National Medical Disaster System Serving the Federal Response with Disaster Medical Services

Welcome to the Department of Defense, Force Health Protection and Readiness, National Disaster Medical System (NDMS) Page!

This website serves to provide an educational resource for our interagency colleagues involved in federal response to civilian authorities requesting federal medical assistance to major disasters.

The National Disaster Medical System (NDMS) combines Federal and non-Federal medical resources into a unified response to meet natural and man-made disaster needs, as well as support patient treatment requirements from military contingencies.

The National Response Framework (NRF) utilizes the National Disaster Medical System (NDMS), under Emergency Support Function #8 (ESF #8), Health and Medical Services, to support Federal agencies in the management and coordination of the Federal medical response to major emergencies and federally declared disasters such as natural disasters, major transportation accidents, technological disasters, and acts of terrorism including weapons of mass destruction events.

The NDMS is an interagency partnership between the Department of Health and Human Services (HHS), the Department of Homeland Security (HS), the Department of Defense (DoD), and the Department of Veteran’s Affairs (VA) and is based on the 2005 Memorandum of Agreement (MOA)between these agencies.

Components of the National Disaster Medical System

I. Medical Response:

The first component of the NDMS is medical response. This includes personnel, teams and individuals, supplies, and equipment. The National Disaster Medical System (NDMS) Response Teams can include

II. Patient Movement

III. Definitive Medical Care

Patient Movement

In the event that the local medical systems within a disaster area are overwhelmed, there may be a need for a system to move patients out of the disaster area. When this occurs, local authorities may operate Casualty Collection Points (CCPs) that feed into State-operated Aerial Points of Embarkation (APOE). If State or local authorities are unable to establish APOEs and/or CCPs, Federal authorities may deploy appropriate assets to assist (e.g., DMATs, HHS Public Health Service, DoD, VA medical assets). If State or local authorities determine that resources are inadequate to transport or care for all patients, a request for Federal medical evacuation assistance can be initiated.

Patient movement, within NDMS, includes patient evacuation, medical regulating, en-route care, and patient tracking/in-transit visibility.

The DoD coordinates patient movement for the NDMS in collaboration with other ESF #8 partners, as required. The DoD US Transportation Command (USTRANSCOM) Defense Distribution Operations Center is the single manager for the movement of NDMS in-patients who require en route medical care, to include accepting requests for movement of NDMS patients out of the disaster area, regulating patients to definitive medical care, tracking patients between disaster area and definitive care reception sites, and coordinating patient transportation.

Transportation by air may be accomplished through the USTRANSCOM's Air Mobility Command (AMC).

Patient Regulating: If DoD assets (to include National Guard assets in Title 32 or Title 10 status) are utilized to transport patients by air, they will be tracked by the Global Patient Movement Requirements Center (GPMRC). Evacuation that is performed by DoD is generated by the completion and validation of patient movement requests (PMR), and is coordinated through the GPMRC (intra or inter-state strategic ESF #8 aeromedical evacuation (AE) from aerial port of embarkation (APOE) to aerial port of debarkation (APOD) only). The responsible receiving agency will provide in-transit visibility from the receiving airhead to the destination facility (e.g., National Disaster Medical System (NDMS) hospital). For example, the Federal Coordination Centers (FCC), if activated within NDMS will provide in-transit visibility from the APOD to the destination facility (e.g., NDMS hospital).

Patient Tracking:The NDMS has developed a national patient tracking system called Joint Patient Assessment and Tracking System (JPATS). The CONOPS for this tool is currently in DRAFT.

You may request a JPATS Account here.

Definitive Care

Patients moved via NDMS from a disaster area for definitive medical care arrive at a Federal Coordinating Center’s (FCC) Patient Reception Area (PRA). The mission of a FCC is to receive, triage, stage, track and transport inpatients, affected by a disaster, to a participating National Disaster Medical System (NDMS) inpatient hospital capable of providing the required definitive care. The PRA generally operates from pre-identified airfield, bus station or railhead Patient Reception Sites (PRS). More information about NDMS FCCs can be found in the current FCC guide.

The following graphic shows the locations of the the current VA and DoD FCCs:

Map of current Federal Coordinating Centers

Definitive Care, according to the NDMS CONOPS, dated July 2009, is defined as:

•   To the extent authorized by NDMS, in the particular public health emergency, medical treatment or services beyond emergency medical care, initiated upon inpatient admission to an NDMS hospital and provided for injuries or illnesses resulting directly from a specified public health emergency, or for injuries, illnesses and conditions requiring non-deferrable medical treatment or services to maintain health when such medical treatment or services are temporarily not available as a result of the public health emergency. NDMS payment will end when one of the following occurs, whichever comes first: completion of medically indicated treatment (maximum of 30 days); exhaustion of Diagnosis Related Group (DRG) payment schedule; voluntary refusal of care; return home or to point of origin/fiscally comparable location or to destination of choice for patient (whichever costs less). Definitive care is rendered by a nationwide network of voluntarily participating, pre-identified, non-Federal and Federal hospital services. The network includes an ability to track available beds by medical specialty. In a public health emergency, these services provide definitive medical care for victims. In a military health emergency, NDMS non-Federal hospitals provide backup to the available military and VA medical services for military beneficiaries. In the case of DoD and VA hospital services, use in a public health emergency is contingent on availability and appropriate approval. FCCs monitor the status of NDMS patients treated at medical facilities associated with their FCC.

