Command and Control
Joseph A. Barone, Pharm.D., FCCP
Professor and Chair
Dept. of Pharmacy Practice &
Administration
Ernest Mario School of Pharmacy
“Command and Control”
Acknowledgements
Mr. David Gruber,
Sr. Deputy Commissioner
NJ DHSS
Ernest Mario School of
Pharmacy
“Command and Control”
Outline
•
•
•
•
•
•
Command and Control Concepts
National Level
New Jersey Level
New Jersey Innovations
Future Challenges
Conclusion
Ernest Mario School of
Pharmacy
“Command and Control”
Everybody’s Example
• Katrina
Ernest Mario School of
Pharmacy
“Command and Control”
Command and Control Concepts
• There is no one concept that fits all
• CC is a fluid state
• Applications from the military don’t always fit
non-military applications, but are pretty good
• CC has exciting health care possibilities
• CC offers opportunities for pharmacists
Ernest Mario School of
Pharmacy
“Command and Control”
National Level
• National Incident Management System (NIMS)
– Flexible
– Standardized
Ernest Mario School of
Pharmacy
“Command and Control”
National Incident Management System
Components
•
•
•
•
•
•
Command and Management
Preparedness
Resource Management
Communication and Information Management
Supporting Technologies
Ongoing Management and Maintenance
Ernest Mario School of
Pharmacy
“Command and Control”
Command and Management
• Incident Command System
• Multiagency Coordinating Systems
• Public Information Systems
Ernest Mario School of
Pharmacy
“Command and Control”
Preparedness
•
•
•
•
•
•
•
Planning
Training
Exercises
Personnel qualification and certification
Equipment qualification and certification
Mutual aid
Publication management
Ernest Mario School of
Pharmacy
“Command and Control”
Communications and Information
Management
• Incident management communications
• Information management
Ernest Mario School of
Pharmacy
“Command and Control”
Incident Command System
• Standardized on-scene incident management
concept
• Allows responders to adopt an integrated
organizational structure equal to the severity of
single or multiple incidents
• Not hindered by jurisdictional boundaries
Ernest Mario School of
Pharmacy
“Command and Control”
Incident Command System
• ICS emergency response functions
– Command (incident commander/unified
command)
– Operations
– Planning
– Logistics
– Finance and administration
Ernest Mario School of
Pharmacy
“Command and Control”
Incident Commander
•
•
•
•
•
•
Responsible for all aspects of the response
Establish immediate priorities
Stabilize the incident
Determine objectives and strategy
Monitor incident organization
Ensure health and safety
Ernest Mario School of
Pharmacy
“Command and Control”
Joint Medical Command and Control
(JMCC)
• Natural disasters usually require DoD medical
assistance
• Command operations
• Medical homeland defense planning and
response
• JMCC intended for natural disasters and
CBRNE
Ernest Mario School of
Pharmacy
“Command and Control”
Joint Medical Command and Control
(JMCC)
• Technology is usually not most difficult aspect
• Challenge is understanding agency-specific
processes and needs of medical planners
• “Air Force Portal” under development
• Goal is to increase situational awareness of
resources near the event
Ernest Mario School of
Pharmacy
“Command and Control”
“Air Force Portal”
• Use existing infrastructure and technology
• Assimilate information from various sources
(people, supplies, civilian assets/hospitals)
• Distribute information to medical planners in a
virtual environment
• Modifiable data links (ie. weather for evacuation)
• Other military portals coming on line
• Other commercial platforms available
Ernest Mario School of
Pharmacy
“Command and Control”
“Network-Centric” Emergency
Response
• Driven by technology
• Rapid collection, transfer, and dissemination of
information
• Arises from network-centric warfare
Ernest Mario School of
Pharmacy
“Command and Control”
Emergency Response vs. Military CC
• Differences in mission and training
• Different skills sets and expertise between
emergency responders and military personnel
• Similar need to establish CC and build situational
awareness in a changing and hostile environment
Ernest Mario School of
Pharmacy
“Command and Control”
Network-Centric Challenges
•
•
•
•
•
•
•
Figure out what information you need
Train the decision makers
Train emergency personnel
Train organizations
PRACTICE
ASSESS
PRACTICE SOME MORE
Ernest Mario School of
Pharmacy
“Command and Control”
Network-Centric Challenges
•
•
•
•
Information overload
Data masquerading as information
Unfiltered information
Conflict with CC hierarchy
– Excessive control from above
– Uncontrolled improvisation below
• Unnecessary networking
Ernest Mario School of
Pharmacy
“Command and Control”
National Level
