On Sept 23, 2008 the National Biodefense Science Board (NBSB) held an afternoon meeting to review the report and recommendations for the National Disaster Medical System (NDMS) that had been prepared by the Disaster Medicine Working Group. The Working Group had assembled an assessment panel which evaluated previous reports done on the NDMS and put together their own report and specific recommendations which, with the approval of the NBSB, would be transmitted to the Assistant Secretary for Preparedness and Response.
Kevin Yeskey, Director of the Office of Preparedness and Response and Deputy Assistant Secretary for Preparedness and Response began the meeting by giving an overview of NDMS and its capabilities. He also highlighted the recent response to hurricanes Gustav and Ike and contrasted NDMS participation to what occurred in response to hurricane Katrina. For Gustav and Ike they had been able to mobilize fully equipped teams, totaling 1100 response personnel rather than the 37 in the wake of Katrina.
Next, Dr. Stephen Cantrill, the Chair of the Working Group presented the assessment panel’s key recommendations and the NBSB had the chance to go over each and comment. Below is an outline of the recommendations, as the panel chose to organize them.
Recommendation 1: Envisioning the Future
1.1 Develop a clear strategic plan for the NDMS and integration of all other disaster medicine response mechanisms.
1.2 Develop a civilian advisory group for NDMS.
Recommendation 2: Integrating the Past
2.1 Establish a formal mechanism to track the implementation of lessons learned and recommendations from after-action reports.
Recommendation 3: Strengthen the team
3.1 Ensure teams are fully staffed and well-equipped
3.2 Improve and streamline application process for all personnel – *This point was removed during the discussion because based on Director Yeskey’s opening presentation, the NBSB determined that this has been done. Yeskey reported that the application and hiring process has been reduced from 8-12 months to 42 days.
3.3 Implement a uniform training program across NDMS.
3.4 Put into place a system to register non-overlapping personnel so that response capability can be precisely accounted.
Recommendation 4: Serving the patient
4.1 Determine who the patient is, consider patients that have been displaced across state lines NDMS patients even if they were not receiving NDMS care.
4.2 Expand reimbursement so that it is not limited to NDMS hospitals. Ensure that it is timely.
4.3 Define a concept of operations for patient moving and tracking.
4.4 Expand Electronic Medical Records for field use.
4.5 Examine barriers to patient care in emergency response and define criteria for temporary suspension of HIPPA or other requirements during an emergency.
Recommendation 5: Engaging Partners
5.1 Partner with state and local organizations.
5.2 Seek out public/private sector partnerships for patient transport and care.
Recommendation 6: Secure Funding
6.1 Funding is inadequate for the program. Seek out new sources for sustained funding.
Recommendation 7: Future
7.1 Request feedback from ASPR for the NBSB Spring/Summer 2009 meeting on which of the recommendations are complete, in progress or will not be undertaken.
7.2 Recommend that a longer term follow-up study be conducted to focus on the NDMS and these recommendations – * This point was added by the NBSB during the discussion.
The next NBSB meeting will take place Nov 18-19, 2008 and the Board is expecting to hear a presentation from the Disaster Mental Health Subcommittee, a report from the Medical Countermeasure Processes Working Group, a report from the Personal Preparedness Working Group and receive a white paper from the Education and Training Working Group.