ESF-8:
Resource Roundup
TEXAS DISASTER MEDICAL SYSTEM
TEXAS EMERGENCY MANAGEMENT CONFERENCE
APRIL 2012
Objectives
 Define Emergency Support Function (ESF)-8
 Describe ESF-8 Resources
 Local
 State
 Federal
 Illustrate Resource Request Process
Emergency Support Functions
1 Transportation
2 Communications
3 Public Works and Engineering
4 Firefighting
5 Emergency Management
6 Mass Care, Housing, and Human Services
7 Resources Support
8 Public Health and Medical Services
9 Urban Search and Rescue
10 Oil and Hazardous Materials Response
11 Agriculture and Natural Resources
12 Energy
13 Public Safety and Security
14 Long-term Community Recovery and Mitigation
15 External Affairs
ESF-8 Functional Areas
Health and Medical
Supplies/Equipment
 To support: general /
medical shelters,
existing medical
facilities & EMS
assets
Assessment of Health
and Medical Needs
 PH infrastructure
 Mental health care
 Hospital, dialysis, and
LTC facilities and
capacity
 EMS
 Home-bound
population
ESF-8 Functional Areas
Evacuation
 Medical ground and
air assets
 Staging
 Facility evacuations
and destinations
 Embarkation/reception
triage/shelter
placement
In-Hospital Care
 Surge Resources
ESF-8 Functional Areas
Medical/PH Care
Personnel
 Deployment teams
and staff
(see handouts)
Health
Surveillance
 General and medical
shelters
 Hospitals, dialysis,
and LTC facilities
 Illness, injuries, and
death
ESF-8 Functional Areas
Food/Drug/Medical
Devices
Mental Health
Services
 Food safety
 Disaster behavioral
 Pharmacy services
health
 Substance abuse
services
 Supplies and
equipment
 O2
ESF-8 Functional Areas
Mortuary Services
PH/Medical
Information
 Victim Identification
 Risk messaging
 Mortuary services
 Worker health and
safety
 EMS
 PH policy and
guidance
ESF-8 Functional Areas
Environmental
Health
Recovery
 Potable water/
 Re-entry of evacuees
wastewater
 Solid waste disposal
 Infrastructure
 Vector control
Emergency Management
Emergency Management
EMS
Fire
Police
Law Enforcement
ESF-8
Requires
Multi-agency
Coordination
ESF-8 Coordination
Local PH Depts
Regional PH Depts
Non-Profit Orgs
Community Based Orgs
Faith Based Orgs
Public Health
RACs
LMHA
Dialysis Centers
Healthcare Providers
Academic Health Centers
Clinics
Nurses
Hospitals
Doctors
Acute Medical Care
Local ESF-8 Resources
 EMS Providers
 Local Public Health Departments
 Healthcare institutions
 Local Mental Health Agencies
 Trauma Regional Advisory Councils (RACs).
 Regional DSHS Offices (Health Service Region)
 Disaster District Committees
Regional Advisory Councils
 22 Regional Advisory Councils in Texas (A-V)
 Coordinating body for a trauma service area (TSA)
 Advancement of healthcare services (trauma,
stroke, pediatric, cardiac care) and disaster
preparedness
 Multi-disciplinary approach of regional
coordination
 Hospitals,
LTAC, EMS, public safety, public health
Trauma
Service
Areas
Correlate with
Regional
Advisory
Councils
(RAC) regions
What can
Regional
Advisory
Councils
do for
you?
Manage
Available
Beds
HPP
Ventilators
PPE Supplies
Pan Flu PPE
Cache
Surge Beds
Bariatric
Cache
Regional DSHS Offices
 11 Health Service Regions
 8 Regional DSHS Headquarters
 Coordination of local, regional, and state public
health partners
 Ensures the provision of public health services to
the community
 Including
during disasters and disease outbreaks
Health
Service
Regions
Anchored
with Regional
DSHS Offices
Disaster District Committees
 Offices (DDCs) that serve as the initial source of
state emergency assistance to local jurisdictions
 Committee Chairman is the local Texas Highway
Patrol (Captain or Lieutenant)
 District Coordinators (formerly RLOs) coordinate
disaster preparedness and response in the region
 Multi-disciplinary response
 Law
enforcement, fire, EMS, emergency management,
transportation, public health and medical
DPS
Regions
Correlate with
Disaster
District
Committee
(DDC) Regions
7
1. Dallas Region
2. Houston Region
3. McAllen Region
4. El Paso Region
5. Lubbock Region
6. San Antonio Region
6.
