The State of Texas The State of Texas Disaster Medical System – Disaster Medical System – An Overview of TDMS and An Overview of TDMS and ESF-8 Coordination ESF-8 Coordination Bruce Clements, MPH Bruce Clements, MPH Director, Community Preparedness Section Director, Community Preparedness Section Texas Dept of State Health Services Texas Dept of State Health Services Rick Bays Rick Bays Director, Response and Recovery Unit Director, Response and Recovery Unit Texas Department of State Health Services Texas Department of State Health Services Emily Kidd, MD Emily Kidd, MD Assistant Professor, UT Health Science Center San Assistant Professor, UT Health Science Center San Antonio Antonio Project Director – Texas Disaster Medical System Project Director – Texas Disaster Medical System
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The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination
The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination. Bruce Clements, MPH Director, Community Preparedness Section Texas Dept of State Health Services Rick Bays Director, Response and Recovery Unit Texas Department of State Health Services Emily Kidd, MD - PowerPoint PPT Presentation
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The State of Texas The State of Texas Disaster Medical System – Disaster Medical System – An Overview of TDMS and An Overview of TDMS and
Director, Community Preparedness SectionDirector, Community Preparedness SectionTexas Dept of State Health ServicesTexas Dept of State Health Services
Rick BaysRick BaysDirector, Response and Recovery UnitDirector, Response and Recovery Unit
Texas Department of State Health ServicesTexas Department of State Health Services
Emily Kidd, MDEmily Kidd, MDAssistant Professor, UT Health Science Center San AntonioAssistant Professor, UT Health Science Center San Antonio
Project Director – Texas Disaster Medical SystemProject Director – Texas Disaster Medical System
TDMS UpdateTDMS Update
Emergency Support Function 8, Emergency Support Function 8, Public-Private PartnershipPublic-Private Partnership
ESF-8 Capacity
National Preparedness StrategiesNational Preparedness Strategies
• Public health and healthcare preparedness is part of a national preparedness strategy
• Presidential Policy Directive 8: National Preparedness– “…aimed at strengthening the security and resilience
of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber attacks, pandemics, and catastrophic natural disasters.”
– “…aimed at facilitating an integrated, all-of-Nation, capabilities-based approach to preparedness.”
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Vision and Strategy AlignmentVision and Strategy Alignment
National Health Security Strategy
(NHSS)
National Preparedness GoalCore Capability List
Pandemic and All-Hazards Preparedness Act
(PAHPA)
Homeland Security Presidential Directives
Public Health and Healthcare Preparedness Capability Development
OPHPR Strategic Plan
Trust for America’s HealthReady or Not
Project PublicHealth Ready
Conceptualizing and Defining Public Health
Emergency Preparedness
Health PreparednessCapability Prioritization
Project
* Note: Partner documents are not an exhaustive list, shown for representation purposes only
13Public Health Surveillance and Epidemiological Investigation
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14 Responder Safety and Health 14 Responder Safety and Health
15 Volunteer Management 15 Volunteer Management
Public Health and Healthcare Public Health and Healthcare Preparedness CapabilitiesPreparedness Capabilities
• Consistent with national preparedness strategies
• Capabilities-based planning and implementation
• Provides national guidance with a “whole of community” and “all of nation” approach
• Serve as the foundation for the 2012 HPP-PHEP cooperative agreements
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• Acute Healthcare and Public Health• Two sets of distinct functions that strongly
influence each other• They can stand alone but are much
stronger together• Can’t be too close
– Complete integration is not possible (placing acute care in public health or vice versa)
• Can’t be too far apart– They strongly influence each other
Illustrating and Communicating Illustrating and Communicating ESF-8 ComplexityESF-8 Complexity
ESF-8 Coordination: The KeystoneESF-8 Coordination: The Keystone
Collaboration of public health and acute medical
care preparedness
ResourcesResources
Spectrum of Resources
– Equipment (e.g. AMBUS)
– Equipment with Crew (e.g. Mobile Medical Unit)
– Teams with Equipment (e.g. Ambulance Strike Teams)
– Persons with Skills (e.g. Physicians, Epidemiologists)
TDMS Resource Typing and CredentialingTDMS Resource Typing and Credentialing
RESOURCE TYPE– External attributes that
are obvious• Measurable• Countable• “Things”• Unlikely to change
– Quantitative - Descriptive Definition
– “Equipment” or “Teams”
CREDENTIAL–Internal attributes that are not obvious
• Skills• Knowledge• Ability• Can to be transitory
– Vetted Identity– Badge to combine Identity and Attributes
– “Persons”
TDMS ProcessTDMS Process
EVALUATE/ IMPROVE
PLAN
ORGANIZE/ EQUIP
EXERCISE
TRAIN
• Collaborative planning • Response hierarchy
coordination• Role and responsibility
clarification• Sequencing response
actions• Focusing resources on
risks• Defining resources and
support• Improvement processes
The TDMS process is a forum for collaborative planning for healthcare and public health stakeholders to refine preparedness and response
TDMS – Texas Disaster TDMS – Texas Disaster Medical SystemMedical System
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.
