Coordination - Texas Emergency Management

National Ambulance Contract
CDR Amy O. Taylor
Emergency Coordinator
Cole Bricker
DHS/FEMA Region 6
Federal National Ambulance Service: PURPOSE
The purpose of the Federal National Ambulance and Para-transit
Support Services contract is to provide a full array of licensed
ground and air ambulance services and para-transit services that
may be ordered as needed to supplement the Federal and
Military response to a disaster, act of terrorism or other public
health emergency in any of the 48 contiguous states.
• Why a National Ambulance Contract?
– Cost
– Complexity
– Credentials
– Coordination
• Multi-Agency Effort
The Department of Health and Human Services
provides technical assistance to FEMA in support
of contracted ground + air ambulances, and
para-transit vehicles to support State, tribal and
local governments ability to prepare for and
respond to the effects of a major disaster.
• Centrally managed, regionally coordinated contract
• Provide a full array of licensed ground, air ambulance and
para-transit services to assist states in accomplishing patient
• May be ordered as needed to supplement response to a
disaster, act of terrorism or other public health emergency.
• State public health authorities determine there are unmet
requirements to rapidly and safely evacuate patients with
complex and ongoing medical needs;
• Initiate request for Federal assistance.
• FEMA contract
executed through HHS
operational support
• Can only be utilized
within a Stafford Act
Contract Zones
Performance Requirements Per Zone
– 300 ground ambulances (ALS & BLS)
– Typically a 70%/30% ALS/BLS split
– 25 air ambulances, helicopter and/or fixed wing
– Ability to Transport 3,500 individuals
– Not 3,500 vehicles
Ground Ambulance Services
Types of Ground Ambulances
 Type II – Advanced Life Support, Non-HazMat
 Type IV – Basic Life Support, Non-HazMat
 Type V – Bariatric Ambulance, ALS
 Type VI – Med-Evac Bus, ALS
> 4 stretcher patients
EMS Roles
Patient triage, treatment & transport
Hazard recognition
Symptom surveillance & reporting
On-scene medical standby
Redistribution of pts. to free up hosp. beds
Distributing immunizations
Staffing shelters
Staffing emergency departments
Setting up mobile medical units
Para-Transit Services
6 Types of Para-Transit Vehicles
Para-transit Restrictions
• Sending facility responsible for determining host
• One-way distance < 200 miles or 6 hrs.
• Multiple trips expected
• No medical staff on vehicles
• Caregiver must accompany patient if medical care is required
• Order by patient type, not by vehicle type
Non-ambulatory, wheelchair bound
Ambulatory with assistance
Ambulatory & no assistance needed
Types of Fixed-Wing Aircraft
• Type I – critical care ALS 2+ pts.
• Type II – critical care ALS 1 pt.
• Type III – ALS 2+ pts.
• Type IV – BLS 1 pt.
• Type V - Neonatal
Types of Rotary-Wing Aircraft
• Type II – ALS 2+ pts., night ops.
• Type III – ALS 1 pt., non-night ops.
• Type IV – ALS 1 pt., night ops. VFR
• Type V - Neonatal Specific
Performance Requirements Per Zone
1 Zone
2 Zones
3 Zones
4 Zones
300 ground amb.
600 ground amb.
900 ground amb.
1,200 ground amb.
25 air ambulances
50 air ambulances
75 air ambulances
100 air ambulances
3,500 bus seats
7,000 bus seats
10,500 bus seats
14,000 bus seats
State Considerations
• Medical Evacuation Planning (State ESF-8 lead)
• Activation Request to FEMA Region (Governor)
• Coordination with HHS /ESF-8 regional office
Medical Evacuation Planning Considerations
Planning must be performed whether it be
deliberate or crisis-action and is a state ESF-8
responsibility. It should include:
Number of patients to evacuate
Patient locations (Pick up Points)
– Hospitals
– Nursing Homes
– Residences
Where will patients go?
– Intrastate or Interstate evacuation
– Shelter/Hospital Agreements
Medical Evacuation Planning Considerations (cont)
• Staging area (Check-In site) locations
• Security
• Repatriation
• Medical Assets
– Can this be handled through EMAC?
– Will this require Federal augmentation
Activation Request to Region
If activating the Federal Ambulance Contract, the state must prepare an ARF
identifying the following information (at the very least):
• No. of patients to evacuate & condition:
– Critical/Intensive Care
– Advanced Life Support
– Basic Life Support
• Check-in site
• How they will be used
– Local augmentation of 911 dispatch
– Transportation/Evacuation of Patients
Needs Identification
• State/local identify numbers needing specific
type of support during planning.