7 Capital Region
WebEOC & TWIRP
 Web-based Crisis Information Management
System for decision-making before, during,
and after disasters
 Texas WebEOC Interoperability Project (TWIRP)
 Provision
of interoperable communications
 Consistency throughout the state
 Improvement of application from Lessons Learned
Texas ETN
 Texas ETN = Emergency Tracking Network
 Activated by TDEM/DSHS during statewide
emergencies
 Connects 4 disparate standalone systems into
an integrated statewide tracking system
 EMTrack
+ EvacCenter + SNCA + WebEOC
State ESF-8 Resources
 Department of State Health Services (DSHS)
 Lead
agency for ESF-8 coordination in Texas per
Texas Emergency Management Plan, Annex H
 Texas Disaster Medical System (TDMS)
 DSHS Public Health Deployable Teams
 Emergency Medical Task Force (EMTF)
Texas Disaster Medical System
 “Alphabet soup” of Texas ESF-8 Resources
drove the need for a coordinated system
 Formed and funded in 2010
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.
Steering Committee Objectives
Overview –
Strategy
Document
EMTF Oversight
Coordination
Guidance
Training and
Exercise for
Disaster Teams
Medical
Information
Management and
Communication
ESF-8
Coordination
Acute
Care
Public
Health
TDMS
Steering
Committee
ESF-8
Coordination
TDMS Today…
 Gaining knowledge of current planning and
operational groups around the state
 Identifying gaps and overlaps in ESF-8 response
 Educating local jurisdictions about TDMS
 Forming 4 subcommittees
 Resource
Typing, Education, Staffing, Document
 Constructing Overview Document and Strategic
Plan
DSHS PH Deployable Teams
MIST
•Medical Incident Support Team
•Support medical response efforts of the EOC/DDC
RAT
•Rapid Assessment Team
•Assess public health events and available resources
CAT
•Command Assistance Team
•Public Health-centric Incident Management Team
DOG
•Diversified Occupational Group
•Strike team based on public health specialty
DSHS PH Deployable Teams
AST(L)
ASM
CASPER
BHAT
•Ambulance Strike Team (Leader)
•Augment medical transport capacity
•Ambulance Staging Manager
•Oversight of the Ambulance Staging Area Team
•Community Health Assessment for Public Health Response
•Documents population-based needs post-disaster
•Behavioral Health Assistance Team
•Provides crisis counseling, behavioral health resources
DSHS PH Deployable Teams
MBT
•Medical Bus Transport Team
•Coordinate use of medical buses in evacuation
SST
•Shelter Support Team
•Provide admin and PH support to shelters
RSS
•Receiving, Staging, and Storing
•Management and inventory control of SNS assets
DMS
•Disaster Mortality Strike Team
•Provide mortuary and victim identification services
mergency
edical
ask
orce
Need
for
EMTF?
EMTF Response Strategy
 Rapidly deployable for statewide incidents
 Builds upon regional capability
 Integrated command & control elements
 Self-sufficient for 72 hours
 NIMS-compliant
 Modular deployment options
 ASPR-funded strategy for FY11 & FY12
EMTF Structure
 Regional & Statewide Strategic Oversight Group
 Budget,
Strategy, Legal, Policy Issues
 Final Decision-Making Authorities
 Regional & Statewide EMTF TFL/Managers
 Operations,
Protocols, Mission Profile, Equipment,
Position Descriptions, Personnel Management
Emergency Medical Task Force Leadership Team
•Command/General Staff (from EMS agencies/hospitals in local jurisdictions)
•ICS 100, 200, 300, 400, and AHIMT certs, with position specific certs as well
•Must have EMS/ER/IMT management experience
•Full comms package to communicate with all group and Local EOC/DDC/MACC/DSHS/TDEM-SOC
•Logistics package to support all groups
5 Ambulance Strike
Teams
•5 Ambulances in each
Strike Team (25 total
ambulances)
•Each Strike Team has
pre-assigned Strike
Team Leader
•Teams are Prerostered
•10 min launch time for
<12 hr deployment
•4 hour launch time for
minimum for 72 hr
deployment with
additional gear as
needed.
