The State of Texas The State of Texas Disaster Medical System – Disaster Medical System – An Overview of TDMS and An Overview of TDMS and

ESF-8 CoordinationESF-8 CoordinationBruce Clements, MPHBruce Clements, MPH

Director, Community Preparedness SectionDirector, Community Preparedness SectionTexas Dept of State Health ServicesTexas Dept of State Health Services

Rick BaysRick BaysDirector, Response and Recovery UnitDirector, Response and Recovery Unit

Texas Department of State Health ServicesTexas Department of State Health Services

Emily Kidd, MDEmily Kidd, MDAssistant Professor, UT Health Science Center San AntonioAssistant Professor, UT Health Science Center San Antonio

Project Director – Texas Disaster Medical SystemProject Director – Texas Disaster Medical System

TDMS UpdateTDMS Update

Emergency Support Function 8, Emergency Support Function 8, Public-Private PartnershipPublic-Private Partnership

ESF-8 Capacity

National Preparedness StrategiesNational Preparedness Strategies

• Public health and healthcare preparedness is part of a national preparedness strategy

• Presidential Policy Directive 8: National Preparedness– “…aimed at strengthening the security and resilience

of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber attacks, pandemics, and catastrophic natural disasters.”

– “…aimed at facilitating an integrated, all-of-Nation, capabilities-based approach to preparedness.”

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Vision and Strategy AlignmentVision and Strategy Alignment

National Health Security Strategy

(NHSS)

National Preparedness GoalCore Capability List

Pandemic and All-Hazards Preparedness Act

(PAHPA)

Homeland Security Presidential Directives

Public Health and Healthcare Preparedness Capability Development

OPHPR Strategic Plan

Trust for America’s HealthReady or Not

Project PublicHealth Ready

Conceptualizing and Defining Public Health

Emergency Preparedness

Health PreparednessCapability Prioritization

Project

* Note: Partner documents are not an exhaustive list, shown for representation purposes only

Public Health and Healthcare Public Health and Healthcare Preparedness CapabilitiesPreparedness Capabilities

Public Health

Emergency Management

10 Essential Services of Public Health

National Preparedness

Core Capabilities

Public Health and Healthcare

PreparednessCapabilities

Healthcare

TDMS

TDMS Intersects “The Critical Three”TDMS Intersects “The Critical Three”Public Health Emergency Preparedness

Hospital Preparedness Program

Department of Homeland Security

Emphasis on strengthening community resilience

√ √ √

“All-of-Nation” “All-of-State” / whole community approach

√ √ √

Capabilities-based approach

√ √ √

Identification of “gaps” √ √ √

Requirement for risk assessment

√ √ √

Need for demonstration of ROI

√ √ √

NDMS and TDMSNDMS and TDMS

• HHS may activate the NDMS to provide aid to victims of a public health emergency or to be present at locations at risk of a public health emergency.

• HHS is the lead federal agency for Emergency Support Function #8 (ESF#8): Public Health and Medical Services. 

• DSHS may activate TDMS to provide aid to victims of a public health emergency or to be present at locations at risk of a public health emergency.

• DSHS is the lead state agency for Emergency Support Function #8 (ESF#8): Public Health and Medical Services. 

Healthcare and Public Health Healthcare and Public Health CapabilitiesCapabilities

• Public Health Emergency Preparedness (PHEP) awardees address 15 public health preparedness capabilities

• Hospital Preparedness Program (HPP) awardees address 8 healthcare preparedness capabilities

• 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

Capabilities OverviewCapabilities Overview

Capabilities OverviewCapabilities OverviewPublic Health 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

13Public Health Surveillance and Epidemiological Investigation

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14 Responder Safety and Health 14 Responder Safety and Health

15 Volunteer Management 15 Volunteer Management

Public Health and Healthcare Public Health and Healthcare Preparedness CapabilitiesPreparedness 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

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• Acute Healthcare and Public Health• Two sets of distinct functions that strongly

influence each other• They can stand alone but are much

stronger together• Can’t be too close

– Complete integration is not possible (placing acute care in public health or vice versa)

• Can’t be too far apart– They strongly influence each other

Illustrating and Communicating Illustrating and Communicating ESF-8 ComplexityESF-8 Complexity

ESF-8 Coordination: The KeystoneESF-8 Coordination: The Keystone

Collaboration of public health and acute medical

care preparedness

ResourcesResources

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)

TDMS Resource Typing and CredentialingTDMS 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”

TDMS ProcessTDMS Process

EVALUATE/ IMPROVE

PLAN

ORGANIZE/ EQUIP

EXERCISE

TRAIN

• Collaborative planning • Response hierarchy

coordination• Role and responsibility

clarification• Sequencing response

actions• Focusing resources on

risks• Defining resources and

support• Improvement processes

The TDMS process is a forum for collaborative planning for healthcare and public health stakeholders to refine preparedness and response

TDMS – Texas Disaster TDMS – Texas Disaster Medical SystemMedical System

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.

