FEMA

National Ambulance ContractCDR Amy O. Taylor

DHHS/ASPR R6Emergency Coordinator

Cole BrickerDHS/FEMA Region 6

Operations

The purpose of the Federal National Ambulance and Para-transit

Support Services contract is to provide a full array of licensed

ground and air ambulance services and para-transit services that

may be ordered as needed to supplement the Federal and

Military response to a disaster, act of terrorism or other public

health emergency in any of the 48 contiguous states.

Federal National Ambulance Service: PURPOSE

Background

• Why a National Ambulance Contract?– Cost– Complexity– Credentials– Coordination

• Multi-Agency Effort– GSA– HHS– FEMA

Mission

The Department of Health and Human Services provides technical assistance to FEMA in support of contracted ground + air ambulances, and para-transit vehicles to support State, tribal and local governments ability to prepare for and respond to the effects of a major disaster.

• Centrally managed, regionally coordinated contract• Provide a full array of licensed ground, air ambulance and

para-transit services to assist states in accomplishing patient evacuation

• May be ordered as needed to supplement response to a disaster, act of terrorism or other public health emergency.

• State public health authorities determine there are unmet requirements to rapidly and safely evacuate patients with complex and ongoing medical needs;

• Initiate request for Federal assistance.

Authorities

• FEMA contract executed through HHS operational support

• Can only be utilized within a Stafford Act Activation/Declaration

Contract Zones

Performance Requirements Per Zone

• GROUND AMBULANCE– 300 ground ambulances (ALS & BLS)– Typically a 70%/30% ALS/BLS split

• AIR AMBULANCE– 25 air ambulances, helicopter and/or fixed wing

• PARA-TRANSIT– Ability to Transport 3,500 individuals– Not 3,500 vehicles

BOTTOM LINE: LIMITED NUMBER OF RESOURCES

Resources

Ground Ambulance Services

Types of Ground Ambulances

Type II – Advanced Life Support, Non-HazMat

Type IV – Basic Life Support, Non-HazMat

Type V – Bariatric Ambulance, ALS

Type VI – Med-Evac Bus, ALS

> 4 stretcher patients

EMS Roles

• Patient triage, treatment & transport• Hazard recognition• Symptom surveillance & reporting• On-scene medical standby• Redistribution of pts. to free up hosp. beds• Distributing immunizations• Staffing shelters• Staffing emergency departments• Setting up mobile medical units

Para-Transit Services

6 Types of Para-Transit Vehicles

Para-transit Restrictions

• Sending facility responsible for determining host facilities/destinations

• One-way distance < 200 miles or 6 hrs.

• Multiple trips expected

• No medical staff on vehicles

• Caregiver must accompany patient if medical care is required

• Order by patient type, not by vehicle type• Non-ambulatory, wheelchair bound• Ambulatory with assistance• Ambulatory & no assistance needed

AIR AMBULANCE SERVICES

Types of Fixed-Wing Aircraft

• Type I – critical care ALS 2+ pts.

• Type II – critical care ALS 1 pt.

• Type III – ALS 2+ pts.

• Type IV – BLS 1 pt.

• Type V - Neonatal

Types of Rotary-Wing Aircraft

• Type II – ALS 2+ pts., night ops.

• Type III – ALS 1 pt., non-night ops.

• Type IV – ALS 1 pt., night ops. VFR

• Type V - Neonatal Specific

Performance Requirements Per Zone

1 Zone 2 Zones 3 Zones 4 Zones

300 ground amb. 600 ground amb. 900 ground amb. 1,200 ground amb.

25 air ambulances 50 air ambulances 75 air ambulances 100 air ambulances

3,500 bus seats 7,000 bus seats 10,500 bus seats 14,000 bus seats

State Considerations

• Medical Evacuation Planning (State ESF-8 lead)• Activation Request to FEMA Region (Governor)• Coordination with HHS /ESF-8 regional office

Medical Evacuation Planning Considerations

Planning must be performed whether it be deliberate or crisis-action and is a state ESF-8 responsibility. It should include:• Number of patients to evacuate

• Patient locations (Pick up Points)– Hospitals– Nursing Homes– Residences

• Where will patients go?– Intrastate or Interstate evacuation– Shelter/Hospital Agreements

Medical Evacuation Planning Considerations (cont)

• Staging area (Check-In site) locations

• Security

• Repatriation

• Medical Assets– Can this be handled through EMAC?– Will this require Federal augmentation

Activation Request to Region

If activating the Federal Ambulance Contract, the state must prepare an ARF identifying the following information (at the very least):

• No. of patients to evacuate & condition:– Critical/Intensive Care– Advanced Life Support– Basic Life Support

• Check-in site

• How they will be used– Local augmentation of 911 dispatch– Transportation/Evacuation of Patients

Needs Identification

• State/local identify numbers needing specific type of support during planning.