5 RN Strike Teams
2 Ambuses
Mobile Medical Unit
•5 RN’s in each Strike
Team (25 total RN’s)
•Each Team has preassigned Strike Team
Leader
•3 ER Strike Teams
•1 ICU Strike Team
•1 Specialty area (Burn,
OB, Pedi, NICU, etc)
•6 hour launch time for
minimum of 72 hr
deployment
•Ambuses are capable
of transporting up to
20 litter patients at one
time
•Pre-plumbed for O2,
medical gases, etc
•Assigned to EMS
agencies that will
deploy 4-6 paramedics
•10 min launch time for
12 hour deployment
•4 hour launch time for
72 hour deployment
•16-32 bed capacity
•Able to provide
emergency stabilizing
care (23 hrs only)
•Fully staffed with EM
physicians, ER nurses,
techs, logistics, clerical
and other support
•6-12 hour launch time
for 72 hr deployment
•Further typing for
MMT integration is in
progress
Ambulance
Strike Teams
Currently 32
ASTs engaged,
150+ units
 5 Ambulances/AST (25 total)
 Pre-identified teams
 No-notice regional deployment
 Statewide tasked missions
 Common communications
Mobile 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
EMTF
Deployable
Zumro
Capability
AMBUS 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
MPV:
Current
Response
Statewide Response
Within 30 Minutes
MPV:
Current
Response
Statewide Response
Within 1 hour
MPV:
Current
Response
Statewide Response
Within 1.5 hrs
MPV:
Current
Response
Statewide Response
Within 2 hrs
MPV:
Current
Response
Statewide Response
Within 2.5 hrs
What’s in
store for
2012?
MPV:
2012
Response
Statewide Response
Within 30 min
MPV:
2012
Response
Statewide Response
Within 1 hr
MPV:
2012
Response
Statewide Response
Within 1.5 hrs
MPV:
2012
Response
Statewide Response
Within 2 hrs
MPV:
2012
Response
Statewide Response
Within 2.5 hrs
RN 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
Federal ESF-8 Resources
 Department of Health and Human Services,
Office of the Assistant Secretary for
Preparedness and Response (ASPR)
 Lead
Agency for Federal ESF-8 Support
 Supported by 12 Federal agencies and
American Red Cross
National Disaster
Medical System
 Public & Private sector
NDMS
partnership
 Provides medical support to
DoD/VA conflicts overseas
 Supplement state/local
medical resources during
disasters
Major Components
of NDMS
Supported by:
DHHS
Definitive
Care
DHS
VA
DoD
Medical
Response
Patient
Evacuation
NDMS
Regional
& State
Teams
Disaster Medical
Assistance Team
(DMAT)
National Veterinary
Response Team
(NVRT)
Disaster Mortuary
Operations Response
Team (DMORT)
Specialized Teams
(Burns, Peds, Mental
Health, Med/Surg, etc)
DMAT
 35 personnel/team
 Deploy within 6
hours of activation
(14-day deployment)
 Provide emergency
care within 30
minutes of arrival
 Sustain 24-hr ops for
3-days without
external support
DMAT Response Capabilities
Care Provided
Single Team
(D+0)
35 PAX
14 Teams
(D+1)
490 PAX
Treat & Release
(Outpatient Facility)
250
patients/day
3,500
patients/day
Treat & Limited Holding
(Alternate Care Facility)
160
2,250
outpatients/day outpatients/day
112 inpatients
Entire NDMS System
7,000 patients/day
4,500
outpatients/day
224 inpatients
Standard Medical
(Hospital Ward)
50 patients
700 patients
1,400 patients
Holding & Collection
Facility
150 patients
2,100 patients
4,200 patients
50 DMATs Across
the Nation
AK
MN-1
MINNEAPOLIS
AK-1
MI-1
ANCHORAGE
WESTLAND
NY-2
IA-1
WA-1
TOLEDO
DUBUQUE
MN
ND
WA
SEATTLE
DAYTON
MI
SD
OR
EUGENE
ID
WY
HI-1
NV
UT
KS
VT
NH
NY
MD
OH
HI
AZ
OK
ALBUQUERQUE
MO-1
TX
LA
CA-6
SAN
FRANCISCO
RI-1
CT
PROVIDENCE
NC
AL
GA
CT-1
HARTFORD
VA
NJ-1
LYONS
SC
CHATTANOOGA
NY-4
ROCKLAND CO.