Courtesy TDEM Website

Where does TDMS get its Where does TDMS get its authority?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).

TDMS Steering CommitteeTDMS Steering Committee

Public Health

Acute Care

TDMS Steering Committee

Who is represented on the TDMS Who is represented on the TDMS Steering Committee?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

Issues / gaps identified (so far….)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

Issues / gaps identified (so far….)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

TDMS Overview DocumentTDMS 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

TDMS GoalsTDMS 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

Planning and CoordinationPlanning 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

Planning and Coordination Planning and Coordination FunctionsFunctions

• 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

Planning and Coordination Planning and Coordination Functions (con’t)Functions (con’t)

• 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

The MOCThe MOC(Medical Operations Center)(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

MOC StructureMOC Structure

MOC Development PartnersMOC Development Partners

• Single Jurisdiction– Local public health– 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

ESF – 8 CoordinationESF – 8 CoordinationPrimary FunctionsPrimary 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 - medical volunteer management

ESF – 8 CoordinationESF – 8 CoordinationPrimary FunctionsPrimary Functions

• Health and Medical Supplies and Equipment - general and medical shelters - facilities - EMS - Pharmacy and Oxygen

• Evacuation - coordinate medical ground and

air assets - coordinate staging - coordinate facility evacuations and destinations - coordinate embarkation/reception triage/shelter placement

• Patient Care - facilitate management of medical surge - hospital census and bed availability

ESF – 8 CoordinationESF – 8 CoordinationPrimary FunctionsPrimary Functions

• Food Safety and Security - food safety in shelters - food safety during recovery - food borne illness outbreak • Mental Health Services - Disaster behavioral health - Substance abuse services

• Mortuary Services - assist in Family Assistance Centers - coordinate mortuary services/cemetery

ESF – 8 CoordinationESF – 8 CoordinationPrimary FunctionsPrimary Functions

• Public Health / Medical information - risk messaging to public - public health policy and guidance

• Recovery - re-entry of evacuees - infrastructure - vector

Incident ScenariosIncident Scenarios• Hurricane• Flooding • Wildfire• Catastrophic disease

(including pandemic)• Drought / Water Loss• Tornado• Radiologic Emergency• Food Contamination Attack /

Food Borne Illness

Incident ScenariosIncident Scenarios

Incident ScenariosIncident Scenarios• Awareness of injury risks• Medical care for sheltered individuals• Evacuation• Stress Reactions• Preventing disease in congregate care settings• Mass Fatalities• Medical Surge• ESF-8 Coordination and Management

To name a few……..

Incident ScenariosIncident Scenarios

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)

Pilot CoursesPilot Courses

• Not Throwing Caution to the Wind: 4/3 2:30Deployment Safety

• Exec. Overview of WebEOC in Texas 4/4 10:00

• ESF8 Resource Roundup 1 4/4 2:30• ESF8 Resource Roundup 2 4/4 4:00

• Going Down Range: Deployment Basics 4/5 10:00

Ambulance Ambulance Strike TeamsStrike Teams

Currently 32 Currently 32 ASTs engaged, ASTs engaged,

150+ units150+ units

• 5 Ambulances/AST (25 total)• Pre-identified teams• No-notice regional deployment• Statewide tasked missions• Common communications

Mobile Medical UnitsMobile Medical Units

• 16-32 bed capacity• Provide emergency stabilizing care and

transfer• Staffed with physicians, nurses, techs,

logistics, clerical, etc• 6-12 hr launch time for 72-96 hr deployment• Standardized cache of supplies,

pharmaceuticals, and capabilities

AMBUS ProjectAMBUS Project

• MPV = Multi-Patient Vehicle• Transport >12 litter patient at

a time • Pre-plumbed for O2 and

medical gases• No-notice regional and

statewide taskings• 4-6 paramedics/AMBUS

EMTF 2 – North Central Texas

RN Strike TeamsRN Strike Teams

• Nurses deployed into a “like” environment – standardized training • Must be qualified nurses with critical thinking skills during disaster

situations • Understand NIMS and disaster response • Statewide tasking missions• Still being developed

ESF-8 Coordination in ActionESF-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

ESF-8 Coordination in ActionESF-8 Coordination in Action• TDMS Components active

during wildfire response, con’t– Medical support in general

shelters– DME/ Medical supplies– Public Health

• Shelter surveillance• Public health messaging• Epi surveillance• Infection control• Assessment

Questions and DiscussionQuestions and Discussion