Ernest Mario School of
Pharmacy
“Command and Control”
Ernest Mario School of
Pharmacy
“Command and Control”
Ernest Mario School of
Pharmacy
“Command and Control”
New Jersey Level
Ernest Mario School of
Pharmacy
“Command and Control”
Pharmacist Assets
•
•
•
•
T3 model of pharmacist involvement
Planning, execution, and after action analysis
Participation in CC at many levels
Planning and participating in Strategic National
(and local) Stockpile exercises
• Identifying and designing processes for
safe,effective, and efficient medication
distribution
Ernest Mario School of
Pharmacy
“Command and Control”
Pharmacist Assets
• Staffing POD’s
• Contribute to disaster response planning
• Design medication prophylaxis and treatment
protocols
Ernest Mario School of
Pharmacy
“Command and Control”
Health Infrastructure Preparedness &
Emergency Response Program
Public Health
Region Team
Emergency
Management
Ernest Mario School of
Pharmacy
Healthcare Delivery
System
“Command and Control”
New Jersey’s Health System
• 8.7 million people
• 566 municipalities
• 114 local health
departments
• 21 counties
• 22 lead health agencies
• 5 planning regions
• 81 acute care hospitals
• 9 Medical Coordination
Centers
• 1 Health Command Center
Ernest Mario School of
Pharmacy
“Command and Control”
Health System Command, Control and Communications
DHSS
HCO&A
Public
Ernest Mario School of
Pharmacy
Govt. Agencies
“Command and Control”
Horizontal and Vertical Integration
• Entities outside New Jersey
– Federal DHHS (CDC)
– DHS, FEMA
• NJ State Agencies
– Governor’s office
– Domestic Security Preparedness Taskforce
• Health Care Organizations
• Local and County Public Health Agencies
• Hospitals and Health Care Providers
Ernest Mario School of
Pharmacy
“Command and Control”
Federal and National Collaboration
•Centers for Disease Control and Prevention (CDC)
•Health Resource Services Administration (HRSA)
•Federal Emergency Management Agency (FEMA)
•United States Public Health Service (USPHS)
•Department of Homeland Security (DHS)
•Department of Justice (DOJ)
•Association of State and Territorial Health Officials
(ASTHO)
•National Association of County City Health Officials
(NACCHO)
Ernest Mario School of
Pharmacy
“Command and Control”
Interstate Collaboration
•Mid-Atlantic Public Health Preparedness
Conference (NJ, PA, MD, DE)
•Metro Planning Workgroup (NJ, NYC, NY, CT)
•Executive level preparedness and response
meetings
Top areas of discussion:
Surge capacity
Communications
Credentialing
Ernest Mario School of
Pharmacy
“Command and Control”
REGIONALIZATION
Why:
•Pre-event administration
•State/local linkage
•Event management
Focused operations
Coordination of resources
Increased surge capacity
Who:
•DHSS Regional Coordination Teams
•Emergency Management (MCCs)
•Public Health
•Health care delivery
Ernest Mario School of
Pharmacy
How:
•Population
•Capability
•Geography
“Command and Control”
Ernest Mario School of
Pharmacy
“Command and Control”
Regionalization
Preparedness
County Health
Local Health
Public Health
Local Health
Primary
Care
Emergency
Management
Local OEM
Local OEM
County OEM
Ernest Mario School of
Pharmacy
Hospital
Region Teams
Hospital
Regional Coordinator
MCCs
Health System Liaison
Exercise Coordinator
EMS Liaison
Local Planners
Long Term
Care
Healthcare Delivery
System
“Command and Control”
NJ EMS Task Force
EMS Task Force
Concept
EMS Task Force 1
Public Health Regions 1 & 2
UASI
•A DHSS/DSPTF Effort
•UASI, ODP and MEDPREP Funded
•DHSS asset/coordinated with OEM
EMS Task Force 2
Public Health Regions 3 & 4
ODP
EMS Task Force 3
Public Health Region 5
MEDPREP
Ernest Mario School of
Pharmacy
“Command and Control”
Federal/state
DHSS Command and Control– federal, state and local partners
Joint Operations Center (JOC)/ Joint Field Office (JFO)
Federal
•DHS, FBI, DHHS, CDC
NJDHSS
•Health Command Center (HCC)
•Receipt/Stage/Storage Site (RSS)
•Emergency Communication
Center (ECC)
Local
State
State
•Attorney General’s Office, NJDHSS, OEM
Acute care hospitals
Ernest Mario School of
Pharmacy
State Police Office of Emergency
Management (OEM)
•Emergency Operations Center (EOC)
County OEMs
Local health departments
“Command and Control”
New Jersey Developments
Ernest Mario School of
Pharmacy
“Command and Control”
New Jersey Developments
• MEDPREP
• HEPAC
• HIPPOCRATES
Ernest Mario School of
Pharmacy
Hippocrates
New Jersey’s Health System Situational Awareness
Application
“Command and Control”
New Jersey’s Health Emergency
Response System
NJDHSS HCC
HACC
Statewide
Emergency
Management
System
MCC
MCC
MCC
MCC
MCC
Regional Medical
Coordination
Center
Hospital
State Regional Team
FQHC
MCC
Ernest Mario School of
Pharmacy
Other Health Entities
“Command and Control”
What is Hippocrates ?
