11 The Role of Trauma Centers and Trauma …...The Role of Trauma Centers and Trauma Professionals in an Evolving National Threat Environment 5/1/2019 5 Saving Lives. Protecting Americans

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

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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


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


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


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.


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


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


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


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


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


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


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


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:

[email protected]


Questions?

Documents

11 The Role of Trauma Centers and Trauma …...The Role of Trauma Centers and Trauma Professionals in an Evolving National Threat Environment 5/1/2019 5 Saving Lives. Protecting Americans