HHS Response Assets and Plans for an IND Event

Transcription

1 HHS Response Assets and Plans for an IND Event Institute of Medicine Ann Knebel, RN, DNSC, FAAN Deputy Director Preparedness Planning August 7, 2008

2 Office of Assistant Secretary for Preparedness and Response ASPR RADM C. Vanderwagen Immediate Office of the ASPR Office of Policy & Strategic Planning B. Kamoie Biomedical Advanced Research & Develop Authority R. Robinson Office of Science, Medicine, & Public Health M. Mazanec Office of Preparedness & Emergency Operations K. Yeskey This presentation represents efforts of many from ASPR, NIAID, NCI, FDA, CDC, DHS, RITN, etc

3 MMRS MRC ARC ESAR- VHP NDMS PHS - OFRD PHS - ORA

4 Spectrum of Care and Federal Medical Resources Volunteers Metropolitan Medical Response System VA/DOD NDMS/DMATs Medical Reserve Corps US Public Health Service ARC Shelter Federal Medical Stations NDMS Hospitals Basic First Aid Outpatient Care Emergency Departments ICU/Trauma Critical Care Pre-hospital Care Nursing Home Care Hospital Inpatient Care

5 Metropolitan Medical Response Systems Original Anchorage, Baltimore, Boston, Chicago, Columbus, Dallas, Denver, Detroit, Honolulu, Houston, Indianapolis, Jacksonville, Kansas City (MO), Los Angeles, Memphis, Miami, Milwaukee, New York, Philadelphia, Phoenix, San Antonio, San Diego, San Francisco, San Jose, Seattle, Washington DC (MMST) [Note: Atlanta was also a MMST] 1999 Albuquerque, Austin, Charlotte, Cleveland, El Paso, Fort Worth, Hampton Roads (Virginia Beach) Area, Long Beach, Nashville, New Orleans, Oakland, Oklahoma City, Pittsburgh, Portland (OR), Sacramento, Salt Lake City, St. Louis, Tucson, Tulsa, Twin Cities (Minneapolis) 2000 Akron, Anaheim, Arlington TX, Aurora, Birmingham, Buffalo, Cincinnati, Corpus Christi, Fresno, Hampton Roads (Norfolk) Area, Jersey City, Las Vegas, Lexington-Fayette, Louisville, Mesa, Newark, Omaha, Riverside, Rochester, Santa Ana, St. Petersburg, Tampa, Toledo, Twin Cities (St. Paul), Wichita 2001 Baton Rouge, Colorado Springs, Columbus (GA), Dayton, Des Moines, Garland, Glendale (CA), Grand Rapids, Greensboro, Hialeah, Huntington Beach, Jackson, Lincoln, Little Rock, Lubbock, Madison, Mobile, Montgomery, Raleigh, Richmond (VA), Shreveport, Spokane, Stockton, Tacoma, Yonkers 2002 Amarillo, Arlington VA, Bakersfield, Chattanooga, Columbia, Fremont, Ft. Lauderdale, Ft. Wayne, Glendale, Hampton Roads (Newport News, Chesapeake) Area, Hartford, Huntsville, Irving, Jefferson Parish, Kansas City (KS), Knoxville, Modesto, Orlando, Providence, San Bernardino, Springfield, Syracuse, Warren, Worcester 2003 Atlanta Regional Coalition, Northern New England Region (New Hampshire, Maine, Vermont), Southern Rio Grande Region (TX), Southeast Alaska Region As of March 31, 2004

6 ARC Disaster Services Mass Care (Sheltering, Feeding) Health Services Mental Health Services Welfare Inquiries Casework Critical Response Team Spiritual Response Team Disaster Childcare All Red Cross Disaster Assistance is Free!

