Resources: JVR Health Readiness Inc. Suggestion

JVR Health Readiness Inc. Suggestion “Supporting FEMA’s ESF-6 Mission”

Background: In the last decade, America has endured the terrorist attacks of 9-11, an Anthrax attack on Washington DC and New York and an apparent spike in hurricane and wildfire activities. With those events, FEMA has noted that often, healthcare organizations cannot function well in large scale disasters and have required significant dollar outlays of Public Assistance funding to recover.  During this time, the Homeland Security Council in conjunction with the Department of Homeland Security (DHS) has published 15 Planning Scenarios for use by federal, state and local governments in homeland security preparedness activities.  While mitigation efforts on port security, hydroelectric facilities, transportation and many other elements of America’s critical infrastructure have been recognized and funded, little has been done to mitigate the possibilities of a collapse of the American Healthcare Infrastructure during catastrophic events.  FEMA may task the Department of Health and Human Services (HHS) to medically support jurisdictions under attack or experiencing a natural disaster under the provisions of ESF-8 of the National Response Framework (NRF). However, the current capabilities of the National Disaster Medical System (NDMS) suggest that HHS could mount only a modest effort by providing National Medical Response Teams (NMRT) with limited medical staff and almost no medical logistical support system to sustain medical teams in the field. Even a cursory analysis of the categories and estimated numbers of casualties associated with each of the 15 Federal Planning Scenarios (Attachment 1.) will strongly suggest that FEMA under the NRF ESF-6 must build a robust and extensive network of Mass Care Facilities across America and a medical logistics support system to support and sustain these facilities throughout the types of disasters depicted in the 15 Federal Planning Scenarios.

FEMA’s Mission Change: In a speech to the National Press Club, November 30, 2006 FEMA Administrator R. David Paulison said: “The FY2007 DHS Appropriations Bill presents both opportunity and responsibility for FEMA.  It:

  • Challenges us to improve our core capabilities and strengthen our Regions;
  • Expands our mission to include preparedness and protection along with our traditional missions of mitigation, response and recovery;
  • Directs us to widen our response beyond natural disasters to include terrorist acts and other man-made events;
  • Requires us to engage new constituencies such as the law enforcement community;
  • Establishes a national emergency management system; and
  • Seeks to implement a national preparedness system.

With adversity comes opportunity and for FEMA.  That opportunity may be in the area of bolstering America’s Healthcare Infrastructure through the recently added mission areas of preparedness and protection as well as FEMA’s more traditional roles of mitigation, response and recovery.  JVR Health Readiness Inc. has the breath and depth of professional networks to offer FEMA the flexibility to advance these new mission taskings as resources become available for ESF-6.  JVR Health Readiness Inc. and our teaming partners is both nimble and flexible, making it the ideal FEMA Partner.

Situation: The American Healthcare Industry has been in financial crisis for at least the past 15 years and the reality of increasing patient loads and simultaneously, decreasing Medicare, Medicaid and Managed Care reimbursements has stretched the American Healthcare Industry to the limits. Additional stress such as a nationwide shortage of nurses and other critical medical professionals provides a grim picture regarding the ability of the American Healthcare Industry’s capability to function effectively in a large scale disaster. Further, the financial realities of life in America’s Healthcare Industry has essentially meant that little time or resources have been devoted to preparing for and mitigating against future disaster events.

The Department of Health and Human Services (HHS) has distributed federal grant dollars under the auspices of the Hospital Preparedness Program beginning in 2002. However, both the number of mandated critical benchmarks and the very large number of participating healthcare entities have served to dilute the grant’s effectiveness.  In any case, Emergency Support Function (ESF- 6 Mass Care, Housing, and Human Services) is a FEMA mission area and will require an extraordinary effort on the part of FEMA and its human resource partner NISTAC.

Impact: FEMA finance officials will likely determine the initial costs of hurricanes Rita and Katrina at levels above $3 Billion and Hurricane Ike above $1 Billion as the Public Assistance costs alone. It may take ten years to be able to calculate the societal, cultural and economic impacts to cities and entire states on America’s Gulf Coast, as a result of these natural disasters. It is hard to imagine the catastrophic damage and loss of life that would be associated with a well orchestrated nuclear attack (DHS Planning Scenario #1-Attached) on major population centers like Washington DC, New York, Los Angeles, San Francisco, Boston or other American metropolitan areas. It may be harder to imagine the massive disaster response FEMA would be required to mount in such a catastrophe.  It would be equally grim to contemplate the cataclysmic effects an Influenza Pandemic would have on American society in general and America’s Healthcare Industry in particular..

