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Operation UNIFIED RESPONSE
Medical Response to Haiti EarthquakeOperation Unified Response
24 January 2011CAPT Michele Hancock, Deputy SG, US Southern Command
2011 Military Health System Conference
The Quadruple Aim: Working Together, Achieving Success
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1. REPORT DATE 24 JAN 2011 2. REPORT TYPE
3. DATES COVERED 00-00-2011 to 00-00-2011
4. TITLE AND SUBTITLE Medical Response to Haiti Earthquake: Operation Unified Response
5a. CONTRACT NUMBER
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6. AUTHOR(S) 5d. PROJECT NUMBER
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7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) US Southern Command,9301 NW 3rd St,Doral,FL,33172
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12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited
13. SUPPLEMENTARY NOTES presented at the 2011 Military Health System Conference, January 24-27, National Harbor, Maryland
14. ABSTRACT
15. SUBJECT TERMS
16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT Same as
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29
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Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18
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Agenda
• Background Info
• Mission
• Phases of Support
• Deployment Timeline
• Medical Missions
• International Response
• Lessons Learned
Operation UNIFIED RESPONSE
Background Info
• Population: 9,035,536 (approximately 2 million in and around Port-Au-Prince)
• NGOs on the ground for many years, ~3000 in countryUnemployment rate: 65-70%-- 80% population living under poverty line-- 54% in abject poverty
• Military: Only small Coast Guard (no other forces)
Operation UNIFIED RESPONSE
UNCLASSIFIED
UNCLASSIFIED
• A Magnitude 7.0 earthquake struck Haiti at 4:53 pm, Tues, Jan 12, 2010
–230,000 Deaths*–197,000 Injured – 1.1M Displaced People –3,000,000 Affected People–60% of government
infrastructure destroyed–14 of 16 Ministry
Headquarters destroyed
Scope of Disaster
Operation UNIFIED RESPONSE
Mission: JTF-H conducts humanitarian assistance/ disaster relief (HA/DR) operations to support USG efforts in Haiti to mitigate near-term human suffering and accelerate relief efforts to facilitate transition to Government of Haiti, United Nations, and USAID.
Mission Overview
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666
Phase I – Emergency Response
• Immediate Life SavingSearch and Rescue
Care for AMCITS
Hospital Assessments
Medical CONOPS
RSO&I of Medical Personnel
Medevacs
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777
Phase II – Relief
• Mitigate Suffering and Meet Basic Needs Specialized surgical
care
Med Log and blood support
Patient transfers off ship
Medevacs
Troop FHP
Operation UNIFIED RESPONSE
First evacuation of Haitian nationals
Deployment Timeline (January)
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Magnitude 7.0 Earthquake vic. Port au Prince
6.1 Aftershock
COMFORT Arrives
BATAAN ARG Arrives
AFSOC ArrivesSJFHQ Arrives
B CO, 1/73 CAV (82 ABN) ArrivesJTF-B MEDEL Operational EMEDS+10 Arrives
Evacuation of HaitiansSuspended
1 432 5
First HHS Personnel Arrive
MASF & AELT Arrive
AF CCAT & PM-SATOperational
First AMC Executed Evacuation
NASSAU ARG Arrives
VINSON Arrives
Operation UNIFIED RESPONSE
AE ReviewBoard
Suspended
Deployment Timeline (February)
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 281110986 754321
Decision Made NOT to Employ EMF-150
Evacuation of Haitians ResumesDefinitive Care Components of NDMS Activated
AE Review Board Established
USS VINSON Departs153rd Blood Support Det Arrives43rd Veterinary Det Arrives
56th MMB Arrives
Commercial Flights ResumeFrom PaP
COMFORT SurgAugmentsRedeploy
Operation UNIFIED RESPONSE
Deployment Timeline (March)
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 281110986 754321
JTF-H Conducts RIPw/ARSOUTH
Final DHHS TreatmentAsset Redeploys
EMEDS + 10 Redeploys
USTC AE Enablers Redeploy
COMFORT Redeploys
NDMS OfficiallyStood Down
DHHS Stands Down FCCs
Operation UNIFIED RESPONSE
11 11
PORT–AU–PRINCE*30-40% destroyedCommune population: 704,776Metro Population estimate: 2,000,000
H A I T I E A R T H Q U A K E230,000 killed196,595 injured1,200,000 to 1,290,000 displaced3,000,000 affected*All figures are approximate. Commune population figures are as of 2003.SOURCES: OCHA/GoH 02.22.10
GRESSIER*40-50% destroyedCommune population:25,947
CARREFOUR*40-50% destroyedCommune population:373,916
PETIT GOAVE*15% destroyedCommune population:117,504
LÉOGÂNE*80-90% destroyedCommune population:134,190
JACMEL*50-60% destroyedCommune population:137,966
POPULATION MOVEMENT*Source: OCHA 02.22.10
* Population movements indicated include only individuals utilizing GoH provided transportation and do not include people leaving Port-au-Prince utilizing private means of transport.
