 7,000 bus seats 10,500 bus seats 14,000 bus seats

State Considerations Medical Evacuation Planning (State ESF-8 lead) Activation Request to FEMA Region (Governor) Coordination with HHS /ESF-8 regional office

Medical Evacuation Planning Considerations Planning must be performed whether it be deliberate or crisis-action and is a state ESF-8 responsibility. It should include: Number of patients to evacuate Patient locations (Pick up Points) Hospitals Nursing Homes Residences Where will patients go? Intrastate or Interstate evacuation Shelter/Hospital Agreements

Medical Evacuation Planning Considerations (cont) Staging area (Check-In site) locations Security Repatriation Medical Assets Can this be handled through EMAC? Will this require Federal augmentation

Activation Request to Region If activating the Federal Ambulance Contract, the state must prepare an ARF identifying the following information (at the very least): No. of patients to evacuate & condition: Critical/Intensive Care Advanced Life Support Basic Life Support Check-in site How they will be used Local augmentation of 911 dispatch Transportation/Evacuation of Patients

Needs Identification State/local identify numbers needing specific type of support during planning. State incorporates EMAC assets in planning (follow GAP analysis concept). State works with HHS Region to identify Federal piece. NOTE: The national contract is NOT a panacea- it is intended to augment State and local resources.

Coordination Pre-Event During the Event Post-Execution HHS Regional Emergency Coordinators work with States to determine if medical evacuation assistance may be necessary and identify potential check-in sites for assets. Finalize State coordination of requirements. State ID’s potential types and numbers. During the Event Monitor usage State ID’s types and numbers Post-Execution Forward draw-down and demobilization plan

Caveats Regions work through HQs No individual direct contact with contractor prior to activation ESF #8 manages, FEMA pays Joint decision-coordination process Under utilization= demobilization State/ local exhaust available support Own contracts/assets Mutual aid and EMAC

How does it work?

Check In Ground Ambulance - verify quantity at Check-in ALS (usually 70%) BLS (usually (30%) Para-transit (seats) Verify quantity at check in 25% of seats must have working wheelchair lifts Air – Verify quantity at check in. This may occur at a separate check in site from the ground assets. COTR must validate check-in times for each asset 29

AMR/FEMA Vehicle Placard A=ALS ground ambulance B=BLS ground ambulance C=ALS bariatric grnd amb D=ALS Med-Evac bus G=Type I sedan/minivan H=Type II minibus J=Type III coach transit bus K=Type IV wheelchair van L=Type V ADA minibus M=Type VI ADA coach bus X=Support vehicle

Check-In Form

Inspection COTR Inspections (Random) “Contractor is responsible for maintaining all provisioning necessary to resupply all ambulances provided pursuant to any task order for extended periods” – SOO Section C-4 COTR Inspections (Random) Medical Supply Inspections Expiration Date Type of supplies required are adequate for tasks assigned Personnel Credentials State DOT may perform vehicle inspections as well

Equipment Issuance Transportation Management Services (TMS) contractor support staff will be at the check in site to tag each ground asset with a GPS transponder Used for deployed evacuation assets across the evacuation transportation enterprise Plots and tracks assets in real time using Sprint i365 GPS enabled phone Provides long-term historical tracking information Provides online (web-based) real-time reporting through Telenav Enables quick setup and management – anytime from anywhere

Corrugated Container Box BESS Kit Contents Adhesive Placard 12V Y-Adapter 120V AC Charger Laminate Placard Corrugated Container Box Portable 12V DC Power Pack Sprint i365 12V DC Charger

Reporting / Tracking The COTR must Provide regular status reports – frequency will be set by the National COTR. These reports will capture information on mobilization, missions being performed, asset utilization, inspections, demobilization, etc Coordinate with state representatives at staging areas and issue work orders to the contractor for missions (which will assign certain assets to a specific purpose for a duration of time) Adjust work orders as mission requirements demand Maintain a spreadsheet that tracks work order progress

Asset Utilization How many assets are redlined and why? Maintenance Issues Assets should never be down due to driver rest requirements COTRs must identify how many assets are on missions out of total available (percent utilization)? Asset Utilization is the key metric used to lead demobilization coordination calls with the states.

Patient Encounter Form

ICS 220 Operational Status Reports (measures asset utilization) Ground ambulance Para-transit Air Ambulance

Demobilization COTR is responsible for demobilization coordination ESF-8 liaison at state EOC RRCC JFO OHA FEMA National COTR

Demobilization, Check-Out Form

Lessons Learned

Deployments Hurricane Dean Aug 08 $15M Hurricane Gustav/Ike Aug 08 $120M Presidential Inauguration Jan 09 $8M

Successes Met performance requirement Deployed safely Logistical support Mission Ready Accomplished assigned missions

Challenges Check in process Direct resource communication & tracking Resource utilization Inter-agency coordination Logistics leveraging Costs

Summary Planning Activation Deployment Demobilization State and HHS region coordinate Project assets needed/ staging Activation Deploy assets to staging area FEMA placards for vehicle ID State/local briefing; credentialing (if necessary) Deployment Resources deploy from sating area to site(s) Once assets leave staging area, assigned to state State/ local gov’t provide medical direction; patient distribution and tracking Demobilization Once task(s) or assignments complete, or asset no longer needed

QUESTIONS ?