7 MRC At A Glance Mission: Improve the health and safety of communities across the country by organizing and utilizing public health, medical and other volunteers Key Points: Organize/utilize locally Affiliate/integrate with existing programs and resources Volunteer management - identify, screen/verify credentials, train Foster community resiliency

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9 ESAR VHP During Hurricane Katrina, over 8,300 volunteers were deployed through ESAR-VHP In 2006, developed and exercised Federal Protocol 40 States and Territories have operational ESAR-VHP systems 80% of the top ten population States have operational ESAR-VHP systems As of April 2007, there are a total of 122,616 registered ESAR-VHP volunteers By the end of CY 2008, it is expected that all 50 states will have operational ESAR-VHP systems

10 National Disaster Medical System HHS DHS DOD VA A Nationwide Medical Response System to: Supplement state and local medical resources during disasters or major emergencies Provide backup medical support to the military/va medical care systems during an overseas conventional conflict

11 National Disaster Medical System Major Components of NDMS HHS VA Definitive Care ESF #8 LEAD DHS Medical Response Patient Evacuation DoD NRF Coordination

12 NDMS Response Teams (93) 52 Disaster Medical Assistance Teams 3 National Medical Response Teams / WMD + 1 Contracted Team 5 Burn Teams 2 Pediatric Teams 1 Crush Medicine Team 3 International Medical / Surgical Teams 2 Mental Health Teams 5 National Veterinary Response Teams 11 Disaster Mortuary Operational Response Teams (1 WMD) 1 Disaster Portable Morgue Unit Logistics Team 1 Family Assistance Center Team 3 National Pharmacy Response Teams (East, Central & West) 3 National Nurse Response Teams (East, Central & West) 1 Respiratory Therapist Team

13 USPHS Commissioned Corps Tier 1 5 Rapid Deployment Force (RDF) Teams Report within 12 hours 1 Team on call every 5 months 105 officers (clinical, mental health, & applied public health) 2 Teams in NCR 1 Team in GA, SC, NC 1 Team in AZ, NM 1 Team in TX, OK 5 Incident Response Coordination Teams (IRCT) Report within 12 hours 2 Teams on call every 5 months 30 officers (command and control) 1 Team assigned to each HHS Region 1 Emergency Management Group (EMG) Support Team Report within 4 hours Support EMG at Secretary s Operation Center LNO

14 AK NMDP- component of Radiation Injury Treatment Network RITN I X HI IX VIII I X: FEMA Regions Primary Transplant Centers Primary Donor Centers Cord Blood Banks Secondary Transplant Centers VI VII V IV II PR III RITN includes NCI Cancer Centers and is growing Weinstock et al. Figure 1

15 Playbook: Action Steps Highlights decision points, key actions and who is responsible Organized around phases Immediate Phase: 0-12 Hours Post Detonation Trigger: Detonation of an Improvised Explosive Device, Radiological Material Realized Briefing Papers / Decision Papers Actions / Issues Coordinating / Support Agencies U.S. Goals / Strategy: Maximize Survivors, Deploy Resources, prevent additional radiological exposures and prevent additional potential threats. Decision Paper 1 Declare a Public Health Emergency SEC HHS Briefing Paper 3 Activate the HHS Emergency Management Group Communicate with relevant agencies to determine size and scope of damage. IMAAC- weather and possible plume information. CDC- Activate the Advisory-Team (aka The A-Team). SEC HHS/ASPR ASPR DOE, DHS, IMAAC, CDC, state and local officials

16 Radiation Event Medical Management REMM Dr. Judy Bader

17 (Notional) Sources of Emergency Public Health and Medical Personnel for Disasters Mutual Aid/EMAC State ESAR VHP Requests for Assistance State Incident Command Federal ESF 8 Response Event State ESAR VHP Federal Personnel Unpaid Temporary Federal Employees NDMS/DMATs DOD VA US Public Health Service

18 Assumptions With catastrophic event there may be insufficient assets to assist Distributing burden across the broader health care system; regional considerations Need to maintain critical infrastructures Terminology Standard of care appropriate for the situation Changes from usual to austere Planning guide for how one allocates scarce resources, distributes materiel, and decides who receives what type of care. Suggestions for protocols to adjust clinical algorithms to optimize scarce resources Allocation of Scarce Resources