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The State of Texas Disaster Medical System

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The State of Texas Disaster Medical System An Overview of TDMS and ESF-8 Coordination Emily Kidd, MD Assistant Professor, UT Health Science Center San Antonio – PowerPoint PPT presentation

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Title: The State of Texas Disaster Medical System


1
The State of Texas Disaster Medical System An
Overview of TDMS and ESF-8 Coordination
  • Emily Kidd, MD
  • Assistant Professor, UT Health Science Center San
    Antonio
  • Project Director Texas Disaster Medical System
  • Texas Hospital Association
  • September 14, 2012

2
What are ESFs?
  • Emergency Support Functions
  • Provide the structure for coordinating Federal,
    State, and Local response to an incident
  • Mechanism for grouping functions most commonly
    utilized for response to disasters and
    emergencies
  • Each ESF has a Primary Agency and Support Agencies

3
What are ESFs?
  • ESF 1 Transportation
  • ESF 2 Communications
  • ESF 3 Public Works and Engineering
  • ESF 4 Firefighting
  • ESF 5 Emergency Management
  • ESF 6 Mass Care and Sheltering
  • ESF 7 Logistics Management / Resource Support
  • ESF 8 Public Health and Medical
  • ESF 9 Search and Rescue
  • ESF 10 Oil and Hazardous Materials Response
  • ESF 11 Agriculture and Natural Resources
  • ESF 12 Energy
  • ESF 13 Public Safety and Security
  • ESF 14 Long-term Community Recovery
  • ESF 15 External Affairs

4
What are ESFs?
  • ESF 8 Public Health and Medical

5
ESF 8 CoordinationPrimary Functions
  • Health and Medical Supplies and Equipment
  • - general and medical shelters
  • - facilities
  • - EMS
  • Evacuation
  • - coordinate medical ground and
  • air assets
  • - coordinate staging
  • - coordinate facility evacuations
  • and destinations
  • - coordinate embarkation/reception
    triage/shelter
  • placement
  • In-hospital care
  • - facilitate resources

6
ESF 8 CoordinationPrimary Functions
  • Assessment of Health Medical Needs
  • - P. H. infrastructure
  • - Mental Health services
  • - hospital dialysis and LTC
  • facilities Capacity
  • - EMS
  • - home bound population
  • Health Surveillance
  • - general and medical shelters
  • - hospitals, dialysis and LTC facilities
  • - illness, injury, deaths
  • Medical Care Personnel
  • - coordinate and manage deployed staff and teams
  • - facilitate resources

7
ESF 8 CoordinationPrimary Functions
  • Food/Drug/Medical Device
  • - food safety
  • - pharmacy services
  • - supplies and Equipment
  • - O2
  • Mental Health Services
  • - Disaster behavioral health
  • - Substance abuse services
  • Mortuary Services
  • - facilitate victim ID
  • - coordinate mortuary services/cemetery

8
ESF 8 CoordinationPrimary Functions
  • Public Health / Medical information
  • - risk messaging
  • - worker health and safety
  • - EMS
  • - public health policy and guidance
  • Recovery
  • - re-entry of evacuees
  • - infrastructure
  • - vector

9
ESF 8 CoordinationMission
  • Management of public health and medical resources
    during a disaster
  • Communication with/among public health and
    medical resources and partners
  • Support incident management for health and
    medical activities and needs

10
ESF 8 CoordinationCenters of Operation in Texas
  • Local EOC
  • Regional Medical
  • Operations Centers
  • (RMOC)
  • Disaster District
  • State Operations Center (SOC)

11
ESF 8 CoordinationObjectives
  • Set overall public health and medical service
    priorities
  • Maintain and disseminate situational awareness
  • Be central point for communications,
    coordination, and resource management for health
    and medical services
  • Facilitate development of public health guidance
  • Facilitate resource needs and allocation
  • Manage and track critical resources assigned

12
ESF-8 Public-Private Partnership
ESF-8 Capacity
13
What is TDMS?
14
ESF-8 OrganizationalChallenges
15

Epi Teams
Food Safety
MSN Shelters
HPP
CAT
Hospital Planning
RAT
GETAC D/EP Committee
ESRD Network
TxMAT
M-IST
PCC
TMF
DOG
DMS
EMTF
BAT
PHEP
MMU
CASPER
RN Strike Team
FNSS ?!?!
AST ASTL
16
TDMS Texas Disaster Medical System
Courtesy TDEM Website
  • The Texas Disaster Medical System is the
    collaboration of all public health and acute
    medical care preparedness initiatives within the
    State of Texas relating to the mitigation of,
    response to, and recovery from natural and
    manmade disasters and other significant events
    within any region in Texas, with respect to
    Emergency Service Function (ESF)-8 functions.