• State incorporates EMAC assets in planning (follow GAP analysis concept).

• State works with HHS Region to identify Federal piece.

• NOTE: The national contract is NOT a panacea- it is intended to augment State and local resources.

Coordination

• Pre-Event– HHS Regional Emergency Coordinators work with States to determine if medical

evacuation assistance may be necessary and identify potential check-in sites for assets.

– Finalize State coordination of requirements.– State ID’s potential types and numbers.

• During the Event– Monitor usage– State ID’s types and numbers

• Post-Execution– Forward draw-down and demobilization plan

Caveats

• Regions work through HQs• No individual direct contact with contractor prior to activation• ESF #8 manages, FEMA pays

– Joint decision-coordination process– Under utilization= demobilization

• State/ local exhaust available support– Own contracts/assets– Mutual aid and EMAC

How does it work?

Check In

• Ground Ambulance - verify quantity at Check-in– ALS (usually 70%)– BLS (usually (30%)

• Para-transit (seats)– Verify quantity at check in– 25% of seats must have

working wheelchair lifts

• Air – Verify quantity at check in. This may occur at a separate check in site from the ground assets.

• COTR must validate check-in times for each asset

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AMR/FEMA Vehicle Placard

A=ALS ground ambulance

B=BLS ground ambulance

C=ALS bariatric grnd amb

D=ALS Med-Evac bus

G=Type I sedan/minivan

H=Type II minibus

J=Type III coach transit bus

K=Type IV wheelchair van

L=Type V ADA minibus

M=Type VI ADA coach bus

X=Support vehicle

Check-In Form

Inspection

• COTR Inspections (Random)– Medical Supply Inspections

• Expiration Date• Type of supplies required are

adequate for tasks assigned

– Personnel Credentials

• State DOT may perform vehicle inspections as well

“Contractor is responsible for maintaining all provisioning necessary to resupply all ambulances provided pursuant to any task order for extended periods” – SOO Section C-4

Equipment Issuance

Transportation Management Services (TMS) contractor support staff will be at the check in site to tag each ground asset with a GPS transponder

• Used for deployed evacuation assets across the evacuation transportation enterprise

• Plots and tracks assets in real time using Sprint i365 GPS enabled phone

• Provides long-term historical tracking information• Provides online (web-based) real-time reporting through Telenav• Enables quick setup and management – anytime from anywhere

BESS Kit Contents

Adhesive Placard

Laminate Placard

Sprint i365

12V Y-Adapter

12V DC Charger

Corrugated Container Box

120V AC Charger

Portable 12V DC Power Pack

Reporting / TrackingThe COTR must• Provide regular status reports – frequency will be set by the National

COTR. These reports will capture information on mobilization, missions being performed, asset utilization, inspections, demobilization, etc

• Coordinate with state representatives at staging areas and issue work orders to the contractor for missions (which will assign certain assets to a specific purpose for a duration of time)

• Adjust work orders as mission requirements demand• Maintain a spreadsheet that tracks work order progress

Asset Utilization

• How many assets are redlined and why? – Maintenance Issues– Assets should never be down due to driver rest requirements

• COTRs must identify how many assets are on missions out of total available (percent utilization)?

• Asset Utilization is the key metric used to lead demobilization coordination calls with the states.

Patient Encounter Form

ICS 220 Operational Status Reports(measures asset utilization)

•Ground ambulance

•Para-transit

•Air Ambulance

Demobilization

• COTR is responsible for demobilization coordination– ESF-8 liaison at state EOC– RRCC– JFO – OHA– FEMA National COTR

Demobilization, Check-Out Form

Lessons Learned

Deployments

• Hurricane Dean Aug 08 $15M

• Hurricane Gustav/Ike Aug 08 $120M

• Presidential Inauguration Jan 09 $8M

Successes

• Met performance requirement

• Deployed safely

• Logistical support

• Mission Ready

• Accomplished assigned missions

Challenges

• Check in process

• Direct resource communication & tracking

• Resource utilization

• Inter-agency coordination

• Logistics leveraging

• Costs

Summary

• Planning State and HHS region coordinate Project assets needed/ staging

• Activation Deploy assets to staging area FEMA placards for vehicle ID State/local briefing; credentialing (if necessary)

• Deployment Resources deploy from sating area to site(s) Once assets leave staging area, assigned to state State/ local gov’t provide medical direction; patient distribution and tracking

• Demobilization Once task(s) or assignments complete, or asset no longer needed

QUESTIONS ?