NORTHWEST45,862
ARTIBONITE162,509
NORTH13,531
NORTHEAST8,500
CENTER90,997
WEST35,253
DOMINICANREPUBLICUnconfirmedNumbers
NIPPES33,351
SOUTH88,533
GRANDEANSE119,871
EARTHQUAKE INTENSITYThe Modified Mercalli (MMI) Intensity Scale*
Operation UNIFIED RESPONSE
Afloat Based Medical Support
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13
Maritime Laydown
VINSON (CVN)USNS COMFORT (T-AH)
NORMANDY (CG)BUNKER HILL (CG)
HIGGINS (DDG)UNDERWOOD (FFG)
BATAAN ARG with 22 MEU:
BATAAN (LHD)FORT MCHENRY (LSD)CARTER HALL (LSD)
GUNSTON HALL (LSD)
NASSAU ARG with 24 MEU:NASSAU (LHD)
MESA VERDE (LPD)ASHLAND (LSD)
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050
100150200250300350400450
1/12 1/19 1/26 2/2 2/9 2/16 2/23 3/2 3/9
Patients Aboard
Surgeries
Patient Discharges
Patients Admitted
15 Jan: MTF FOS crew, initial NGO embark 16 Jan:
COM deploys
19 Jan: First HN patient aboard
4 Feb: NGO surgical augment team aboard
27 Feb: Last HN patient discharge
10 Mar: COM redeploys
28 Jan: Peak census: 411 26 Feb: Last HN
surgical procedure
12 Jan: Haiti hit by earthquake
20 Jan: CDS40 Embark
• 1002 total admissions (872 patients, 130 escorts)
• 931 surgical procedures
COMFORT Timeline
Phase I Phase II Transition to Redeployment
Max Patient Capacity
Operation UNIFIED RESPONSE
Placeholder
AS OF: 1500, 13 MAR
Land Based Medical Support
Operation UNIFIED RESPONSE
- BCT/BN HQ
- Distribution Hubs
JTF-H MEDICAL COP Phase I: o/a 20JAN – 051300RFEB10
1-73 CAV LV IYF8400517368Ws x 23 each
Haitian Hosp
Hosp
Embassy
1-325 AIR YF 8617583268Ws x 34 each
2-325 AIR YF 7984 5319Tailgate MED68Ws x 33 each
2BSTB YF 89575619Tailgate Med68Ws x 10 each
BLACK LV ITailgate YF8275548368Ws x 17 each
LEVEL IIYF 8457561968Ws x 44 each
LEVEL II
MASF/SPEARR/AELT/AFSOC SOST(-)
YF85175605
EMEDSYF80565512
JTF HQYF89575451
• AFSOC SOST
FDPMU YF8298 5750
Interim After Care FacilityYF91255352
Colombian MED TmMexican Surgical Tm
JTF-B FST/Colombian Surg/Mexican
SurgYF76485115
Operation UNIFIED RESPONSE
EMEDS Response
• Served as “Gate keeper” • 10+ beds and 1 OR • 300 patients and 200
escorts moved• 125 inpatients rec’vd care
• 12 day trips• Assisted 3 NGO’s• 1500 patients seen• 4 tons medical supplies
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Medical Logistics Support
18
Support to PROMESS Warehouse
Logistics Advisory Team Re-organized warehouse Provided inventory mgmt Teams at port to organize donations Forklift support
Operation UNIFIED RESPONSE
Patient Movement Missions
19
• Ground ambulance• Rotary wing medevac• Small boat medevac• Evac to GTMO and CONUS
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20
AE Staging MacDill, AFB
Port-au-Prince APOE
GITMO Naval Hospital
Patient Movement – CONUS
NDMS Started NDMS Ended
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8 8 7
1310 9 9
23
7
45
22
4
17
6 7 58
36 6 5
12
47
57
12
7
3 1
9
1 1
6
1 1 1 4 1 1
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3
0
5
10
15
20
25
30
35
40
45
50
14‐Jan
16‐Jan
18‐Jan
20‐Jan
22‐Jan
24‐Jan
26‐Jan
28‐Jan
30‐Jan
1‐Feb
3‐Feb
5‐Feb