•   NDMS Hospitals are reimbursed for the care they provide in accordance with the signed NDMS Memorandum of Agreement.

•   HHS is responsible for coordinating the discharge and transportation of patients returning to their point of origin, or other destinations, as authorized. Patients requiring continuing care are returned as soon as appropriate care is available in the area from which they were evacuated and the patient can be transported safely.

DoD Role in NDMS

The DoD Role in Defense Support to Civil Authorities (DSCA):

The Assistant Secretary of Defense for Homeland Defense and Global Security (ASD(HD&GS)), under the authority, direction, and control of the Under Secretary of Defense for Policy USD(P), exercises overall supervision of homeland defense activities of the Department of Defense. Under this authority, the ASD(HD&GS) serves as:

•    The principal civilian advisor to the Secretary of Defense and the USD(P) on DSCA, serves as the Defense Domestic Crisis Manager

•    Approval authority for requests for assistance from civil authorities sent to the Secretary of Defense, except for those Item retained in paragraphs 4.h., 4.i., and 4.j. of DoD Directive 3025.dd, or delegated to other officials. The Secretary of Defense shall be notified immediately of the use of this authority. Such matters shall be coordinated with the Chairman of the Joint Chiefs of Staff and/or the Joint Staff

The ASD(HD&GS) also develops, coordinates, and oversees the implementation of DoD policy for DSCA and:

•    Through the Chairman of the Joint Chiefs of Staff as it pertains to DSCA matters, monitors the activation, deployment, and employment of Federal military forces (including Reserve Component forces), the National Guard, DoD civilian personnel, and all facilities, equipment, fiscal accounts, supplies, and services owned by, controlled by, or under the jurisdiction of a DoD Component in response to requests for DSCA and for DoD support to special events

DoD Role in NDMS:

The Assistant Secretary of Defense for Health Affairs (ASD(HA)), under the authority, direction, and control of the Under Secretary of Defense for Personnel and Readiness USD(P&R), and as the principal advisor to the Secretary of Defense for all DoD health policy, provides guidance and support for all domestic crisis situations or emergencies that require health or medical-related DSCA to ASD(HD&GS) and exercises authority, in accordance with section 300hh-11 of title 42, United States Code, and according to DoD policy, for participation in the NDMS.

Request for DoD Assistance to support Civil Authorities

Request for DoD Assistance to support Civil Authorities The following outlines the key steps in the formal processing of Mission Assignments (MAs) and Requests for Assistance (RFAs) for support to the NDMS under 42 USC, Section 5121, Robert T. Stafford Act, as amended:

1. The Governor of an affected State may request Federal assistance under the provisions of the Stafford Act. The State Coordinating Officer requests Federal assistance from the FEMA Regional Director or Federal Coordinating Officer (FCO), as applicable.

2. The FEMA Regional Director or FCO coordinates the request with the appropriate Regional ESF-8 representative and forwards the request through the Regional Response Coordination Office (RRCC) or the Joint Field Office (JFO) to the DHS FEMA National Response Coordination Center (NRCC).

3. To obtain support from NDMS Partners, the DHS FEMA Federal Approving Official in the NRCC issues a FEMA Form 90-129 "Mission Assignment" in accordance with the NRF Financial Management Support Annex.

4. The NRCC forwards approved MAs/ RFAs for Federal health and medical assets to the HHS Secretary's Operations Center (SOC). ( MAs/RFAs for assets that are solely provided by the DoD are forwarded directly to DoD (Secretary of Defense, Executive Secretary) via the DoD Liaison in the NRCC.

5. The HHS Emergency Management Group (EMG) of the Secretary’s Operations Center (SOC) convenes an NDMS Patient Movement Coordination Group (PMCG) [formerly known as the Medical Inter-agency Coordination Group (MIACG)] to communicate mission requirements and establish an integrated concept of NDMS operations. The PMCG is comprised of a representative(s) from each of the partner agencies (HHS, DoD, VA, and DHS), especially when patient movement and definitive care are needed. The HHS SOC coordinates the completion of "ESF Mission Assignment Subtasking Request Form(s)", as needed, in accordance with the NRF Financial Management Support Annex.

6. The HHS SOC forwards mission assignment Subtaskings to the VA Readiness Operations Center (ROC) as applicable. The HHS SOC will also request that DHS/ FEMA issue an RFA through and approved and funded MA directly to the Secretary of Defense, Executive Secretary. The HHS SOC coordinates with the HHS NDMS Operations Branch as applicable. The HHS SOC/Operations Division will notify the NDMS Operations Branch when to alert, activate and deploy response teams as applicable.

7. The Secretary of Defense's Executive Secretary forwards the RFAs ( FEMA MAs) to the Office of the Assistant Secretary of Defense for Homeland Defense & America's Security Affairs (OASD(HD&ASA)) and the Joint Director of Military Support (JDOMS). The RFA (FEMA MA) is forwarded to the Secretary of Defense for approval.

8. Upon Secretary of Defense approval, JDOMS coordinates and forwards Execute Orders (EXORDs) and/or Operations Orders (OPORDs) to the applicable Combatant Commands (e.g., U.S. Northern, Pacific, or Southern Command) and/or to the military Services (i.e., Army, Navy and Air Force) as applicable, to direct activation of DoD assets, such as USTRANSCOM AE patient assets and DoD FCCs.

9. The VA ROC forwards approved MA subtaskings for VA medical assets to the Office of the VA Under Secretary for Health (USH). The VA USH alerts or activates VA FCCs, as applicable.

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