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The Role of Trauma Centers and Trauma Professionals in an Evolving National Threat Environment
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The Role of Trauma Centers and Trauma Professionals in an Evolving
National Threat Environment
Robert Kadlec, MD, MTM&H, MS
Assistant Secretary for Preparedness and Response
Trauma Center Association of America 22nd Annual ConferenceMay 1, 2019 | Las Vegas, NV
2Saving Lives. Protecting Americans.
ASPR’s Purpose: Unity of Command
Bringing Federal Medical & Public Health Assets in Support of State
& Local Authorities
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ASPR Mission
Save Lives and Protect
Americans from 21st Century
Health Security Threats
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Historic and Ongoing Response Environment
Hurricanes Harvey, Maria, and Irma,
Las Vegas Shooting
Boston Marathon Bombing
Amtrak Derailment, Zika, Pulse Shooting
Fukushima Nuclear Disaster
Deepwater Horizon, Joplin
Tornado
H1N1 Influenza, Fort Hood Shooting
Hurricanes Katrina, Rita, and Wilma
Hurricanes Ike, Gustav
H5N1 InfluenzaHaiti
Earthquake
Ebola, MERS,Chikungunya
H7N9 Influenza, Wannacry, WA
Amtrak train derailment
9/11 and Anthrax attack
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
The public and private sector have worked together to make significant progress in preparedness and response
Mudslides,Measles
Outbreaks
Alaska Earthquake
Nisqually Earthquake
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21st Century: An Increasingly Complex & Dangerous World
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21st Century Threats: An Increasingly Complex & Dangerous World
Natural• Extreme Weather• Natural Disasters• Pandemic and Infectious Diseases
Hybrid• Exploiting System Vulnerabilities During:
• Extreme Weather/Natural Disasters• Pandemic and Infectious Diseases Outbreak
Technological (human made/caused)• Emerging and Disruptive Technology and
Cyber Attacks• Adversaries and Malign Actors Poised for
Aggression• Dam breach, Chemical spill, Water
systems, Supply chain
Complex• Adversaries and Malign Actor Aggression• Chemical, Biological, Radiological, and Nuclear
Attacks (deliberate)
(Examples of threats identified in the National Health Security Strategy and the 2018 Worldwide Threat Assessment )
Planning for Readiness Limited Readiness
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ASPR’s Key Priorities
Foster Strong
Leadership
Build a Regional
Disaster Health Response
System
Sustain Robust and Reliable Public Health
Security Capabilities
Advance an Innovative
Medical Countermeasures
Enterprise
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National Disaster Medical System• Four Components
Patient Care NDMS Medical Teams Facilitated Support through Industry (Contract) Specialty Care Capabilities
Patient Movement NDMS Partnership
– DoD– VA– DHS/FEMA - National EMS Contract
Definitive Care ~1900 participating civilian health care facilities through a Memorandum of Agreement Coordinated across 65 DoD (14) and VA (51) Federal Coordinating Centers (FCC) Reimbursed at 110% of Medicare Part A rates (payer of last resort)
Fatality Management Disaster Mortuary Response Operation Teams (DMORT) Subject Matter Expertise - Fatality Management Assessment
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HPP: Response Ready. Community-Driven. Health Care Prepared.
• The Hospital Preparedness Program (HPP) is a cooperative agreement administered by ASPR and is the only source of federal funding for health care delivery system readiness
• HPP prepares the health care system to save lives during emergencies that exceed day-to-day capacity of the health and emergency response systems
HPP does this by developing and sustaining regional health care coalitions (HCCs)
HCCs incentivize diverse and often competitive health care organizations with differing priorities and objectives to work together
• HPP promotes a sustained national focus on improving patient outcomes, minimizing the need for supplemental state and federal resources during emergencies, and enabling rapid recovery
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What is a Healthcare Coalition?
Community Partners
Academic InstitutionsNon-profitsVolunteers
Elected OfficialsFire Departments
Police Departments
Long Term Care
Skilled Nursing FacilitiesHospice Care
Hospitals
Public Health Departments
Outpatient Facilities
Primary CareSpecialists
Health Care
Coalition (HCC)
Health Centers
Rural Health CentersCommunity Health Centers
Local Government
Emergency Medical Services
Home Health Agencies
Emergency Management Agencies
Behavioral and Mental Health Centers and Agencies
Physicians
A HCC is a group of individual health care and response organizations in a defined geographic location. HCCs play a critical role in developing health care delivery system preparedness and response capabilities.
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Socializing HCC Membership
72% 93%
In a survey conducted by the Trauma Center Association of America (TCAA),
72% of respondents did not know if their trauma center belonged to an HCC
According to HPP’s most recent data, 93% of TCAA members belong to an HCC
HCCs have an increasingly large and diverse member base, but socializing HCC membership within individual facilities remains a challenge.
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We Work Better Together
of HCCs have a complete and approved Preparedness Plan72%
of HCCs that have a complete and approved Response Plan25%
NA
TIO
NA
L A
VE
RA
GE
S
Budget Period 1X CAT data current as of 1/31/2019
of HCCs do not have a documented, coordinated plan to respond to large
burn emergencies
57%34%of HCCs do not have a
documented, coordinated plan to respond to large
trauma emergencies
of HCCs have not yet fully documented their
information sharing procedures
53%
Data from the Coalition Assessment Tool (CAT)
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Casualty estimates for 21st-Century
threats (and some old threats) far
exceed the capacity and capability of the current health care
system
Health care preparedness and
response is fragmented and uncoordinated
across jurisdictions
NDMS and HPP require updating to
meet current challenges
Regional Disaster Health Response System |Why We Need a New Approach
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ASPR’s Key Priorities | Regional Disaster Health Response System
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ASPR Key PrioritiesRegional Disaster Health Response System (Notional)
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RDHRS Demonstration Projects
Goal of the new cooperative agreement:Improve the clinical specialty and medical surge capabilities necessary in response, while
focusing specifically on building and maturing the partnerships that are required to coordinate patient and resource movement to support medical response and ensure
medical surge capacity at the local, state, and regional levels.