Solution: The time may be right for the very successful FEMA- JVR Health Readiness Inc relationship to develop a risk-based “Healthcare Infrastructure Preparedness, Protection and Mitigation Program.”  This program would be an integral element of the National Incident Management System (NIMS) and would be scalable and elastic enough to manage the entire spectrum of local, state, regional and National disasters. The “National Mass Care Sheltering Initiative” will offer the Secretary of Homeland Security and the FEMA Administrator total asset visibility and “real-time, on-line” situational awareness regarding the status and functionality of all participating Mass Care facilities across America during normal times and during disaster operations.

The “National Mass Care Sheltering Initiative” (NAMCSI) will be cost effective in that it would prevent the collapse and the subsequent cost of rebuilding the American Healthcare Industry after a catastrophic event.  It is likely that a robust fully supportable NAMCSI would save tens of thousands of lives in a large-scale disaster.

It will ultimately save FEMA and the American taxpayer millions of dollars annually and Billions of dollars during a major National disaster or Public Health emergency.

Opportunity: “FEMA in partnership with JVR health Readiness Inc. can significantly enhance America’s capability to effectively manage man-made and natural disasters in a manner which optimizes the saving of lives and minimizes the impact on American society in the aftermath of catastrophic disasters outlined in the Federal Planning Scenarios”.

Preparedness Activities:

1.  Plan, budget, procure and maintain Deployable Medical Systems (DEPMEDS) which can be rapidly deployed to a network of participating healthcare organizations across America during large scale disasters. These deployable medical units would be used as hospital expansion units and are available from DOD contracts using Federal Supply Schedules (FSS). These units are designed for maximum versatility and scalability and can be used as medical wards, specialty units such as burn, orthopedic and radiation sickness units, staff quarters, support services facilities and even public health education facilities. By using DEPMEDS as healthcare expansion units, hospitals and medical centers across America in conjunction with the Medical Reserve Corps and voluntary health professionals, FEMA may be able to effectively and efficiently manage tens of thousands of casualties generated by any catastrophic attack or other disaster event.

  1. Healthcare Emergency Management: Healthcare Organizations across America are currently required to acquire a wide variety of enhanced Emergency Management capabilities in order to meet the 2009 accreditation standards of “The Joint Commission.”(Formerly this organization was named the Joint Commission on the Accreditation of Healthcare Organizations or JCAHO).  By participating in FEMA’s “Healthcare Infrastructure Preparedness, Protection and Mitigation Program, HIPPMP” hospitals, medical centers and specialty centers will attain a significant level of disaster Readiness which will represent an important step toward meeting The Joint Commission’s 2009 standards.
  2. Medical Logistics and Training Support . The medical logistics support plan associated with HIPPMP will also enhance participating healthcare organizations’ disaster-related sustainment capabilities. Healthcare organizations will enjoy FEMA logistics support throughout a disaster, which will eliminate hospital closures due to insufficient supplies, equipment, medicinal gases, food, fuel and services. FEMA can also incentivize healthcare organizations to participate in HIPPMP through readiness credentialing, FEMA training and exercising with established FEMA exercise teams.
  3. Back to the Future. In the 1960s and 70’s the United States under the Civil Defense Program, built 1,900 Packaged Disaster Hospitals, each with 250 beds, (475,000 beds) an operating room and a portable x-ray machine (1900 operating rooms and 1900 X-ray units). Today we may have 500 beds total in America.