NC-1
ST LOUIS
NM
SC-1
FL
AL-1
WINSTON-SALEM
CHARLESTON
GA-4
BIRMINGHAM
AUGUSTA
PR
AL-3
MOBILE
CA-11
SACRAMENTO
CA-2
SAN BERNARDINO
TN-1
MS
NJ
DC
KY
IN
AR
WORCESTER
RI
DE
WV
TN
NM-1
MA-2
MA
PA
NORFOLK
MO
ME
ERIE
YOUNGSTOWN
IL
TULSA
CO
KY-1
IA
BOSTON
PA-3
VA-1
OK-1
CA
WAILUKU,
MAUI
DERRY
OH-6
M
I
NE
PA-2
PITTSBURG
FORT THOMAS
WI
OR-2
PA-1
OH-5
MT
MA-1
VALHALLA
OH-1
CA-1
NV-1
CO-2
TX-1
TX-4
SANTA ANA
LAS VEGAS
DENVER
EL PASO
DALLAS
FL-1
AR-1
PENSACOLA
LITTLE ROCK
TX-3
FL-6
FL-4
LAMARQUE
ORLANDO
JACKONSVILLE
CA-9
LOS ANGELES
CA-4
SAN DIEGO
AZ-1
TUCSON
GA-3
FL-2
RIVERDALE
PORT CHARLOTTE
FL-3
ST PETERSBURG
FL-5
MIAMI
PR-1
SAN JUAN
Mobile Acute Care Strike Team
 18-person MAC-ST deployed with 24 hours of
notification (72 hour deployment)
 Operational within 1 hour of arrival time
 Able to receive six critically ill patients and
provide critical care from handoff from
ambulance personnel  transfer to transport
personnel
NDMS
Response
Teams
50
• Disaster Medical Assistance Teams
11
• Disaster Mortuary Operational Response Tams
3
• National Pharmacy Response Teams
3
• National Nurse Response Teams
3
• National Medical Response Teams
4
• Burn Teams
2
• Pediatric Teams
1
• Crush Medicine Teams
3
• International Medical/Surgical Teams
2
• Mental Health Teams
5
• National Veterinary Response Teams
US Public Health Teams
Incident Support
Teams
Operational Teams
 10 Regional IST
 5 Rapid Deployment
 5 National IST
Force Teams
 5 Applied Public
Health Teams
 5 Mental Health
Teams
 1 National Capital
Region IST
 5 Emergency
Management Group
Support Teams
Aeromedical Evacuation
Definitive Care
Patients
from area
hospitals
Disaster Aerial Staging
Facility (DASF)
At an
Aerial Port of Embarkation
(APOE)
National Disaster Medical System
(NDMS) /Federal Coordinating
Center (FCC)
At
Aerial Port Of Debarkation (APOD)
National Ambulance Contract
 Contracted with FEMA
 Ground Ambulances
 300 ALS/BLS Ambulances (split 70%/30%)
 Air Ambulances
 25 Helicopter and/or Fixed Wing Ambulances
 Para-transit
 Ability to transport 3,500 individuals
 NOT 3,500 vehicles
Federal Coordinating Centers
 Receives patients transported from a disaster
area (or war zone)
 Monitors the status of patients once they are
placed into a medical facility
 Coordinates lodging & fiscal information
 Assists discharged patients in returning home
 Transport those requiring continued care to their
point of origin
FCC Locations
WA
AK
MT
ND
ME
MN
VT
OR
NH
WI
SD
ID
CA
WY
PA
IA
NJ
NE
UT
OH
IL
CO
MO
AZ
OK
NC
TN
MS
DE
VA
KY
AR
Services
MD
WV
IN
KS
65 FCCs coordinate
> 82 receiving areas
Solicit and Organize
Community Support
RI
CT
MI
NV
Network of about
2,000 non-Federal
hospitals
MA
NY
SC
AL
TX
LA
Enroll Non-Federal
Local Hospitals in
NDMS
NM
FL
USVI
Coordinate Bed
Availability
HI
Coordinate with
Local/State
Authorities
GUAM
Army FCC
GA
PR
Navy FCC
Air Force FCC
VA FCC
Strategic National Stockpile
 Provides medicine and medical supplies
 Stored in different locations across the US
 Exact
locations are not made public
 1st push pack available within 12 hours
 Includes vaccines
 Managed by HHS/CDC; Deployed by HHS ASPR
What is NOT Provided by SNS?