• State incorporates EMAC assets in planning
(follow GAP analysis concept).
• State works with HHS Region to identify Federal
• NOTE: The national contract is NOT a panacea- it
is intended to augment State and local
• Pre-Event
– HHS Regional Emergency Coordinators work with States to determine if medical
evacuation assistance may be necessary and identify potential check-in sites for
– Finalize State coordination of requirements.
– State ID’s potential types and numbers.
• During the Event
– Monitor usage
– State ID’s types and numbers
• Post-Execution
– Forward draw-down and demobilization plan
• Regions work through HQs
• No individual direct contact with contractor prior to activation
• ESF #8 manages, FEMA pays
– Joint decision-coordination process
– Under utilization= demobilization
• State/ local exhaust available support
– Own contracts/assets
– Mutual aid and EMAC
How does it work?
Check In
• Ground Ambulance - verify
quantity at Check-in
– ALS (usually 70%)
– BLS (usually (30%)
• Para-transit (seats)
– Verify quantity at check in
– 25% of seats must have
working wheelchair lifts
• Air – Verify quantity at check in.
This may occur at a separate
check in site from the ground
• COTR must validate check-in
times for each asset
AMR/FEMA Vehicle Placard
A=ALS ground ambulance
B=BLS ground ambulance
C=ALS bariatric grnd amb
D=ALS Med-Evac bus
G=Type I sedan/minivan
H=Type II minibus
J=Type III coach transit bus
K=Type IV wheelchair van
L=Type V ADA minibus
M=Type VI ADA coach bus
X=Support vehicle
Check-In Form
“Contractor is responsible for maintaining all provisioning necessary to resupply all
ambulances provided pursuant to any task order for extended periods” – SOO Section
• COTR Inspections (Random)
– Medical Supply Inspections
• Expiration Date
• Type of supplies required are
adequate for tasks assigned
– Personnel Credentials
• State DOT may perform vehicle
inspections as well
Equipment Issuance
Transportation Management Services (TMS) contractor support staff
will be at the check in site to tag each ground asset with a GPS
• Used for deployed evacuation assets across the evacuation
transportation enterprise
• Plots and tracks assets in real time using Sprint i365 GPS enabled
• Provides long-term historical tracking information
• Provides online (web-based) real-time reporting through Telenav
• Enables quick setup and management – anytime from anywhere
BESS Kit Contents
Adhesive Placard
12V Y-Adapter
120V AC Charger
Laminate Placard
Container Box
Portable 12V DC
Power Pack
Sprint i365
12V DC Charger
Reporting / Tracking
The COTR must
• Provide regular status reports – frequency will be set by the National
COTR. These reports will capture information on mobilization, missions
being performed, asset utilization, inspections, demobilization, etc
• Coordinate with state representatives at staging areas and issue work
orders to the contractor for missions (which will assign certain assets to a
specific purpose for a duration of time)
• Adjust work orders as mission requirements demand
• Maintain a spreadsheet that tracks work order progress
Asset Utilization
• How many assets are redlined and why?
– Maintenance Issues
– Assets should never be down due to driver rest requirements
• COTRs must identify how many assets are on missions
out of total available (percent utilization)?
• Asset Utilization is the key metric used to lead
demobilization coordination calls with the states.
Patient Encounter Form
ICS 220 Operational Status Reports
(measures asset utilization)
•Air Ambulance
• COTR is responsible for demobilization coordination
ESF-8 liaison at state EOC
FEMA National COTR
Demobilization, Check-Out Form
Lessons Learned
• Hurricane Dean
Aug 08
• Hurricane Gustav/Ike
Aug 08
• Presidential Inauguration
Jan 09
• Met performance requirement
• Deployed safely
• Logistical support
• Mission Ready
• Accomplished assigned missions
• Check in process
• Direct resource communication & tracking
• Resource utilization
• Inter-agency coordination
• Logistics leveraging
• Costs
• Planning
 State and HHS region coordinate
 Project assets needed/ staging
• Activation
 Deploy assets to staging area
 FEMA placards for vehicle ID
 State/local briefing; credentialing (if necessary)
• Deployment
 Resources deploy from sating area to site(s)
 Once assets leave staging area, assigned to state
 State/ local gov’t provide medical direction; patient distribution and tracking
• Demobilization
 Once task(s) or assignments complete, or asset no longer needed
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