17
Where does TDMS get its authority?
  • The Texas Disaster Medical System (TDMS)
    Steering Committee was established under the
    direction of the Texas Department of State Health
    Services (DSHS) in 2010. DSHS is the lead agency
    for Emergency Support Function (EDF)-8 (Public
    Health Medical Services) per the state of Texas
    Emergency Management plan, Annex H, Texas
    Government Code 418.042, 418.043(13), and
    418.173(a).

18
TDMS Steering Committee
TDMS Steering Committee
Public Health
Acute Care
19
Who is represented on the TDMS Steering Committee?
  • Local Public Health Authorities
  • Local Health Departments
  • Regional Public Health Authorities
  • Regional Health Departments (HSRs)
  • Texas Department of State Health Services
  • Trauma Service Areas / Regional Advisory Councils
  • Hospitals and the Texas Hospital Association
  • Hospital Emergency Management
  • Academic Medicine
  • EMS Agencies Rural, Urban, Fire-based
  • Texas Division of Emergency Management

20
The First Year.
21
TDMS Goals
  • Ensure highest level of readiness to respond
  • Ensure coordination, communication and
    collaboration among partners
  • Ensure understanding of roles and
    responsibilities of partners
  • Maintain updated list of ESF-8 resources

22
Planning and Coordination
  • Bring together all partners from public health
    and acute care
  • Reveals gaps and overlaps
  • Facilitates better understanding of roles and
    responsibilities
  • Provides for continuous improvement
  • Partner workgroups at local jurisdiction,
    regional/multijurisdictional and state

23
Planning and Coordination Functions
  • Access all current plans de-conflict and
    coordinate
  • Compile list of available resources, assess gaps
    and overlaps
  • Establish mutual aid agreements
  • Develop organizational model for MOC and assign
    participants
  • Develop communications plan among partners

24
Planning and Coordination Functions (cont)
  • Determine how local and regional plans integrate
    with state plans
  • Develop written documents for plans and resources
  • Disseminate plans to all partners
  • Communicate gaps and capabilities to DSHS and
    TDMS Steering Committee

25

State of Texas Emergency Management Plan
ESF-8 (Public Health and Medical) Plans and
Resources
State of Texas ESF-8 Strategy Document
Identification and Coordination of all ESF-8
plans, initiatives, and resources in Texas
MSN Shelters
AST ASTL
Food Safety
CAT
Epi Teams
GETAC D/EP Committee
CASPER
EMTF
FNSS
TMF
TxMAT
26
TDMS Overview Document
  • Strategic framework and resource guide for P.H.
    and medical response and recovery
  • Guidelines, protocols, concepts, tasks,
    responsibilities, resource management information
  • Proposes MOC structure for ESF-8 coordination
  • Not intended to supplant local plans

27
The MOC(Medical Operations Center)
  • During response and recovery both acute care and
    public health must come together quickly
  • Single organization for ESF-8 coordination
  • MOC is not stand alone but is integrated into
    incident command
  • Flexible and scalable based upon the incident

28
MOC Structure
29
MOC Development Partners
  • Single Jurisdiction
  • Local public health
  • RAC
  • EMS
  • Local EM
  • Local health authority
  • Hospitals/nursing homes
  • ME/JP
  • DME providers
  • Medical staffing agencies
  • Mental Health Centers
  • Disability community
  • Multi-jurisdictional
  • DDC/Regional coordinators
  • RAC
  • DADS
  • DARS
  • Community mental health centers
  • Disability community
  • ME/JP

30
Incident Scenarios
  • Hurricane
  • Flooding
  • Wildfire
  • Catastrophic disease
  • (including pandemic)
  • Drought / Water Loss
  • Tornado
  • Radiologic Emergency
  • Food Contamination Attack /
  • Food Borne Illness

31
Resources
  • Spectrum of Resources
  • Equipment (e.g. AMBUS)
  • Equipment with Crew (e.g. Mobile Medical Unit)
  • Teams with Equipment (e.g. Ambulance Strike
    Teams)
  • Persons with Skills (e.g. Physicians,
    Epidemiologists)

32
TDMS Resource Typing and Credentialing
  • RESOURCE TYPE
  • External attributes that are obvious
  • Measurable
  • Countable
  • Things
  • Unlikely to change
  • Quantitative - Descriptive Definition
  • Equipment or Teams
  • CREDENTIAL
  • Internal attributes that are not obvious
  • Skills
  • Knowledge
  • Ability
  • Can to be transitory
  • Vetted Identity
  • Badge to combine Identity and Attributes
  • Persons