Demonstration projects will:
1 Address health care preparedness challenges
2 Establish best practices for improving disaster readiness across the health care delivery system
3 Show the potential effectiveness and viability of a RDHRS
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RDHRS Pilot Sites
Align plans, policies, procedures related to clinical excellence in disasters
N E B R A S K A M E D I C I N EM A S S A C H U S E T T S
G E N E R A L H O S P I TA L
Sites will build systems that exhibit the following 5 capabilities:
Build a partnership for disaster health response
Develop readiness metrics and conduct an exercise to test capabilities
Improve statewide and regional situational awareness
Increase statewide and regional medical surge capacity
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RDHRS Pilot Sites-Accomplishments to Date
Developed model legislation to address challenges related to the provision of medical care in disasters
Developed a legal reference guide
Established inventory of available volunteer and paid medical support personnel, and a dashboard to request support and assistance
Inventoried existing state models for deployable medical teams
Developed a model for hospital-hosted deployable medical teams
Assembled specialty teams of highly specialized clinicians and SMEs to provide training and on/offsite (i.e., telemedicine) patient care in disasters
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RDHRS Pilot Sites-Accomplishments to Date
Identified training gaps in medical care providers and training opportunities that would increase existing capability
Built the framework for medical emergency operations centers to support statewide and regional clinical disaster response
Identified ways to interface with existing state technical resources to create a knowledge management and technical support system
Established a draft set of readiness metrics that may be used to develop and evaluate future RDHRS sites
Initiated planning of a statewide medical surge exercise to test the RDHRS system and its ability to support statewide and regional disaster response efforts
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RDHRS Pilot Sites-Pending Activities
Develop model legislation that allows for the provision of telemedicine and telehealth through nationally recognized medical associations in disasters
Create templates for specialized surge plans and MOUs to support deployment and receipt of volunteer medical staff
Conduct estimates of the economic cost and ROI of certain preparedness and response activities as well as for start-up and sustainment of RDHRS infrastructure
Explore an improved surge surveillance system that uses novel indicators and thresholds to further discover the point to which an event would overwhelm the system
Create a list of essential elements of information for health care situational awareness and clinical decision-making
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What is the MRC?• The Medical Reserve Corps (MRC) is a national network of
volunteers, organized into local units to improve the health and safety of communities.
• What started as a small demonstration project after September 11 has grown to nearly 900 local units and 190,000 volunteers.
• Approximately 20%-25% of units respond to emergencies every year.
In FY18, more than 500 response activities were reported.
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Medical Reserve Corps | MRC Locations
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Types of MRC Volunteers (continued)March 2019
76,473
020,00040,00060,00080,000
100,000120,000
Nu
mb
er o
f V
olu
nte
ers 108,851
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National Disaster Pediatric Initiative | Pediatric Centers of Excellence
April 2019: Solicited feedback from pediatric stakeholders on:• Unique needs of children during disasters• FOA for Pediatric Centers of Excellence • Equipment and supplies for the care of pediatric patients
July 2019: Release FOA for Pediatric Centers of Excellence• Two pilot project awards available, totaling $6 million• Designed to complement HPP, EMSC, NDMS• Will serve as a nationally available resource to help other
facilities and providers to plan and coordinate the care of children during large-scale national emergencies, particularly those involving health security threats, such as CBRN incidents and pandemics
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Mutual Responsibility for Readiness
Comprehensive Emergency Response
HHS
DHS/FEMA
DoD
VA
DOT
State & Local
EMS
Hospitals and Trauma
Centers
Outpatient Facilities
SupplyChain
Community Partners
Long Term Care
A robust response to 21st-century threats necessitates seamless integration between public and private response. While public sector resources are an essential part of the equation, complementary private sector investments
in readiness are critical to the health care system’s ability to serve patients during a disaster.
Academic Institutions
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Topic Collections
• Explosives and Mass Shooting
• On-Scene Mass Casualty Triage and Trauma Care
Webinars and Tip Sheets
• Healthcare Response to a No-Notice Incident: Las Vegas Webinar
• Mass Shooting/ No-Notice Incident After-Action Interview Guide: Medical Resource Requirements
• No-Notice Incident Tip Sheets
• Post-Mass Shooting Programs and Resources Overview
Working Together | ASPR TRACIE Resources
https://asprtracie.hhs.gov
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Working Together | Medical Response to Large Scale Events Course
• Trauma Surgeons
• Emergency Physicians
• EMS
TARGET AUDIENCE:
PILOT DATE AND LOCATION:
Fall 2019, Noble Hospital, FEMA Center for Domestic Preparedness
PURPOSE:
• The new course we are developing with FEMA’s Center for Domestic Preparedness (CDP) aims to prepare clinicians and EMS providers for medical response to large scale events
• Course content will be informed and developed by clinicians who have led medical responses to large scale mass casualty events, incorporating lessons from prior responses
COLLABORATING PARTNERS
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Contact
For more information, contact:
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Questions?