Courtesy TDEM Website
Where does TDMS get its Where does TDMS get its authority?authority?
The Texas Disaster Medical System (TDMS) Steering Committee was established under the direction of the Texas Department of State Health Services (DSHS) in 2010. DSHS is the lead agency for Emergency Support Function (EDF)-8 (Public Health & Medical Services) per the state of Texas Emergency Management plan, Annex H, Texas Government Code §§ 418.042, 418.043(13), and 418.173(a).
TDMS Steering CommitteeTDMS Steering Committee
Public Health
Acute Care
TDMS Steering Committee
Who is represented on the TDMS Who is represented on the TDMS Steering Committee?Steering Committee?
• Local Public Health Authorities• Local Health Departments• Regional Public Health Authorities• Regional Health Departments (HSRs)• Texas Department of State Health Services• Trauma Service Areas / Regional Advisory Councils• Hospitals and the Texas Hospital Association• Hospital Emergency Management• Academic Medicine• EMS Agencies – Rural, Urban, & Fire-based• Texas Division of Emergency Management
Issues / gaps identified (so far….)Issues / gaps identified (so far….)• Need for standardized training curricula and
schedules for almost every response / resource group
• Overlap of emergency response personnel on multiple team rosters
• Coordination with Texas Military Forces resources
• Funding responsibilities • Liability coverage of medical response personnel• Continuation of funding of teams/assets• Our role in medical component of mass-care
sheltering• FNSS integration into plans and operations• Integration with federal response systems
(timing, resource typing, availability, etc.)• Mass Fatality planning
• Integration of Medical Operations Centers into TDEM organizational chart
• Medical Operations Centers functions and purpose
• Integration of MOCs across the State
TDMS Overview DocumentTDMS Overview Document• Strategic framework and
resource guide for P.H. and medical response and recovery
• Guidelines, protocols, concepts, tasks, responsibilities, resource management information
• Proposes MOC structure for ESF-8 coordination
• Not intended to supplant local plans
TDMS GoalsTDMS Goals
• Ensure highest level of readiness to respond
• Ensure coordination, communication and collaboration among partners
• Ensure understanding of roles and responsibilities of partners
• Maintain updated list of ESF-8 resources
Planning and CoordinationPlanning and Coordination
• Bring together all partners from public health and acute care– Reveals gaps and overlaps– Facilitates better understanding
of roles and responsibilities– Provides for continuous
improvement• Partner workgroups at local
jurisdiction, regional/multijurisdictional and state
Planning and Coordination Planning and Coordination FunctionsFunctions
• Access all current plans; de-conflict and coordinate
• Compile list of available resources, assess gaps and overlaps
• Establish mutual aid agreements• Develop organizational model for MOC and
assign participants• Develop communications plan among partners
Planning and Coordination Planning and Coordination Functions (con’t)Functions (con’t)
• Determine how local and regional plans integrate with state plans
• Develop written documents for plans and resources
• Disseminate plans to all partners
• Communicate gaps and capabilities to DSHS and TDMS Steering Committee
The MOCThe MOC(Medical Operations Center)(Medical Operations Center)
• During response and recovery both acute care and public health must come together quickly
• Single organization for ESF-8 coordination
• MOC is not stand alone but is integrated into incident command
• Flexible and scalable based upon the incident
MOC StructureMOC Structure
MOC Development PartnersMOC Development Partners
• Single Jurisdiction– Local public health– EMS– Local EM– Local health authority– Hospitals/nursing homes– ME/JP– DME providers– Medical staffing agencies– Mental Health Centers
– Disability community
• Multi-jurisdictional– DDC/Regional coordinators– RAC– DADS– DARS– Community mental health
Incident ScenariosIncident Scenarios• Awareness of injury risks• Medical care for sheltered individuals• Evacuation• Stress Reactions• Preventing disease in congregate care settings• Mass Fatalities• Medical Surge• ESF-8 Coordination and Management
To name a few……..
Incident ScenariosIncident Scenarios
Basic knowledge related to an integrated TDMS emergency response and its key components
• The target audience is all existing or potential participants of the TDMS
• Core knowledge and skills that are common to most of the TDMS technical teams or activities
• The target audience is individual TDMS members
• Advanced TDMS team training
• The target audience is individuals or entire units assigned to specialized TDMS teams (e.g., MMU, MIST, RAT, CAT, BHAT)
Pilot CoursesPilot Courses
• Not Throwing Caution to the Wind: 4/3 2:30Deployment Safety