 Transportation after received by state agency
 Physical security during state transport
 Pharmaceuticals in “distribution packages”
 They
arrive in bulk packaging
 Special handling of vaccines
 Specialized drug requests (takes additional time)
All functions can be supported by DoD if necessary.
Federal Medical Stations
 DHHS asset, managed by CDC, deployed by ASPR
 Cache of medical supplies and equipment (no
personnel)
 Temporary non-acute medical care facility
 Requires building (no tents are provided)
 Inventory = 60+
 Provides temporary shelter support for medically
fragile, non-hospitalized patients.
DoD Deployable Medical Treatment Facilities
Army
Air Force
• Combat Support
Hospital
• Large and Heavy
• Level III care
• Expeditionary
Medical Support
• Light and lean
• Needs Base
Operating
Support
• Modular
Navy
• Comfort/Mercy
(Level III care)
• Other ships of
opportunity (up
to level III care)
ESF-8:
The Spectrum of Care & Federal Medical Resources
Volunteers
NDMS DMORT
NDMS Hospitals
NDMS DMATs
USPHS RDF
Medical Reserve Corps
USPHS MHT
USPHS APHT
Individual Resources
Food /
Water
Safety
Basic
First Aid
Drug /
Blood
Safety
Health
Surveillance
Mental
Health
Outpatient
Care
Pre-hospital
Care
Emergency
Departments
Nursing
Home
Care
Hospital
Inpatient
Care
ICU/
Trauma
Critical
Care
Fatalities
Management
When Disaster
Strikes…
 Follow the standard resource
How do I
get these
resources?
request procedure
 Otherwise
reimbursement will be
challenging if not impossible
 Describe your needs and
request functions rather than
specific teams
 Understand that there will be a
delay – deployments take time
Resource Request Flow
ALL incidents
begin and
end LOCALLY
Local
Resources
Mutual Aid
Agreements
DDC
RMOC
SOC
SMOC
TFS
EMAC
FEMA
DDC
State
Operations
Center (SOC)
ESF-2
ESF-8 liaison
County / Regional MOC (RMOC)
requests State assistance for PH&M
resources through DDC
ESF-6
ESF-11
ESF-8 Lead Agency
DSHS
State Medical
Operations Center
(SMOC)
RMOC
EMTF
coordinator
Local area requests assistance
from county or RMOC
Local area requests
mutual aid assistance
from surrounding areas
Mutual Aid
not available
Other PH/M
Resource
City/County EOC
Local area runs out of PH&M resources
Disaster
Access to State
ESF-8 Resources
Access to HHS ESF-8 Resources
Locals request support
State determines need and submits Action Request Form (ARF)
FEMA and ESF-8 Lead evaluate need
FEMA generates Mission Assignment (MA)
ESF-8 determines best resource to meet need
State of Texas Assistance Request
 Less complicated than its predecessors
 Fast, easy-to-use interface
 Statewide consistency and interoperability
 Able to request resources, information, and
missions
 Updates visible from all levels
 Does not change request protocol
 Local
 State  Federal
Wrap-Up
 Regionally, statewide, and federally – we have
A LOT of available ESF-8 resources
 By understanding what is available, you can
better prepare your jurisdiction
 Know the proper procedure for requesting
these resources