33
TDMS Training Levels
  • Basic knowledge related to an integrated TDMS
    emergency response and its key components
  • The target audience is all existing or potential
    participants of the TDMS
  • Core knowledge and skills that are common to
    most of the TDMS technical teams or activities
  • The target audience is individual TDMS members
  • Advanced TDMS team training
  • The target audience is individuals or entire
    units assigned to specialized TDMS teams (e.g.,
    MMU, MIST, RAT, CAT, BHAT)

34
Issues / gaps identified (so far.)
  • Need for standardized training curricula and
    schedules for almost every response / resource
    group
  • Overlap of emergency response personnel on
    multiple team rosters
  • Coordination with Texas Military Forces resources
  • Funding responsibilities
  • Liability coverage of medical response personnel
  • Continuation of funding of teams/assets
  • Our role in medical component of mass-care
    sheltering
  • FNSS integration into plans and operations
  • Integration with federal response systems
    (timing, resource typing, availability, etc.)
  • Mass Fatality planning

35
Issues / gaps identified (so far.)
  • Patient tracking issues
  • Standardized patient records
  • Patient records management
  • HIPAA compliance during a disaster
  • Use of MRCs / VOADs / volunteers
  • Integration of Medical Operations Centers into
    TDEM organizational chart
  • Medical Operations Centers functions and purpose
  • Integration of MOCs across the State

36
Emergency Medical Task Force
37
ESF-8 Coordination in Action
  • TDMS Components active during wildfire response
  • State medical operations center
  • DDC medical operations center
  • Ambulance Bus
  • CAT Team
  • Ambulance Strike Teams
  • Mobile Medical Team (MMT/MMU)
  • Pharmacy services
  • Disaster behavioral health

38
ESF-8 Coordination in Action
  • TDMS Components active during wildfire response,
    cont
  • Medical support in general shelters
  • DME/ Medical supplies
  • Public Health
  • Shelter surveillance
  • Public health messaging
  • Epi surveillance
  • Infection control
  • Assessment

39
ESF-8 Coordination in Action
40
ESF-8 Coordination in Action
41
ESF-8 Coordination in Action
42
Onward into the future
43
Public Health and Healthcare Preparedness
Capabilities
  • Consistent with national preparedness strategies
  • Capabilities-based planning and implementation
  • Provides national guidance with a whole of
    community and all of nation approach
  • Serve as the foundation for the 2012 HPP-PHEP
    cooperative agreements

44
Public Health and Healthcare Preparedness
Capabilities
TDMS
45
TDMS Intersects The Critical Three
Public Health Emergency Preparedness Hospital Preparedness Program Department of Homeland Security
Emphasis on strengthening community resilience v v v
All-of-Nation All-of-State / whole community approach v v v
Capabilities-based approach v v v
Identification of gaps v v v
Requirement for risk assessment v v v
Need for demonstration of ROI v v v
46
Healthcare and Public Health Capabilities
  • Public Health Emergency Preparedness (PHEP)
    awardees address 15 public health preparedness
    capabilities
  • Hospital Preparedness Program (HPP) awardees
    address 8 healthcare preparedness capabilities

47
Capabilities Overview
  • Fifteen (15) public health and eight (8)
    healthcare preparedness capabilities
  • Numerical designations cross PHEP and HPP
  • Based on NHSS, PPD-8, NRF, NIMS and CPG101
  • Intent
  • Continuity of essential public health and
    healthcare services to the community
    post-disaster
  • Effective management ESF-8 challenges
  • Ensure ESF-8 priorities and resource needs are
    addressed during response and recovery

48
Capabilities Overview
Public Health Preparedness Capabilities Public Health Preparedness Capabilities Healthcare Preparedness Capabilities Healthcare Preparedness Capabilities
1 Community Preparedness 1 Healthcare System Preparedness
2 Community Recovery 2 Healthcare System Recovery
3 Emergency Operations Coordination 3 Emergency Operations Coordination
4 Emergency Public Information and Warning 4
5 Fatality Management 5 Fatality Management
6 Information Sharing 6 Information Sharing
7 Mass Care 7
8 Medical Countermeasure Dispensing 8
9 Medical Materiel Management and Distribution 9
10 Medical Surge 10 Medical Surge
11 Non-Pharmaceutical Interventions 11
12 Public Health Laboratory Testing 12
13 Public Health Surveillance and Epidemiological Investigation 13
14 Responder Safety and Health 14 Responder Safety and Health
15 Volunteer Management 15 Volunteer Management
49
Current Projects
  • Full scale patient movement exercise
  • How do we improve patient participation in STEAR
    (old TAR / 211)
  • ESRD Coalition
  • ESF-8 coordination in regions
  • Inclusion of Texas Military Forces
  • Mass Fatality Planning

50
Questions and Discussion
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