7‐Feb
9‐Feb
11‐Feb
13‐Feb
15‐Feb
17‐Feb
19‐Feb
21‐Feb
23‐Feb
25‐Feb
27‐Feb
1‐Mar
3‐Mar
5‐Mar
7‐Mar
9‐Mar
11‐M
ar
13‐M
ar
15‐M
ar
Other
DoS
AMC
AFSOC
ISSUES: 1. Supporting DoD Haiti Patient Movement Requirements2. Supporting DoD Chilean Patient Movement Requirements
Patient Movement Breakout
Unclassified
A/O 1200Z14APR10
Contingency PM ReportAirlift SourcingPatient Movement = Total 353
Operation UNIFIED RESPONSE
Patient Outflow – within Haiti Children of Promise** 1Sacred Heart** 45Partners in Health 14Real Hope for Haiti 10Love a Child 90Killick 9Terminal Varreux 360St. Damien’s Children’s Hospital** 30Heart Line 12Angel Missions 10Gheskio Hospital 1PIH / Double Harvest** 4Doctors without Borders 3Canadian Field Hospital 3St. Bonaface** 25Aerovac 77UNCLAS//FOUOGoH / UN approved shore-based medical network provided placement of COMFORT patients
for post-operative care
Operation UNIFIED RESPONSE
Medical Forces AshoreCanadian Field Hospital Russia- Mobile Hospital China- Medical Rescue Team Brazil- Field Hospital Chile-Portable Hospitals Turkey- Field HospitalJapan- Medical team France- Field HospitalJordan - Field Hospital Venezuela- Medical TeamIsrael- Field Hospital Cuba- Medical TeamSpain- Medical Team Italy- Medical Team
International Response
23
Medical Forces Afloat• SPS CASTILLA • ITN CAVOUR • FRS SIROCCO
• ARM HUASTECO • ARM TARRASCO
• ARM PAPALOAPAN• ARC BUENAVENTURA
• ARC CARTAGENA DE INDIAS
Operation UNIFIED RESPONSE
AAR: What we did well
• Interagency Coordination - Pre-crisis professional relationships and routine interagency coordination proved to be essential during the response.
• Collaboration and Synchronization (Strategic) -The USSC SG daily TELECON provided vital situational awareness, identified critical issues, and assisted in assigning responsibility for actions.
Operation UNIFIED RESPONSE
AAR: What we did well
• Collaboration and Synchronization (Operational)USAID sponsored daily USG health meetings to pass information from UN Health Cluster and prioritize USG medical response.
• Operational Environmental Risk Surveillance.Forward Deployed Prev Med Unit (FDPMU) arrived early in deployment and was fully mission capable.
Operation UNIFIED RESPONSE
AAR: What Needed Improvement
• Delay in USG and DoD Policy Concerning Evacuation of Haitian and Foreign Nationals
• Delay in Activation of NDMS Definitive Care Component and Non-Activation of NDMS Patient Movement (PM) Component
• Delay in establishing Medical ROE
Operation UNIFIED RESPONSE
AAR: What Needed Improvement
• No designated medical rep on OFDA Disaster Assistance Response Team (DART)
• COMFORT not initially configured for FDR mission
• No Interagency Common Operating Picture
• JMEWS not used
Operation UNIFIED RESPONSE
• Clearly define mission of DoD medical forces
• Maintain close coordination with OFDA• Partner with NGO’s and international
community• Collaborate, don’t work in a vacuum • Develop transition criteria and decision
points
Final Words of Wisdom
28
Operation UNIFIED RESPONSE
Unity of Effort At All Levels