• Situational awareness application
(routine/emergent)
• Integrated, web-based suite accessible anywhere,
anytime
• Health infrastructure preparedness and
emergency response information
• Displays real-time data for informed decisionmaking during a health emergency
• Customized access so individuals or groups see
only what they need
• Developed and owned by NJ DHSS
Ernest Mario School of
Pharmacy
“Command and Control”
Preparedness and Hippocrates
Health Infrastructure
Preparedness and
Emergency Response
HIPPOCRATES
Ernest Mario School of
Pharmacy
“Command and Control”
Application Development
• Initiated development in 2003
• Piloted during TOPOFF 3 in April 2005
– Identified additional requirements
• Seamless integration of additional health applications
• Increased map area
• New functions such as search
• Bi-directional Email communication and document
sharing
• Additional reporting and summary statistics
• New opportunities for advanced analysis
• Refined Version 1.0 requirements in Fall 2005
• User Acceptance Testing in Summer 2006
• Launched Version 1.0 in December 2006
• More rollouts occurring now
Ernest Mario School of
Pharmacy
“Command and Control”
Dynamic Data Integration
Incidents
Events
Weather/Traffic
HIPPOCRATES
Medical Stockpile
SitStat Surveys
Ernest Mario School of
Pharmacy
HEALTH LAYERS
Post Offices
Schools
Roads
Municipalities
Counties
Surrounding State Counties
Ambulance Locations
BASE MAP LAYERS
REAL-TIME FEEDS
Hospital Divert Status
“Command and Control”
Future Challenges
Ernest Mario School of
Pharmacy
“Command and Control”
Overarching Goals
• Allow planners and responders to work together to
prepare and respond
• Activities should occur without regard to agency or
geography
• Various platforms and portals will need to work
together
Ernest Mario School of
Pharmacy
“Command and Control”
The Horizon
•
•
•
•
•
•
CBRNE event
Influenza pandemic
SARS-like
GPS on/in individual users
Handling mass fatalities
Legal issues in community containment measures
Ernest Mario School of
Pharmacy
“Command and Control”
Exercise Vigilant Shield ‘08
•
•
•
•
Part of TOPOFF 4
United States Northern Command
NORAD
Aerospace detection and defense events across
the venues of Oregon, Arizona, and Guam
• Will exercise aerospace defense, aerospace
control, maritime warning, and coordination of air
operations in a disaster
Ernest Mario School of
Pharmacy
“Command and Control”
TOPOFF-4
• 15,000 participants
• Prevention exercise - law enforcement and
intelligence communities
• HHS - radiologic emergency public health issues
• DoD - global terror threat mitigation
Ernest Mario School of
Pharmacy
“Command and Control”
TOPOFF-4 Scenario
•
•
•
•
Coordinated “dirty bomb” detonations
Guam, first, near a power plant
Portland and Phoenix
Will stress rescue, health, and long-term
decontamination
• N.B. - “Real weapons will not be used in the
scenario…”
Ernest Mario School of
Pharmacy
“Command and Control”
Conclusion
• CC is constantly evolving
• Coordination among national, state, and local
assets is a daunting task
• New Jersey is at the forefront of many
preparedness initiatives
• Pharmacists can provide value at many levels
• Future challenges will involve the event and
coordination of information and assets
Ernest Mario School of
Pharmacy
“Command and Control”
Remember
• It has been 6 years since 9/11
• There is still a need to continually stress and
exercise the medical response systems.
• Pharmacists should involve themselves in the
many aspects of readiness training and thereby
contribute to overall preparedness.
Ernest Mario School of
Pharmacy
“Command and Control”
Resources
• www.dhs.gov - TOPOFF 4, National Incident Management
System
• www.osha.gov - incident command
• www.northcom.mil - Exercise Vigilant Shield
• LtCol Mark Stanovich,USMCR. “Network-Centric” Emergency
Response: The Challenges of Training for a New Command
and Control Paradigm, Institute for Security Technology
Studies, Dartmouth College
Ernest Mario School of
Pharmacy
“Command and Control”
Resources
• www.cdc.gov
• www.state.nj.us/health - New Jersey
preparedness activities
• http://integrator.hanscom.af.mil/2006/Feb
– Joint Medical Command and Control
Ernest Mario School of
Pharmacy