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NDMS Patient Movement


Operations suspended while hurricane makes landfall ... Military Operations. JPMT had limited communications while at the New Orleans Airport ... – PowerPoint PPT presentation

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Title: NDMS Patient Movement

NDMS Patient Movement After Action Review 12-13
Dec 2005 Mr. Mark Mahar USTRANSCOM/GPMRC
National Response Plan
  • Emergency Support Functions-ESFs
  • ESF-8 - Public Health and Medical Services
  • ESF-8, when activated is coordinated by Health
    and Human Services (HHS) through the Secretaries
    Operations Center
  • During initial activation, HHS convenes a
    conference call with the appropriate ESF-8
    partners and State/local representatives

National Response Plan
  • USTC/SG Responsible for
  • Coordination with ESF1-Transportation for
    evacuation of ambulatory patients and Displaced
  • Regulating and tracking patients transported on
    DOD assets
  • Communicating requirements to Federal
    Coordination Centers (FCCs) and providing
    specific reporting instructions on bed
  • Evacuating/Managing patients from patient
    collection points to NDMS patient reception areas

In Response to a Contingency
  • USTC SG GPMRC provides
  • Bed availability data in coordination with FCCs
  • Validation of patient movement
  • Care plan for the patient
  • Joint Patient Movement Team (JPMT)
  • Coordination with movement agencies
  • In-Transit Visibility

Hurricane Katrina Timeline
Moved 791 patients
04 Sep 05
Moved 941patients
03 Sep 05
Moved 409 patients
JPMT augmentees arrived
02 Sep 05
Moved 444 patients
EMEDS arrived in New Orleans
AELT arrived in New Orleans
MASF arrived in New Orleans
JPMT arrived at New Orleans requested litter
01 Sep 05
Moved 142 patients
First official Evac of patients from Hurricane
Attempted to contact FCCs in Region IV and VI
Received Tasking via NORTHCOM SG for deployment
FEMA activated NDMS FCCs region IV and VI
31 Aug 05
Moved 52 patients out of Keesler AFMedCen
JPMT put on official alert
30 Aug 05
Hurricane Katrina Timeline
Last patient moved
20 Sep 05
08 Sep 05
07 Sep 05
Began sustainment operations (regularly scheduled
daily missions)
JPMT returned home to Scott AFB
06 Sep 05
Moved 10 patients
Last MASCAL Evac mission
05 Sep 05
Hurricane Rita Timeline

Moved 129 patients with 3 AE missions from Texas
Request for forces to NORTHCOM for litter bearer
433rd MASF / AELT arrived in Beaumont, Texas
AMC/TACC stands-up glass room
FEMA activated FCCs in Regions IV VI
GPMRC stands up 24/7 contingency operations
TRANSCOM received MA
NORTHCOM/GPMRC provided language for MA to FEMA
22 Sep 05
GPMRC puts 6 member JPMT on alert
NORTHCOM/SG advised of FEMAs verbal request for
DoD assistance for region IV VI
21 Sep 05
Hurricane Rita Timeline

FCCs stand-down
26 Sep 05
GPMRC stands down 24/7 contingency cell
EOCs state no further patient movement requests

25 Sep 05

Operations suspended while hurricane makes
24 Sep 05
433rd MASF/AELT departed Beaumont hrs before the
storm surge
Beaumont reported no further requirements and
ceased operations
Lake Charles reported no further requirements and
ceased operations
Ellington Field reported ceasing operations due
to close proximity of the storm
Moved 1075 patients on 19 AE missions
23 Sep 05
Lessons Learned
  • Air National Guard/Coast Guard/Navy Involvement
  • There were plenty of airframes offered by other
    than AMC that did not have AE crews or equipment.
    There was no identified C2 over these airframes.
  • Impact
  • TRANSCOM/SG approved movement without AE crew -
    utilized local medical attendants.
  • Recommendations
  • Airframes have an identified C2 structure for all
    non-AF responders
  • Mechanism for assigning either an AE crew or
    appropriately qualified medical attendants

Lessons Learned
  • JPMT Mission
  • The JPMT role is to regulate and coordinate
    patient movement. In order for it to be
    effective, an AELT and Air Staging Facility (ASF)
    should be co-located and in place.
  • Impact
  • During initial phase JPMT had to perform duties
    outside of their role (i.e.. Litter bearer,
    triage, etc.)
  • Recommendation
  • Deploy AELT and ASF with JPMT

Lessons Learned
  • TRAC2ES Application
  • TRAC2ES is limited in a tactical situation with
    massive on loads and frequent missions. Mass
    casualty PMRs are too cumbersome. Tactical on
    load forms were generated as a result of
    Katrina and were faxed to the FCCs and MASFs
    for Rita and were still only partially used.
    FCCs kept a record of patients received, but
    often without mission numbers.
  • Impact
  • After the fact PMRs must be generated.
  • Recommendation
  • Change software to accommodate large number of
    patient evacuations.

Lessons Learned
  • Best Mode to Move Patients
  • Use of trains during Rita may have been very
    beneficial in moving large numbers of patients.
  • Impact
  • More patients could have been moved in a shorter
    period of time.
  • Recommendation
  • Evaluate multi-modal patient transport platforms
    for future use.

Lessons Learned
  • Transport to Bed Planner
  • The transport to bed planner is an integral part
    of managing mass casualty planning. During the
    relief efforts the transport to bed planner could
    not be utilized.
  • Impact
  • Missions and patient assignments were manually
    accomplished in TRAC2ES
  • Recommendation
  • Reengineer TRAC2ES to simplify the input of large
    numbers of casualties for matching against
    available beds.

Internal Communications
  • USTRANSCOM received a verbal EXORD from the Joint
  • J-3 alerts USTC Surgeon, GPMRC, and AMC CAT
  • 18AF TACC/CC organized staff in Glass Room to
    work requirements

External Communications
  • - Request from state EOCs to FEMA
  • - FEMA developed an MA and activated NDMS and
  • - FEMA sent the MA to JDOMS to the Joint Staff
    to the Sec of Defense for approval and back to
    the Joint Staff for EXORD
  • - Verbal came from Joint Staff to execute
  • MA

Chain of Command
Chain of Command
Patient Tracking Issues
  • Military Operations
  • JPMT had limited communications while at the New
    Orleans Airport
  • Need an effective ITV (In-Transit Visibility)
  • FEMA DoD
  • Need consistent patient ID system for tracking
  • Need standardized tracking forms
  • Need joint system training

Non-USTC Patient Moves
  • Loss of visibility
  • - Guard assets moved patients
  • - Ground transport to civilian facilities
  • - Coast Guard assets moved patients to unknown
  • - Limited control of the surge of the patients
    to the New Orleans Airport

Response Times
  • Lead time
  • - Activation of FEMA, HHS teleconferences
  • - Pre-planning with JPMT
  • - Team dedicated to Katrina and Rita
  • Lag time
  • - Notification process from the state
  • - Cycling of aircraft, AE Crews, and lay down of
    MASF, EMEDs, and CCATT

Other Modes of Patient Movement
  • Capability existed to move patients through
    various means
  • - Ground
  • - Naval Vessels
  • - Rotary Wing
  • - Fixed Wing

Operational Successes
  • 3813 Patients moved in two separate disasters
  • Deployed first ever JPMT
  • Coordinated closely with FCCs for bed
  • Participated in multiple teleconferences to
    provide updates
  • Put the patient first

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