EMS: EMS: On the Radar On the Radar

Screen at Screen at OPHEP?OPHEP?

Sandy Bogucki, MD, PhD Sandy Bogucki, MD, PhD

Senior Medical AdvisorSenior Medical AdvisorOffice of Public Health Emergency PreparednessOffice of Public Health Emergency Preparedness

Department of Health & Human ServicesDepartment of Health & Human Services

sandy.bogucki@hhs.govsandy.bogucki@hhs.gov

ASPHEPASPHEPStewart SimonsonStewart Simonson

• Secretary’s principal advisor on matters related Secretary’s principal advisor on matters related to:to:– BioterrorismBioterrorism– Other public health emergenciesOther public health emergencies– Natural disasters generating medical emergenciesNatural disasters generating medical emergencies

• Coordinates interagency activities regarding EP Coordinates interagency activities regarding EP and PH emergency responses between HHS and PH emergency responses between HHS andand– Other federal departments, agencies, officesOther federal departments, agencies, offices– State, local officialsState, local officials

e.g. Project BioShield

BioShield was announced by President Bush in his State of the

Union address on January 28, 2003.

Secretaries Thompson (HHS) and Ridge (DHS) jointly transmitted the “Project BioShield Act of 2003 to Congress on February 26, 2003.

Purpose: To accelerate the process of research, development, purchase, and availability of effective countermeasures against agents of bioterror.

OPHEP:OPHEP:• Office of R&D CoordinationOffice of R&D Coordination

• Primarily NIHPrimarily NIH

OPHEP:OPHEP:• Office of R&D CoordinationOffice of R&D Coordination

• Office of State & Local PreparednessOffice of State & Local Preparedness• coordinating and integrating CDC's and HRSA's Cooperative coordinating and integrating CDC's and HRSA's Cooperative

Agreement Programs ($2.5 Billion FY ’02, ’03)Agreement Programs ($2.5 Billion FY ’02, ’03)• Public Health Cooperative Agreement (CDC)Public Health Cooperative Agreement (CDC)

• Regional public health preparedness planningRegional public health preparedness planning

• Increasing lab capacityIncreasing lab capacity

• Increasing surveillanceIncreasing surveillance

• Establishing rapid communication systemEstablishing rapid communication system

• Bioterrorism Hospital Preparedness Cooperative Agreement (HRSA)Bioterrorism Hospital Preparedness Cooperative Agreement (HRSA)• Regional surge planning (beds, personnel, and equipment)Regional surge planning (beds, personnel, and equipment)

• Lab capacityLab capacity

• Mental health consequences of terrorismMental health consequences of terrorism

• Training: ICS, PPE, SmallpoxTraining: ICS, PPE, Smallpox

OPHEP:OPHEP:• Office of R&D CoordinationOffice of R&D Coordination• Office of State & Local PreparednessOffice of State & Local Preparedness• Office of Planning & Emergency Response Office of Planning & Emergency Response

Coordination Coordination (OPERC)(OPERC)– Operates the SOC 24/7, with liaison in HSOCOperates the SOC 24/7, with liaison in HSOC

• Representatives of Op Div’sRepresentatives of Op Div’s– Some via video linkSome via video link

• Interagency LiaisonsInteragency Liaisons• USPHS (CC)USPHS (CC)• Local, regional officesLocal, regional offices

– Coordinates ESF #8Coordinates ESF #8• (federal response)(federal response)

• Preventive and Public Health Services

• Environmental Health Services

• Medical Services • Mental Health Services

Provided by DHS, VA, DoD, and HHS assets

Supplements state/local resources in response to public health and medical care needs following a major disaster or emergency.

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ESF #8 Health & Medical Services

Let the conference calls begin…Let the conference calls begin…

S&R/Recovery, triage, field Rx, Prolonged Tx times? Evacuate hospitals? Augment medical, morgue staffing Hospital beds (hundreds? thousands?) Locate burn care capability? Isolation capability? FAX ARF’s to DHS

Receive mission assignmentsReceive mission assignments NDMSNDMS

TeamsTeams Mass Evac Transport, DestinationMass Evac Transport, Destination

SERT, SNSSERT, SNS USPHS, Op Div’sUSPHS, Op Div’s DoD, VADoD, VA ARCARC Local, mutual aid

State

FEMA HHSOp Div,VA, DoD HHS

Federal aid

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• Speed of mobilizationSpeed of mobilization– To compromised ACF’s, e.g.To compromised ACF’s, e.g.

– For mass casualty careFor mass casualty care

• Difficulty preparing for impending threatDifficulty preparing for impending threat• Inadequate federal work force of Inadequate federal work force of

qualified HCWsqualified HCWs• DoD capabilities degraded when DoD capabilities degraded when

engaged elsewhereengaged elsewhere• Cost effectivenessCost effectiveness• Medical/Mass transportMedical/Mass transport

– DoD assignment as described in NDMSDoD assignment as described in NDMS

– EMS back-up??EMS back-up??

ESF #8 Concerns: Observations & Extrapolations

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• RegionalRegional– All concentric tiers have to become All concentric tiers have to become

functional (not just conduits)functional (not just conduits)– All must have ongoing operational All must have ongoing operational

function (not just function (not just planning/preparation)planning/preparation)

EMS and Hospital Surge Capacity

NeighboringNeighboringStateState

Teams

RegionMutual AidMutual Aid

Federal response other than $Federal response other than $

Teams

Teams

State

RegionalResource Coordinating Center (RRCC) or Joint

Field Office (JFO)

HHSREC

(chair)

SOC

DHS MMRSCoordinator

MMRS programs in Region

EMAC Rep

OP Div Regional Reps e.g.

FDA, HRSA, IHS, BOP, AOA, CMS, SAMHSA,

CDC

Individual Agency Headquarters

CDC & HRSA Cooperative Agreement

Coordinators(State)

Regional ECs CDC & NDMS

Interagency Regional Reps

e.g. VA Regional Manager,

USDA, Forest Service, EPA,

OSHA

SERT

1 rep + 1 alt

Response Operations

Hospital Surge

Function (state)

Hospital Surge

Function across region

(state)

Health Dept.(metropolitan)

Metropolitan Health Depts.

across the region

Hospital Surge Function

(metropolitan)

Hospital Surge Function

across region(Metropolitan)

Ambulance/ EMS System

EMSConsortia

1 rep + 1 alt 1 rep + 1 alt1 rep + 1 alt

State Emergency

Management

State Emergency

Management across region

1 rep + 1 alt

Metropolitan Emergency

Management

Metropolitan Emergency

Management across the

region

1 rep + 1 alt

Medical Reserve Corps (MRC)

Other MRC

units in region

1 rep + 1 alt

State HealthDept.

State Health Depts. across region

1 rep + 1 alt1 rep + 1 alt

1 rep + 1 alt

CDC & HRSA

Program Managers(Federal)

ConclusionConclusion

• Opportunity to include EMS in Cooperative Opportunity to include EMS in Cooperative Agreement GuidanceAgreement Guidance

• EMS on Regional TF’sEMS on Regional TF’s– Representative (operational) consortiaRepresentative (operational) consortia– Inter-medical direction, Inter-state credentialing issuesInter-medical direction, Inter-state credentialing issues– Deployable EMSDeployable EMS– Multiple, mass transport EMS, including inter-facilityMultiple, mass transport EMS, including inter-facility