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					  The Role of the Federal Medical
Station (FMS) in Disaster Response

  Lessons Learned from Hurricanes
          Katrina and Rita

             Eric Trabert

            June 26, 2006
                 Background
• HHS asked CNA to conduct an After Action
  Review of FMS operations during Hurricanes
  Katrina and Rita
  – Capture best demonstrated practices
  – Identify challenges and issues
  – Offer recommendations for improvement
• Analysts deployed to LA and TX to observe
  and document FMS operations
    Initial Development of the FMS
• In 2004, HHS (with DHS) began developing
  a Federal-level contingency care program to
  address medical surge issues
• 3 “types” of platforms under consideration
  – Type 1: transportable field hospital (lead: DHS)
  – Type 2: advanced care for specific clinical
              scenarios (e.g., burn care)
  – Type 3: quarantine and/or non-acute bed
              surge
   Configuration of a Type 3, 250-bed FMS
   Base support                 Non-acute care
                                                           Pharmacy
  with quarantine                 treatment

•Administration                •Primary care          •Antibiotics
•Support                       •Non-acute treatment   •Primary care meds
•Feeding                       •Special needs         •Prophylaxis
•Quarantine
•Beds (50x5)
•Housekeeping
•First aid equipment
•Pediatric care
•Adult care
•Personal protective
equipment (PPE)
                       72 hours of supplies per 250-bed FMS
     Sampling of State/local Requirements
• Building of opportunity: 40K sq ft enclosed space (per 250 beds)
    –   Electrical power source and distribution
    –   Communications support
•   Perimeter security
•   Waste removal, medical waste disposal, laundry
•   Potable water, ice, refrigeration, food service for patients & staff
•   Latrines/showers
•   Local transportation
•   Billeting for 150 personnel per FMS
•   Access to civilian medical personnel and contractors employed in
    patient care, patient transportation, and other supportive services
 FMS Operations During Katrina and Rita
• FMS resources were used in a variety of ways:
  – Support to State-run field hospitals or Special Needs
    Shelters with equipment, supplies, and personnel
  – Function as a stand-alone, federally-operated FMS
  – Augment mobile medical facilities with supplies
• Approximately 5,500 FMS beds were deployed in total
  – Provided care primarily for people suffering from
    exacerbation of chronic disease and/or behavioral
    health conditions
Prevalence of Medical and BH Conditions
                         BH only
                           4%      Medical and
                                     BH 26%




                                             Family/No
                                               Issues
                                                 8%
          Medical only
              62%



                           N=380
Common Conditions Among FMS Patients

         Condition       % affected (n=380)
  Behavioral health             31.8
  Diabetes                      27.4
  Respiratory disease           24.7
  Hypertension                  22.9
  Orthopedic                    17.6
  Gastrointestinal              9.7
  Medical O2 dependent          6.1
Common Behavioral Health (BH) Conditions
              Condition       % affected (n=121)
    Depression                       29.0

    Anxiety                          24.8

    Schizophrenia/Psychosis          20.7

    Bipolar                          14.0

    Alzheimer’s/dementia             10.7
Key Lessons Learned from Katrina and Rita
• Lack of familiarity with the FMS and standing up
  the assets too far away from patients contributed
  to underutilization, especially during Katrina
• Operating requirements were extensive and field
  logistical support took a long time to put in place
   – Buildings of opportunity were scarce
   – Support contracts took a long time to arrange
   – No procedures for procuring items in the field
             Key Lessons Learned

• Patient population was not consistent with what
  the FMS was originally designed to handle
  – Treatment and pharmacy modules were not well
    equipped for patients with behavioral health and
    common chronic conditions
• Skill mix of the FMS staff was not well matched to
  the types of patients seen
  – Fewer physicians and more nurse assistants, mental
    health and social services providers, and general
    support staff were needed
     Current Status of the FMS for 2006
• HHS has moved away from the 3 “type” approach
  – FMS will serve as a base platform that can be
    augmented modularly based on patient need
• Major revisions to the pharmaceutical and materiel
  modules to better care for common chronic
  diseases and behavioral health conditions – much
  more all-hazards
• Creation of multidisciplinary, rapidly deployable
  Public Health Service teams to staff FMS
  – Organic command and control structure based on ICS
  – Team training with the FMS modules
        Updated FMS Mission Statement
• An FMS will provide scalable (in size), modular, and rapidly
  deployable health and medical care to people with:
   –   Non-acute medical, mental health, or other health-related needs
       that cannot be accommodated or provided for in a general shelter
   –   Conditions that require observation, assessment, 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

       An FMS is not an acute care hospital, nursing
             home, or emergency department
   Spectrum of Care and Federal Medical Resources
                                                  Volunteers

                                                                               NDMS Hospitals


                                                                                 DMATs
                                                               VA/DoD

                                                  U.S. Public Health Service

                    Medical Reserve Corps

                                      Federal Medical Stations
          ARC Shelter



        Basic First Aid                  Outpatient               Emergency                 ICU/Trauma
                                           Care                   Departments               Critical Care
                          Pre-hospital                 Nursing                    Hospital
                              Care                    Home Care                Inpatient Care


Slide courtesy of the Office of Mass Casualty Planning, HHS

				
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