The Role of the Federal Medical Station _FMS_ in Disaster Response

The+Role+of+the+Federal+Medical+Station+(FMS)+in+Disaster+Response%0d%0aLessons+Learned+from+Hurricanes+Katrina+and+Rita%0d%0aEric+Trabert+June+26%2c+2006%0d%0a%0d%0a%0cBackground%0d%0a%e2%80%a2+HHS+asked+CNA+to+conduct+an+After+Action+Review+of+FMS+operations+during+Hurricanes+Katrina+and+Rita%0d%0a%e2%80%93+Capture+best+demonstrated+practices+%e2%80%93+Identify+challenges+and+issues+%e2%80%93+Offer+recommendations+for+improvement%0d%0a%0d%0a%e2%80%a2+Analysts+deployed+to+LA+and+TX+to+observe+and+document+FMS+operations%0d%0a%0d%0a%0cInitial+Development+of+the+FMS%0d%0a%e2%80%a2+In+2004%2c+HHS+(with+DHS)+began+developing+a+Federal-level+contingency+care+program+to+address+medical+surge+issues+%e2%80%a2+3+%e2%80%9ctypes%e2%80%9d+of+platforms+under+consideration%0d%0a%e2%80%93+Type+1%3a+transportable+field+hospital+(lead%3a+DHS)+%e2%80%93+Type+2%3a+advanced+care+for+specific+clinical+scenarios+(e.g.%2c+burn+care)+%e2%80%93+Type+3%3a+quarantine+and%2for+non-acute+bed+surge%0d%0a%0d%0a%0cConfiguration+of+a+Type+3%2c+250-bed+FMS%0d%0aBase+support+with+quarantine%0d%0a%e2%80%a2Administration+%e2%80%a2Support+%e2%80%a2Feeding+%e2%80%a2Quarantine+%e2%80%a2Beds+(50x5)+%e2%80%a2Housekeeping+%e2%80%a2First+aid+equipment+%e2%80%a2Pediatric+care+%e2%80%a2Adult+care+%e2%80%a2Personal+protective+equipment+(PPE)%0d%0a%0d%0aNon-acute+care+treatment%0d%0a%e2%80%a2Primary+care+%e2%80%a2Non-acute+treatment+%e2%80%a2Special+needs%0d%0a%0d%0aPharmacy%0d%0a%0d%0a%e2%80%a2Antibiotics+%e2%80%a2Primary+care+meds+%e2%80%a2Prophylaxis%0d%0a%0d%0a72+hours+of+supplies+per+250-bed+FMS%0d%0a%0d%0a%0c%0cSampling+of+State%2flocal+Requirements%0d%0a%e2%80%a2+Building+of+opportunity%3a+40K+sq+ft+enclosed+space+(per+250+beds)%0d%0a%e2%80%93+%e2%80%93+Electrical+power+source+and+distribution+Communications+support%0d%0a%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2%0d%0a%0d%0aPerimeter+security+Waste+removal%2c+medical+waste+disposal%2c+laundry+Potable+water%2c+ice%2c+refrigeration%2c+food+service+for+patients+%26+staff+Latrines%2fshowers+Local+transportation+Billeting+for+150+personnel+per+FMS+Access+to+civilian+medical+personnel+and+contractors+employed+in+patient+care%2c+patient+transportation%2c+and+other+supportive+services%0d%0a%0d%0a%0cFMS+Operations+During+Katrina+and+Rita%0d%0a%e2%80%a2+FMS+resources+were+used+in+a+variety+of+ways%3a%0d%0a%e2%80%93+Support+to+State-run+field+hospitals+or+Special+Needs+Shelters+with+equipment%2c+supplies%2c+and+personnel+%e2%80%93+Function+as+a+stand-alone%2c+federally-operated+FMS+%e2%80%93+Augment+mobile+medical+facilities+with+supplies%0d%0a%0d%0a%e2%80%a2+Approximately+5%2c500+FMS+beds+were+deployed+in+total%0d%0a%e2%80%93+Provided+care+primarily+for+people+suffering+from+exacerbation+of+chronic+disease+and%2for+behavioral+health+conditions%0d%0a%0d%0a%0cPrevalence+of+Medical+and+BH+Conditions%0d%0aBH+only+4%25+Medical+and+BH+26%25%0d%0a%0d%0aFamily%2fNo+Issues+8%25+Medical+only+62%25%0d%0a%0d%0aN%3d380%0d%0a%0d%0a%0cCommon+Conditions+Among+FMS+Patients%0d%0aCondition%0d%0aBehavioral+health+Diabetes%0d%0aRespiratory+disease+Hypertension+Orthopedic+Gastrointestinal+Medical+O2+dependent%0d%0a%0d%0a%25+affected+(n%3d380)%0d%0a31.8+27.4%0d%0a24.7+22.9+17.6+9.7+6.1%0d%0a%0d%0a%0cCommon+Behavioral+Health+(BH)+Conditions%0d%0aCondition%0d%0aDepression+Anxiety+Schizophrenia%2fPsychosis+Bipolar%0d%0a%0d%0a%25+affected+(n%3d121)%0d%0a29.0+24.8+20.7+14.0%0d%0a%0d%0aAlzheimer%e2%80%99s%2fdementia%0d%0a%0d%0a10.7%0d%0a%0d%0a%0cKey+Lessons+Learned+from+Katrina+and+Rita%0d%0a%e2%80%a2+Lack+of+familiarity+with+the+FMS+and+standing+up+the+assets+too+far+away+from+patients+contributed+to+underutilization%2c+especially+during+Katrina+%e2%80%a2+Operating+requirements+were+extensive+and+field+logistical+support+took+a+long+time+to+put+in+place%0d%0a%e2%80%93+Buildings+of+opportunity+were+scarce+%e2%80%93+Support+contracts+took+a+long+time+to+arrange+%e2%80%93+No+procedures+for+procuring+items+in+the+field%0d%0a%0d%0a%0cKey+Lessons+Learned%0d%0a%e2%80%a2+Patient+population+was+not+consistent+with+what+the+FMS+was+originally+designed+to+handle%0d%0a%e2%80%93+Treatment+and+pharmacy+modules+were+not+well+equipped+for+patients+with+behavioral+health+and+common+chronic+conditions%0d%0a%0d%0a%e2%80%a2+Skill+mix+of+the+FMS+staff+was+not+well+matched+to+the+types+of+patients+seen%0d%0a%e2%80%93+Fewer+physicians+and+more+nurse+assistants%2c+mental+health+and+social+services+providers%2c+and+general+support+staff+were+needed%0d%0a%0d%0a%0cCurrent+Status+of+the+FMS+for+2006%0d%0a%e2%80%a2+HHS+has+moved+away+from+the+3+%e2%80%9ctype%e2%80%9d+approach%0d%0a%e2%80%93+FMS+will+serve+as+a+base+platform+that+can+be+augmented+modularly+based+on+patient+need%0d%0a%0d%0a%e2%80%a2+Major+revisions+to+the+pharmaceutical+and+materiel+modules+to+better+care+for+common+chronic+diseases+and+behavioral+health+conditions+%e2%80%93+much+more+all-hazards+%e2%80%a2+Creation+of+multidisciplinary%2c+rapidly+deployable+Public+Health+Service+teams+to+staff+FMS%0d%0a%e2%80%93+Organic+command+and+control+structure+based+on+ICS+%e2%80%93+Team+training+with+the+FMS+modules%0d%0a%0d%0a%0cUpdated+FMS+Mission+Statement%0d%0a%e2%80%a2+An+FMS+will+provide+scalable+(in+size)%2c+modular%2c+and+rapidly+deployable+health+and+medical+care+to+people+with%3a%0d%0a%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+Non-acute+medical%2c+mental+health%2c+or+other+health-related+needs+that+cannot+be+accommodated+or+provided+for+in+a+general+shelter+Conditions+that+require+observation%2c+assessment%2c+or+maintenance+Chronic+conditions+that+require+assistance+with+activities+of+daily+living+but+do+not+require+hospitalization+Medication+needs+and+vital+sign+monitoring+and+who+are+unable+to+do+so+at+home%0d%0a%0d%0aAn+FMS+is+not+an+acute+care+hospital%2c+nursing+home%2c+or+emergency+department%0d%0a%0d%0a%0cSpectrum+of+Care+and+Federal+Medical+Resources%0d%0aVolunteers+NDMS+Hospitals+DMATs+VA%2fDoD+U.S.+Public+Health+Service+Medical+Reserve+Corps+ARC+Shelter+Federal+Medical+Stations%0d%0a%0d%0aBasic+First+Aid%0d%0a%0d%0aOutpatient+Care%0d%0aPre-hospital+Care+Nursing+Home+Care%0d%0a%0d%0aEmergency+Departments%0d%0a%0d%0aICU%2fTrauma+Critical+Care%0d%0a%0d%0aHospital+Inpatient+Care%0d%0a%0d%0aSlide+courtesy+of+the+Office+of+Mass+Casualty+Planning%2c+HHS%0d%0a%0d%0a%0c