Joint Regional Medical Plans & Operations USNORTHCOM Command Surgeon Joint Regional Medical Plans & Operations NDMS Patient Movement Lt Col Tony Voirin USNORTHCOM JRMP – NW Branch

Federal Patient Movement Capabilities National Ambulance Contract 300 Amb/3000 para-transit seats/life-flight Military Ground Ambulance – Humvee Military Helicopters – MEDEVAC/CASEVAC National Guard and Active Duty Civilian Contract Airlines Low acuity/Ambulatory/Chronic patients NDMS Fixed Wing Patient Evacuation

A public/private sector partnership DHS DHHS DOD DVA National Disaster Medical System A public/private sector partnership DHS DHHS DOD DVA

Major Components of the NDMS System Three functions that provide a comprehensive, supplemental health care delivery system during events of national significance. Within the partnership the MEDICAL RESPONSE leg is coordinated & managed by NDMS Headquarters. The Operations Support Center (OSC) coordinates personnel/team movement from home base to the mobilization site/staging area. NDMS response operations are also closely coordinated with the NRCC. MEDICAL RESPONSE consist of the “out the door” teams that hit the affected area. PATIENT EVACUATION is coordinated and managed by DoD. TRANSCOM supported lift out of pre-designated APOEs within or near the disaster area. Patients are received at Patient Reception Areas (PRAs) and regulated to local participating treat facilities by the Federal Coordinating Center (FCC). DEFINITIVE CARE is that care delivered once evacuated patients are admitted to the participating hospitals.

NDMS Patient Evacuation DoD has primary responsibility Movement from point of origin to receiving Federal Coordinating Center (FCC) Patient Reception Area (PRA) Primarily relies on air AE = Aeromedical Evacuation System Components Movement Requests Staging Regulating Lift Reception & Distribution Tracking (HHS JPATs)

System Capability Patient Evacuation can begin 36 hrs from notice System can move 500 patients per day (up to 20% critical) Up to four Airfields Limited capability for patients Suggest the following patients be evacuated by other modes High-acuity burn NICU and PICU Psychiatric (if requires medical supervision)

Reception Sites (FCC)

What we need to know How many patients over what period (approx) What airfields (coordinated approval) Rate of delivery to the Airfield Acuity of Patients (higher Acuity, less patients) Litter/Amb – Space, number of patients/plane Critical – CCATT and Equipment Vented – CCATT, Equipment and O2 How will Patient Movement Requests flow Will need to know but make best guess

Other factors Notice vs No Notice Hurricane vs Earthquake/CBRNE Catastrophic or Not (Potential or Just Bad) 7.8 Earthquake/Nuke or Prestorm/Wildfire State Request Submitted or On Fence Mission Assignment Driven Process Single or Multi-State Event

Regional Hospital Coordinator Ambulances dispatched AE System Overview PT MAN GPMRC State EOC JPMT (GPMRC) PMR LOCAL HOSP Situational Awareness Mission Built PMR Crews Alerted PT MAN LOCAL HOSP PMR LOCAL HOSP AMC (TACC) PMR Regional Hospital Coordinator PMR Mission Specifics (MSN #, Times, Etc.) Ambulances dispatched to hospitals APOE/AMP MASF/AELT Ambulance Control CRE/CRT State/Local IC Pts moved to APOE and loaded JPRT/QRC NDMS HOSP NDMS DMAT/CCT NDMS HOSP AE movement to APOD NDMS HOSP APOD/FCC

Challenges Patient Movement Requests Number of patients; over period of time (approximately) FEMA Mission Assignment (MA) to DoD Identification and allocation of space on Airfields Rate of delivery to the Airfield(s) right patient right airhead right order/time Acuity of patients (higher acuity = less patients) Litter/Ambulatory – space, number of patients/plane Critical – CCATT, Equipment, O2 (20% max) Vented – CCATT, Equipment, O2 # Non-medical attendants (i.e. pediatric patients - 20% max)

Questions?