    These Packaged Disaster Hospitals were deployed with a logistical support package containing sufficient consumable medical supplies to operate without sustainment support for 30 days.  These assemblages were maintained in “ready to go” condition in locations across America.  While these assets would have been most useful to FEMA today, funding decreases in the 1970s caused these medical assets to gradually decay and lose their readiness capabilities. FEMA’s Healthcare Infrastructure Preparedness, Protection and Mitigation Program” (HIPPMP) will enable America to regain much of its healthcare readiness posture.
  4. Medical Personnel. HIPPMP may incorporate the Medical Reserve Corps, the Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP) and the Emergency Management Assistance Compact (EMAC) into it’s support structure to form the medical personnel human resource elements of HIPPMP.  The framework is already in place and well over 130, 000 medical professionals are registered and medically credentialed, ready to respond to a disaster. This beginning cadre can be significantly and systematically expanded to meet the personnel requirements for disasters depicted in each of DHS’ 15 Planning Scenarios.
  5. Transportation: Casualty Evacuation & Tracking. Build a scalable National patient evacuation and tracking system consisting of a Patient Regulating Office (for assigning patients beds at appropriate hospitals and to specialty centers America). FEMA’s Healthcare Infrastructure Preparedness, Protection and Mitigation Program” (HIPPMP) may include a robust network of ground, rail and airframe resources tied into a Patient/Casualty Regulating Office for the rapid transport of trauma, burn and radiation-sickness patients away from the attack jurisdiction to medical specialty centers in adjacent jurisdictions or across America.

Mitigation Activities:

1. Fortify healthcare organizations and regional health system’s ability to defend in place during a disaster, ensuring communities of continuity of medical services throughout a disaster and into recovery.  The following activities will serve to fortify individual healthcare organizations during disasters. Based on the jurisdiction’s planning scenarios NISTAC contractors may:

A. Conduct a facility hazard vulnerability assessment (HVA) designed to detect and correct vulnerabilities in:

  1. Heating Ventilation and Cooling (HVAC) system
  2. Security and emergency lock down procedures
  3. Departments and functions connected to the back-up power generator grid (Chillers/Air Conditioning)
  4. Generator fuel suppliers inventories / alternate fuel sources
  5. Capacity of emergency back-up generator
  6. Water supply system
  7. Waste stream system
  8. Alternative treatment centers associated with the healthcare facility.

B. Conduct healthcare organizations or regional health systems disaster-related support system evaluations to detect and assist in correcting vulnerabilities in the support structure.

  1. Advanced contract arrangements for surges in requirements for medical supplies, equipment and service requirements. Include Prime Vendor distribution centers in addition to normal distribution center.
  2. Advanced contract arrangements for surges in requirements for housekeeping supplies, plant operations supplies, additional back-up power generators and fuel
  3. Disaster-related contract services for per diem healthcare providers,  other per diems for housekeeping, transporters, materials handlers, security guards, public affairs, dietary workers
  4. Disaster related blood bank and tissue bank contracts including re-supply from outside the affected jurisdiction.
  5. Medical and non-medical supply and equipment vendors depth of inventories
  6. Medicinal gases suppliers inventories and automated refills
  7. Vendor existing plans to redeploy supplies and equipment from distant distribution centers into the disaster-affected  hospitals
  8. Regulated medical waste (RMW) treatment capability (transporting may be impossible in some long term disasters)

C. Some of the benefits of meaningful mitigation efforts to enable a healthcare organization to defend in place and continue offering medical services include:

  1. Saving lives of seriously ill patients not able to survive evacuation
  2. Avoiding evacuation costs, often in the millions of dollars
  3. Protecting healthcare workers from evacuation related injuries
  4. Serving the healthcare needs of a community during a disaster
  5. Conserving the healthcare workforce that would often be lost to other communities if a healthcare system or systems are closed.
  6. Reducing the damages to the Healthcare System’s facilities
  7. Saving FEMA and the American taxpayer hundreds of millions of dollars in potential health system damages for each disaster.
  8. Enabling healthcare services to continue during the response and recovery stages of a disaster-the most critical time to a community.
  9. Decreasing or eliminating the need for costly portable medical units
  10. Avoiding the economic and societal disruption related to the loss of a healthcare infrastructure.

2.  Protect and ensure the survivability of the National Healthcare Infrastructure during Pandemic or a catastrophic terrorist attack by:

  1. Bolster America’s Healthcare supply chains by building and maintaining Strategic National Reserves of medical supplies, medical equipment, food and water (potable and chillers/washing water)
    1. Medical Materials
      1. Purchase medical supplies and equipment for National Reserve System
      2. Store and manage in storage (stock rotation, QC etc.) in Private Sector healthcare distribution centers across America
      3. Establish transportation contracts with UPS/FedEx etc. to air ship National Reserve materials to airports near the jurisdiction suffering a disaster
      4. Establish a Materials Management Information System to order, manage, distribute and track during normal periods and during disasters
      5. Establish linkages to FEMA and to Joint Field Offices and to Area Field Offices in disaster areas for situational awareness and for briefings
    2. Food and Water
      1. Purchase water, meals ready to eat and for Special Needs persons, specialty food and supplemental feeding products for National Reserve System
      2. Store and manage in storage (stock rotation, QC etc.) in Private Sector food distribution centers across America
      3. Establish transportation contracts with UPS/FedEx etc. to air-transport National Reserve materials to airports near the jurisdiction suffering a disaster
      4. Establish a Materials Management Information System to order, manage, distribute and track during normal periods and during disasters
      5. Establish linkages to FEMA and to Joint Field Offices and to Area Field Offices in disaster areas for situational awareness and for briefings
  2. Enhance the Civilian Reserve Air Fleet (CRAF) by contracting for airframes  and conversion kits suitable for Aeromedical evacuation service
    1. CRAF already has a limited Air Evacuation component which can be significantly expanded
    2. Establish a Patient Regulating Office to communicate with FEMA patient evacuation components of FEMA Area Field Offices (AFO)
    3. Establish Air Evacuation linen/litter and medical material resupply hubs at CRAF dispatching airports and at airfields designated by FEMA as re-supply centers
  3. Develop National service contracts for oxygen, anesthesia agents and other medicinal gasses and respirator/ventilator rental companies with requirements for emergency reserves of medicinal gasses
    1. Establish contracts with medicinal gas companies like “Airgas” or “Praxair” capable of filling large National orders during disasters or other events of National significance.
    2. Establish contracts with National Medical equipment rental companies like MEDIQ and KCI etc. to serve as both a per diem provider of medical equipment and as a manager of National Reserves of specialty beds, infant transport units, hypothermia systems etc.
  4. Provide products and services for “Special Needs” persons in hospitals, alternative care centers and Alternative Care Centers
    1. Establish a comprehensive requirements list of items of supply and equipment which is representative of special needs needed by persons in the areas of mobility, hearing, vision, bariatric, mental health and other categories of special needs.
    2. Purchase, store and manage special needs equipment and supplies in distribution centers mentioned in #1 and #3 above and transport these items per #2 above.
  5. Provide Critical Healthcare Infrastructure healthcare organizations with continuous-run  FEMA-procured “Prime Power Rating” generators
    1. Purchase “Prime Power Rating” (long run continuous power) generators for High Risk jurisdictions hospitals, medical centers, health systems, Public Health departments and trauma centers.
    2. Establish National contracts establishing tactical fuel reserve centers. Require automated deliveries to all sites in these high risk healthcare and public health centers with FEMA generators
  6. Deploy regulated medical waste (RMW) “on-site treatment” units to eliminating the need to transport infectious material across public roads during any widespread disaster.
    1. Purchase mobile regulated medical waste (RMW) treatment equipment capable of sterilizing RMW during disasters when transporting RMW to landfill, incinerator or chemical treatment centers is impossible due to inaccessibility to public highways, a state quarantine or other restrictions on movement of RMW.
    2. During disasters or Public Health emergencies, move the portable RMW units to healthcare or public health facilities which generate RMW.
    3. Execute contracts for consumables required to collect and to sterilize (autoclave) RMW at the facilities where the portable on-site units have been deployed.

Conclusion: FEMA has concluded that Prevention, Protection and Mitigation are cost-effective measures which, when put in place prior to a disaster, can save lives, prevent suffering, protect and preserve property and protect the vital infrastructures on which American depends. While these measures require substantial investments in dollars, time and effort, the end result will save taxpayers dollars, protect the Homeland and result in the saving of American lives.  Including Preparedness and Protection to FEMA’s core mission elements will represent an investment that will pay dividends in every future disaster.  Using NISTAC as FEMA’s human resource “expansion joint” will enable FEMA to expand and contract as situations and mission requirements dictate.

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